Scoliosis

 A scoliosis is a lateral or sideways curve in the spine that is apparent when viewing the spine from behind. A mild degree of scoliosis is common, occurring in up to 50 per cent of the population. Scoliosis generally does not require any specific treatment. However, severe scoliosis does indeed need treatment. Scoliosis occurs mainly in the thoracic and thoraco-lumbar regions. There are two basic types of scoliosis, structural and functional. In the structural scoliosis the mechanics of the curve are such that rotation of the vertebrae occurs in combination with lateral curvature, and this usually produces a protuberance of one side of the rib cage, seen best when a person bends forward. This is the worst type of scoliosis, and it can be progressive. In the functional scoliosis, fixed rotation does not occur, and the curvature is usually non-progressive. This type of scoliosis is classified into postural, which disappears on forward bending, and compensatory, which is most commonly due to a short leg.

There are many causes of a structural scoliosis, but by far the most common (80 to 90 per cent) is the unknown, or idiopathic. This idiopathic scoliosis develops usually as the spine is growing rapidly. The earliest form, or infantile form, occurs in the first three years of life, and it usually resolves with time. The juvenile form occurs up to the age of nine, and has a high familial relationship. It can often be a progressive scoliosis. The adolescent form is the most common, and occurs from nine to fourteen years, and the most severe cases involve females. It is not known for sure why some children get a scoliosis. It appears that genetic inheritance is a major contributor to a scoliosis.

It is often difficult for the untrained eye to detect a developing scoliosis when standing from behind, as although the bones may be twisted to a considerable degree the spine can appear straight because the spinous processes (the parts of the spine that project backwards and can be felt under the skin) can remain in a fairly straight line, while the front of the vertebrae rotate to a large extent. A better guide to the extent of a scoliosis can often be obtained by looking at a person from the front. In this view, the asymmetry of the body can be more readily detectable. This view may detect an abnormally shaped chest, or protuberance of some of the ribs on one side. The best way to look for a scoliosis is to look at the back from behind as the person bends forward. It is then easy to see the curve as one side of the rib cage will project more than the other. If there is any suggestion of a scoliosis medical opinion should be sought. Plain x-rays of the spine may be ordered. These x-rays can easily detect the extent of a scoliosis.

Signs and symptoms

The spine is an elegant structure – from the side it takes the form of an elongated S, the upper back bowing outward and the lower back curving slightly inward. Viewed from behind though, the spine should appear as a straight line from the base of the neck to the tailbone. Scoliosis is an abnormal curvature of the spine.

Signs and symptoms of scoliosis may include:

Uneven shoulders

• One shoulder blade that appears more prominent than the other
• Uneven waist
• One hip higher than the other
• Leaning to one side
• Fatigue

If a scoliosis curve gets worse, the spine will also rotate or twist, in addition to curving side to side. This causes the ribs on one side of the body to stick out farther than on the other side. Severe scoliosis can cause back pain and difficulty breathing.

Causes

Doctors don’t know what causes the most common type of scoliosis. When a cause can’t be identified, scoliosis is called idiopathic.

Sometimes, an underlying disease that affects the neuromuscular system, a leg-length discrepancy or a birth defect may cause scoliosis. Scoliosis can also begin during fetal development. Congenital scoliosis is a type of birth defect that affects the development of the vertebrae and may occur with other congenital problems, such as heart or kidney abnormalities.

Scoliosis runs in families and may involve genetic (hereditary) factors that haven’t yet been identified. Doctors also recognize that spinal cord and brainstem abnormalities play a role in some cases of scoliosis.

Scoliosis isn’t caused by poor posture, diet, exercise, or the use of backpacks.

Risk factors

The cause of most scoliosis is unknown (idiopathic). Scoliosis is often first noticed around the time of adolescence, during a growth spurt. Growth is often the cause for worsening of an existing curve.

Other than growth, risk factors that make it more likely that a scoliosis curve will get worse include:

• Sex. Curves in girls are more likely to worsen than are curves in boys.
• Age. The younger the child when scoliosis appears, the greater the chance the curve will worsen.
• Size of the curve. The greater the curve size, the higher the likelihood that it will worsen.
• Location. Curves in the middle to lower spine are less likely to progress than are those in the upper spine.
• Spinal problems at birth. Children who are born with scoliosis (congenital scoliosis) have a greater risk of worsening of the curve. Congenital scoliosis is thought of as a birth defect affecting the size and shape of the bones of the spine.

Management of Scoliosis

The management of a scoliosis is determined by the extent of the scoliosis. A number of methods are used to decide upon the most appropriate treatment. In most instances a mild scoliosis requires no specific treatment. Advice in regard to posture and exercises may be offered. If the scoliosis is more severe it must be treated.

The options are:

1. Bracing

Although a definite inconvenience, bracing is sometimes necessary, and may prevent the need for surgery. A recent study has shown that bracing is effective in stopping the progression of the curve in about 80 per cent of patients, until the age of 16. A variable degree of relapse of the curve does occur after the cessation of bracing, usually at the age of 15 – 16. However, those children who have been braced generally still have curves within the acceptable range, which should not carry any particular disadvantage into adulthood.

2. Physiotherapy

Surface electrical stimulation has now been discredited as a treatment, and studies have shown that the children treated in this way do no better than those left untreated. Treatment such as manipulation has no place in the management of the mechanical defect in scoliosis, although manipulation and physical therapies can help any low back pain that occurs in association with a scoliosis. In the majority of functional scolioses, Physiotherapists can give advice regarding:

Posture

Strengthening of muscles and correction of muscle imbalance

Strapping

Ergonomics

Exercise

Exercises can be prescribed, but they will probably not effect the progression of a curve. If a brace is required, an exercise program will also be prescribed, but if not required, instruction regarding review of the scoliosis and exercises will be provided.

3. Surgery

In the rare cases where the scoliosis reaches the point of no return, surgery may be required. In thoracic scoliosis it entails the insertion of metal rods – called Cotrel-Dubousset Instrumentation – along the spine. These rods act as braces to straighten the spine and prevent further deterioration of the scoliosis. These rods are usually left in the spine throughout life. These operations are performed by Orthopedic Surgeons, who are specialized in the area of Pediatric Orthopedics. This type of surgery does not require the patient to wear a plaster jacket after the operation. The stay in hospital is about 7 to 9 days, and return to school is about 1 month. Life after surgery returns to near normal by about 9 months, except that body contact sports are not permitted. Lumbar scoliosis is treated with other operations including fusion, and the underarm brace is required for up to 6 months after surgery.

What happens if the severe scoliosis is not treated?

If it is not treated the degree of scoliosis will usually become worse due to the continual loading on the spine during normal daily activities. The spine will buckle under the added load and the curve will become worse. Women have a further aspect to consider. During pregnancy the load on the spine increases dramatically, and the best way to prevent future problems associated with pregnancy is to deal with the scoliosis when it reaches a significant level during these earlier years. The untreated severe scoliosis is a substantial problem. Studies indicate that the quality and length of life are markedly affected by scoliosis. The prevalence of backache is twice that of the normal population, unemployment and the rate of disability pensions are high, poor self-image is common, and the majority do not marry. Respiratory and cardiac problems also become common, causing further severe disability and reduced life expectancy.

To obtain full text:

http://www.mayoclinic.com/health/scoliosis/DS00194

http://www.mayoclinic.com/health/scoliosis/DS00194