A Dangerous Curve

Merely being able to look back over her shoulder brings great satisfaction to Debra Tietz, 19, a beautician in Cottage Grove, Minn. For nearly seven years, she could not bend her neck or back: her torso was held rigid from the chin to the pelvis by a cumbersome steel and leather brace. Debra was the victim of scoliosis, or abnormal curvature of the spine. The brace, which she was finally able to discard last year, not only straightened her back but may well have saved her life.

Scoliosis (from the Greek for crooked), in varying degrees of severity, occurs in about 2% of the U.S. population. It strikes in childhood, five times more often among adolescent girls than boys. Most cases are classified by doctors as idiopathic, meaning that the causes are unknown. But the symptoms are all too familiar. Scoliosis is a progressive disease; without treatment, the curvature may become worse as a youngster grows older, disfiguring him with a hunched back. Eventually, the increasing curvature can distort the vital organs within the chest cavity and produce conditions that may cause death in young adulthood.

Directing Growth. Until about ten years ago, scoliosis was not usually diagnosed until it was far advanced; even when it was recognized early, doctors could do little to alleviate it. Indeed, many merely prescribed corrective shoes to help relieve the condition. But new methods of detection and treatment have now greatly improved the prospects of scoliosis victims. A major advance has been the development of mass-testing procedures for use in the schools. Delaware, through a program involving the Alfred I. du Pont Institute and the state board of health, routinely checks schoolchildren with a simple test: the youngsters are asked to bend at the waist and touch their knees with their fingertips; a curvature will usually produce a visible fullness on one side of the rib cage or the other. In most Minnesota schools, nurses and physical education teachers regularly check youngsters in the fifth through tenth grades. Testing is also routinely conducted in Downey, Calif., and a program is being proposed for elementary schools in New York's Nassau County.

For about 75% of all scoliosis victims, some form of corrective device --usually a Milwaukee-brace* is prescribed. The brace consists of a girdle that fits around the hips and three vertical bars that attach at the top to a neck ring and throat mold. Early models --made of leather and steel, and quite heavy--have given way to lightweight aluminum-and-plastic versions that are still neither attractive nor comfortable. But they do work, redirecting the growth of the spine to help it to grow straight. "Shoe lifts and exercises alone are not proper treatment for progressive scoliosis," says Dr. David B. Levine of New York City's Hospital for Special Surgery and one of the country's leading authorities on the disease. "But in most cases, the brace is."

Instant Growth. In more advanced cases, surgery is necessary. The most common operation for scoliosis was developed about ten years ago by Houston's Dr. Paul Harrington, and is now performed on about 80% of all patients requiring surgery. Doctors implant thin steel rods next to the spine, placing them over the bone and under the back muscles. The rods, which are attached to the vertebrae with metal hooks, are then tightened--much like a set of orthodontic braces--to force the spine to straighten. At the same time, the spine is fused to give it additional strength. Patients who undergo surgery must spend up to four weeks in the hospital and as long as ten months in a body cast.

But the technique can produce spectacular results. Wendy Clifford, 16, of Minneapolis, literally grew two inches on the operating table as doctors used a Harrington rod to straighten her crooked spine. "I'm glad I had it done," she says. "The doctors told me that by the time I was 30 I would have been completely crippled."

Scoliosis patients whose spines can be straightened by braces can usually live relatively normal lives even while under treatment. Those requiring surgical correction can recover quickly. Some come out of the operations with stronger spines than before. One of Levine's patients, a 15-year-old girl, was struck by a car 18 months after her operation. The accident produced multiple fractures of her arms, broke a thighbone and left her with a plethora of bruises. But the girl's spine remained intact.

Others who undergo scoliosis surgery lose no time resuming their activities. Women can have normal pregnancies a year or two after surgery; youngsters can be back on the playing fields only a few months after leaving the hospital. Laurie Lacrosse, 17, of Grand Forks, N. Dak., was so determined to play in the North Dakota State Tennis Tournament that she entered six weeks after her operation. Playing in a body cast, she made it to the finals before losing to the state champion.

* Developed in Milwaukee in 1946 by Drs. Walter Blount and Albert Schmidt.

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