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scoliosis

 
Medical Encyclopedia: Scoliosis
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Definition

Scoliosis is a side-to-side curvature of the spine.

Description

When viewed from the rear, the spine usually appears perfectly straight. Scoliosis is a lateral (side-to-side) curve in the spine, usually combined with a rotation of the vertebrae. (The lateral curvature of scoliosis should not be confused with the normal set of front-to-back spinal curves visible from the side.) While a small degree of lateral curvature does not cause any medical problems, larger curves can cause postural imbalance and lead to muscle fatigue and pain. More severe scoliosis can interfere with breathing and lead to arthritis of the spine (spondylosis).

Approximately 10% of all adolescents have some degree of scoliosis, though fewer than 1% have curves which require medical attention beyond monitoring. Scoliosis is found in both boys and girls, but a girl's spinal curve is much more likely to progress than a boy's. Girls require scoliosis treatment about five times as often. The reason for these differences is not known.

— Liz Meszaros


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Dictionary: sco·li·o·sis   (skō'lē-ō'sĭs, skŏl'ē-) pronunciation
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n.
Abnormal lateral curvature of the spine.

[Greek skolios, crooked + -OSIS.]

scoliotic sco'li·ot'ic (-ŏt'ĭk) adj.

Dental Dictionary: scoliosis
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(skō′lēō′sis)
n

A lateral curvature of the spine.

Alternative Medicine Encyclopedia: Scoliosis
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Definition

Scoliosis is defined as an abnormal side-to-side or front-to-back curvature of the spine.

Description

When viewed from the rear, the spine usually appears perfectly straight. Scoliosis is a lateral (side-to-side) curve in the spine, usually combined with a rotation of the vertebrae. The lateral curvature of scoliosis should not be confused with the normal set of front-to-back spinal curves visible from the side. While a small degree of lateral curvature does not cause any medical problems, larger curves can cause postural imbalance and lead to muscle fatigue and pain. More severe scoliosis can interfere with breathing and lead to arthritis of the spine (spondylosis).

Approximately 10% of all adolescents have some degree of scoliosis, though fewer than 1% have curves that require medical attention beyond monitoring. Scoliosis is found in both boys and girls, but a girl's spinal curve is much more likely to progress than a boy's. Girls require scoliosis treatment about five times as often. The reason for these differences is not known.

Causes & Symptoms

Four out of five cases of scoliosis are idiopathic, meaning that the cause is unknown. Idiopathic scoliosis tends to run in families; genetic screening has identified several different patterns of genetic transmission as of late 2001. In some families, idiopathic scoliosis is transmitted in an autosomal dominant pattern, while in others the mode of inheritance is X-linked. Children with idiopathic scoliosis appear to be otherwise entirely healthy, and have not had any bone or joint disease early in life. Scoliosis is not caused by poor posture, diet, or carrying a heavy book-bag exclusively on one shoulder.

Idiopathic scoliosis is further classified according to age of onset:

  • Infantile. Curvature appears before age three. This type is quite rare in the United States, but is more common in Europe.
  • Juvenile. Curvature appears between ages three and 10. This type may be equivalent to the adolescent type, except for the age of onset.
  • Adolescent. Curvature appears between ages of 10 and 13, near the beginning of puberty. This is the most common type of idiopathic scoliosis.
  • Adult. Curvature begins after physical maturation is completed.

Causes are known for three other types of scoliosis:

  • Congenital scoliosis is due to congenital birth defects in the spine, often associated with other organ defects.
  • Neuromuscular scoliosis is due to loss of control of the nerves or muscles that support the spine. The most common causes of this type of scoliosis are cerebral palsy and muscular dystrophy.
  • Degenerative scoliosis may be caused by degeneration of the discs that separate the vertebrae or arthritis in the joints that link them.

