Scoliosis is a three dimensional, tri-planer skeletal deformity in which there is lateral deviation and rotation
of the spine in an upright position. It can be caused by either neurologically,
congenital, or can be caused by carcinoma, e.g. spinal tumors. The lateral
curvature of the spinal cord is normally 10 degrees or less, but during scoliosis,
it can increase from 10 and can go up to 40 degrees. The most common type of
scoliosis (about 80-90%) is idiopathic (proper caused by the disease is
unknown) and can occur in all ages but commonly seen in adolescent age. It can
be properly seen in frontal plane by taking x-ray from the posterior side, but
it can also be done anteriorly. In the sagittal plane, the kyphosis (extensive
outward curve of cervical and thoracic region) and lordosis) inward curvature
of the spine at lumbar or cervical level) can also be checked out, which are
usually caused alongside scoliosis. In the transverse plane, the rotational
curvature of the spine can be seen.
Scoliosis depends on its
type, either it is structural or functional. Structural scoliosis is based on
the structural changes that occur in the vertebral body, facet orientation,
wedging of vertebrae, bone defects, osteoporosis, inter vertebral disc collapse,
bone rigidity, and bed-bound patients. Functional scoliosis is not related to
the body structuralization of the spine, but the muscles, tendons, and
ligaments are checked as it is caused by faulty posture, muscular weakness,
muscle atrophy, and partial flexibility. During forward bending, functional
scoliosis would show no deviation of the spine, but in structural scoliosis,
there would be a proper deviation, which can be seen which x-ray, limited
flexibility, and scapular prominence.
During child growth,
there can be certain factors that can lead to the onset of adolescent idiopathic
scoliosis, i.e. heavy bag pack, poor posture, trauma, prolonged sitting in abnormal
back posture, etc. can be some of the leading causes of this disease.
Diagnosis
The steps which are used
to diagnose scoliosis are
- Curve: the direction, shape
(either C or S-shaped) and side location of the vertebral column
- Etiology: the cause which caused
this to occur. It can be moving vehicle collision, trauma, infection, cerebral
palsy, muscular dystrophy, etc. this can be checked by taking the history of
the patient.
- Decompensation: failure of visceral
organs (lungs, heart, liver) due to compression exertion.
- Flexibility: the spine can move
either partially or with no flexibility; it depends on the type of scoliosis.
- Neurology: spinal
problems occurred by this (can be a direct hit on the spine or nerve
compression)
Due to the curvature of the
spine, one of the few first signs that occur is muscular weakness around the
spine, which can restrict movement. There is already limited movement in the
region of thorax as there is no space for movement of the vertebrae due to the
placement of ribs, but after muscular weakness, thorax along with limited
lumbar and cervical movement is possible. Scapula of the affected side is
prominent along with uneven shoulder and lateral pelvic tilt.
Due to the angulation of the spine, the
affected vertebrae also affects its corresponding ribs, which will cause
rotation of the ribcage that will immediately affect the cardiopulmonary system
as there would be less space for the lungs to inflate properly which will cause
less saturation oxygen and fatigue. Myocardial space will also be compressed
and can restrict the pumping of blood and can cause heart failure in the long
term.
Abdominal visceras, such as the liver can also
be affected. Due to the vertebral column rotation, the spinal cord inside can
be directed compressed, which can cause loss of movement of the lower limbs or
can either cause nerve compression, which is the sensory or motor loss of a
specified area along with a tingling sensation accompanied by pain.
Pain is not a common symptom of scoliosis as
the body has already compensated for the changed, but it can occur when the Cobbs
angle increases to more than 40 which can be cured surgically by using titanium
rods and a plate or removing the affected vertebrae and replacing them with
artificial custom made vertebral bodies.
Rib hump or paraspinal muscular prominence indicates spinal rotation.
Signs which indicate scoliosis are raised chest, abnormal gait, shoulder
downwards, prominent and raised scapula along with pelvic tilt. The relationship
of pedicle of vertebral body to midline determines the degree of rotation of the
vertebral column.
Mild scoliosis is caused
when the Cobbs angle is between 10 degrees to 19 degrees, but there is no
prominent structural change and can only be seen in X-ray. Further increase in
cobs angle from 20 degrees to 40 degrees is moderate scoliosis is seen by the
naked eye. Severe scoliosis is when the angle increases further from 40 degrees.
After this point, no amount of physical therapy can change the deformity and
can only be cured using surgical methods.
There are a few risk
factors for developing the most common type of scoliosis:
- Age: The signs and symptoms
of scoliosis usually begin at some stage in the growth spurt that occurs just before
puberty.
- Gender: Although both girls and boys
develop mild scoliosis at the same age, yet there is a greater risk of
increasing curvature of the vertebral column and requiring proper treatment.
- Family history: Scoliosis may be
hereditary, but the majority of the cases do not have a family history of this
disease.
Mild scoliosis can be
easily treated with scoliosis specific physical therapy, bracing, and medical
observation. Moderate scoliosis is treated by specific physical therapy, braces
which are customized according to the patient size and severity of the
curvature and mobilization. Different exercises are used to strengthen the
muscles surrounding the vertebral column and pelvis, such as a step down and
one arm reaches, upward and downward dog, split stance with arm's reach. By being proactive and performing proper
exercises, the curvature can be reversed, but the process will be slow but will
decrease the pain. Pilates and yoga routines are also added to the regime to
improve spinal flexibility and muscular atrophy.
