Definition and Overview
Scoliosis is a medical disorder that is characterized by an abnormal curvature of the spine. In scoliosis, there is a deviation of the spinal cord from its normal midline location, creating a C- or S-shaped spine.
There are several types of scoliosis, based on the age when the scoliosis appears and the cause of the condition. Congenital scoliosis is a rare condition where the insult occurs in utero and scoliosis is present at birth while Idiopathic scoliosis is the most common type. It is subdivided into three categories: infantile scoliosis, juvenile scoliosis, and adolescent scoliosis. Unlike the idiopathic type, which occurs in children and adolescents, degenerative scoliosis is the kind that occurs in adults typically due to arthritis, degeneration of the discs, laxity of the spinal ligaments, and osteoporosis. The last type is secondary scoliosis; wherein scoliosis occurs as a result of another disease.
Scoliosis occurs in approximately 3% of the population, affecting more females than males. The condition is typically discovered during adolescence, with about 80% of patients diagnosed between the ages of 10 and 15 years. In most cases of scoliosis, minimal intervention is necessary. Majority of patients who are diagnosed with this condition continue to live productive, normal lives.
Cause of Condition
The most common type of scoliosis remains to be the idiopathic type. The cause of this condition is not known, although multiple factors are believed to contribute to its development. Genetics, specifically the CHD7 gene, has been linked to the occurrence of scoliosis. Meanwhile, congenital scoliosis is believed to be due to an insult occurring in fetal life, resulting in a malformation of the spine. The spine either fails to form or to separate, resulting in a vertebra with an abnormal shape. Finally, secondary scoliosis is caused by diseases wherein there is a lack of support for the spine, resulting in unequal pressures on the sides of the spinal cord. Secondary scoliosis is usually due to a neuromuscular disorder such as cerebral palsy, poliomyelitis, spina bifida or a muscular dystrophy.
The most obvious symptom of scoliosis is a visible curvature of the spine. This is usually mild and occurs slowly over time, such that it can be missed at the onset. For some people, scoliosis may make one shoulder or one hip appear higher than the other side. One leg may also appear shorter than the other. The ribs may likewise appear prominent on one side, which is due to the rotation of the thorax and ribcage.
Scoliosis is generally not painful; if a patient with scoliosis develops back pain, he or she may need further investigation as to what is causing the pain. Severe forms of scoliosis may result in mechanical restriction of the heart and the lungs. The additional pressure placed on these vital organs can result in diminished lung capacity and cardiac output, leading to symptoms such as shortness of breath, chest pain and decreased functionality.
Who to See and Types of Treatments Available
Scoliosis is best assessed by your doctor or health care provider. A complete physical and neurological examination will be conducted. You will also be asked to perform several special tests, such as the Adam’s forward bend. In this test, you will be requested to bend as far as you can. The curve becomes more obvious when a person is in this position. An x-ray will confirm the diagnosis and can determine the degree of your spinal curvature. The management of scoliosis will depend on the severity of the curvature and its progression. Management can generally be divided into three categories: observation, use of braces, and spine surgery. An orthopedic surgeon specializing in spine diseases can best manage this condition.
If you are diagnosed with mild scoliosis, observation can initially be done. During puberty, there is a risk of progression of the scoliosis, due to the adolescent growth spurt experienced at this time. Your physician will make measurements of your spine’s curvature on a regular basis to check if the condition is getting worse. If the curvature of your spine, measured as the Cobb angle, has reached at least 30 degrees, you may need some form of intervention.
Patients who present with progressing spinal curvatures, and who still have remaining growth, may need to use back braces. The aim of bracing is to prevent the worsening of the curve until the patient’s growth spurt has ended. The brace is a device that supports and covers the chest, and may occasionally extend up to the area of the neck. The braces are custom-made and molded around the patient’s body. There are basically two kinds of braces: the thoracolumbar sacral orthosis, or TLSO, brace, which has to be worn almost the entire day; and a Charleston back brace, which applies greater pressure on the spine and is used only at night.
Finally, for severe cases of scoliosis, and for cases that are highly likely to progress, surgery may be required. Spinal fusion is usually performed. For this operation, a bone graft is attached to the vertebra, using screws and rods, in order to solidify the spine and make the vertebral column rigid. This surgery can be approached either from the back of the spine (posterior approach) or from the side to access the front of the spine (anterior approach). The recovery after surgery varies, but generally, spinal fusion for scoliosis has evolved to produce good outcomes, with successful correction and minimal risks, for most patients.
Physical therapy is an important aspect in the management of scoliosis. It is carried out in coordination with all of the aforementioned treatment strategies. Your physical therapist will instruct you on postural training methods and supports for various positions. You will also be taught strengthening exercises for the muscles of the spine, such as arm and leg extensions. If you undergo surgery, your physical therapist will guide you as to what activities you can do and how you can adapt and return to your usual activities after the operation. Older patients with degenerative scoliosis will also benefit from physical therapy.
- National Scoliosis Foundation