Scoliosis
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Alternative Names Spinal curvature; Kyphoscoliosis
Definition Scoliosis is a lateral (toward the side) curvature in the normally straight vertical line of the spine. The normal spine curves gently backward in the upper back and gently inward in the lower back. When viewed from the side, the spine should show a mild roundness in the upper back and shows a degree of swayback (inward curvature) in the lower back. When a person with a normal spine is viewed from the front or back, the spine appears to be straight. When a person with scoliosis is viewed from the front or back, the spine appears to be curved.
Causes There are many types and causes of scoliosis, including: 1. Congenital scoliosis. A result of a bone abnormality present at birth. 2. Neuromuscular scoliosis. A result of abnormal muscles or nerves, frequently seen in
people with spina bifida or cerebral palsy or in those with various conditions that are accompanied by, or result in, paralysis. 3. Degenerative scoliosis. This may result from traumatic (from an injury or illness) bone
collapse, previous major back surgery or osteoporosis (thining of the bones).
4. Idiopathic scoliosis. The most common type of scoliosis, idiopathic scoliosis, has no
specific identifiable cause. There are many theories, but none have been found to be conclusive. There is, however, strong evidence that idiopathic scoliosis is inherited.
Symptoms Backache or low-back pain •
Fatigue
•
Shoulders or hips appear uneven
•
Spine curves abnormally to the side (laterally)
Exams and Tests The health care provider will perform a physical exam, which includes a forward bending test that will help the doctor define the curve. The degree of curve seen on an exam may underestimate the actual curve seen on an x-ray, so any child found with a curve is likely to be referred for an x-ray. The health care provider will perform a neurologic exam to look for any changes in strength, sensation, or reflexes. Tests may include: •
Scoliometer measurements (a device for measuring the curvature of the spine)
•
Spine x-rays (taken from the front and the side)
•
MRI (if there are any neurologic changes noted on the exam or if there is something unusual in the x-ray )
Treatment 1. Observation 2. Orthopaedic bracing 3. Surgery
Prognosis The prognosis of scoliosis depends on the likelihood of progression. The general rules of progression are that larger curves carry a higher risk of progression than smaller curves, and that thoracic and double primary curves carry a higher risk of progression than single lumbar or thoracolumbar curves. In addition, patients who have not yet reached skeletal maturity have a higher likelihood of progression.
Possible Complications Emotional problems or lowered self-esteem may occur as a result of the condition or its treatment (specifically, wearing a brace) •
Failure of the bone to join together (very rare in idiopathic scoliosis)
•
Low back arthritis and pain as an adult
•
Respiratory problems from severe curve
•
Spinal cord or nerve damage from surgery or severe, uncorrected curve
•
Spine infection after surgery
Alternatives In children with immature skeletons and remaining growth potential, Schroth-method physical therapy is used in combination with the Rigo System-Cheneau brace, not only to prevent progression of (and often reduce) the abnormal curvature, but also to train and strengthen patients in holding their bodies in a corrected position after completion of the bracing treatment (i.e., when the skeleton has reached maturity). A patient’s consistent practicing of an individualized Schroth program has been clinically shown to inhibit the mechanical forces, exacerbated by poor postural habits and gravity, that otherwise perpetuate the progression of the curvature over time (the so-called “vicious cycle”), even after the cessation of physical growth.
Pathophysiology
Definition Scoliosis is a lateral (toward the side) curvature in the normally straight vertical line of the spine. The normal spine curves gently backward in the upper back and gently inward in the lower back. When viewed from the side, the spine should show a mild roundness in the upper back and shows a degree of swayback (inward curvature) in the lower back. When a person with a normal spine is viewed from the front or back, the spine appears to be straight. When a person with scoliosis is viewed from the front or back, the spine appears to be curved.
Causes There are many types and causes of scoliosis, including: 1. Congenital scoliosis. A result of a bone abnormality present at birth. 2. Neuromuscular scoliosis. A result of abnormal muscles or nerves, frequently seen in
people with spina bifida or cerebral palsy or in those with various conditions that are accompanied by, or result in, paralysis. 3. Degenerative scoliosis. This may result from traumatic (from an injury or illness) bone
collapse, previous major back surgery or osteoporosis (thining of the bones).
4. Idiopathic scoliosis. The most common type of scoliosis, idiopathic scoliosis, has no
specific identifiable cause. There are many theories, but none have been found to be conclusive. There is, however, strong evidence that idiopathic scoliosis is inherited.
Symptoms Backache or low-back pain •
Fatigue
•
Shoulders or hips appear uneven
•
Spine curves abnormally to the side (laterally)
Exams and Tests The health care provider will perform a physical exam, which includes a forward bending test that will help the doctor define the curve. The degree of curve seen on an exam may underestimate the actual curve seen on an x-ray, so any child found with a curve is likely to be referred for an x-ray. The health care provider will perform a neurologic exam to look for any changes in strength, sensation, or reflexes. Tests may include: •
Scoliometer measurements (a device for measuring the curvature of the spine)
•
Spine x-rays (taken from the front and the side)
•
MRI (if there are any neurologic changes noted on the exam or if there is something unusual in the x-ray )
Treatment 1. Observation 2. Orthopaedic bracing 3. Surgery
Prognosis The prognosis of scoliosis depends on the likelihood of progression. The general rules of progression are that larger curves carry a higher risk of progression than smaller curves, and that thoracic and double primary curves carry a higher risk of progression than single lumbar or thoracolumbar curves. In addition, patients who have not yet reached skeletal maturity have a higher likelihood of progression.
Possible Complications Emotional problems or lowered self-esteem may occur as a result of the condition or its treatment (specifically, wearing a brace) •
Failure of the bone to join together (very rare in idiopathic scoliosis)
•
Low back arthritis and pain as an adult
•
Respiratory problems from severe curve
•
Spinal cord or nerve damage from surgery or severe, uncorrected curve
•
Spine infection after surgery
Alternatives In children with immature skeletons and remaining growth potential, Schroth-method physical therapy is used in combination with the Rigo System-Cheneau brace, not only to prevent progression of (and often reduce) the abnormal curvature, but also to train and strengthen patients in holding their bodies in a corrected position after completion of the bracing treatment (i.e., when the skeleton has reached maturity). A patient’s consistent practicing of an individualized Schroth program has been clinically shown to inhibit the mechanical forces, exacerbated by poor postural habits and gravity, that otherwise perpetuate the progression of the curvature over time (the so-called “vicious cycle”), even after the cessation of physical growth.
Pathophysiology