Scoliosis causes a noticeable asymmetry in the torso when viewed from the front or back. The first sign of scoliosis is often seen when a child is wearing a bathing suit or underwear. A child may appear to be standing with one shoulder higher than the other, or to have a tilt in the waistline. One shoulder blade may appear more prominent than the other due to rotation. In girls, one breast may appear higher than the other, or larger if rotation pushes that side forward.

Curve progression is greatest near the adolescent growth spurt. Scoliosis that begins early is more likely to progress significantly than scoliosis that begins later in puberty.

More than 30 states have screening programs in schools for adolescent scoliosis, usually conducted by trained school nurses or physical education teachers.

Diagnosis

Diagnosis for scoliosis is typically continued by an orthopedist. A complete medical history is taken, including questions abouta a family history of scoliosis. The physical examination includes determination of pubertal development in adolescents, a neurological examination (which may reveal a neuromuscular cause), and measurements of trunk asymmetry. Examination of the trunk is done while the patient is standing, bending over, and lying down. The forward bending test is sometimes referred to as the Adams test. It involves both visual inspection and use of a simple mechanical device called a scoliometer.

If a curve is detected, one or more x rays will usually be taken to define the curve or curves more precisely. An x ray is used to document spinal maturity, any pelvic tilt or hip asymmetry, and the location, extent, and degree of curvature. The curve is defined in terms of its beginning and ending points, its direction, and by an angle measure known as the Cobb angle. The Cobb angle is found by projecting lines parallel to the vertebrae tops at the extremes of the curve, projecting perpendiculars from these lines, and measuring the angle of intersection. To properly track the progress of scoliosis, it is important to project from the same points of the spine each time.

Occasionally, magnetic resonance imaging (MRI) is used, primarily to look more closely at the condition of the spinal cord and nerve roots extending from it if neurological problems are suspected.

Treatment

Although important for general health and strength, exercise has not been shown to prevent or slow the progression of scoliosis. It may help to relieve pain from scoliosis by helping to maintain range of motion. Good nutrition is also important for general health, but no specific dietary regimen has been shown to control scoliosis development. In particular, dietary calcium levels do not influence scoliosis progression.

Chiropractic treatment may relieve pain but cannot halt scoliosis development, and should not be a substitute for conventional treatment of progressive scoliosis. Acupuncture and acupressure may also help reduce pain and discomfort, but they cannot halt scoliosis development either.

Other movement therapies (yoga, t'ai chi, qigong, and dance) improve flexibility and are useful when used with such movement education therapies as Feldenkrais, the Rosen method, the Alexander technique, and Pilates.

Allopathic Treatment

Treatment decisions for scoliosis are based on the degree of curvature, the likelihood of significant progression, and the presence of pain, if any.

Curves less than 20° are not usually treated, except by regular follow-up for children who are still growing. Watchful waiting is usually all that is required in adolescents with curves of 20–30°, or adults with curves up to 40° or slightly more, as long as there is no pain.

For children or adolescents whose curves progress to 30°, and who have a year or more of growth left, bracing may be required. Bracing cannot correct curvature but may be effective in halting or slowing progression. Bracing is rarely used in adults, except where pain is significant and surgery is not an option, as in some elderly patients.

Two general styles of braces are used for daytime wear. The Milwaukee brace consists of metal uprights attached to pads at the hips, rib cage, and neck. The under-arm brace uses rigid plastic to encircle the lower rib cage, abdomen, and hips. Both of these brace types hold the spine in a vertical position. Because it can be worn out of sight beneath clothing, the underarm brace is better tolerated and often leads to better compliance. A third style, the Charleston bending brace, is used at night to bend the spine in the opposite direction. Braces are often prescribed to be worn for 22–23 hours per day, though some clinicians allow or encourage removal of the brace for exercise.

Bracing may be appropriate for scoliosis due to some types of neuromuscular disease, including spinal muscular atrophy, before growth is finished. Duchenne muscular dystrophy is not treated by bracing, since surgery is likely to be required and later surgery is complicated by loss of respiratory capacity.

Surgery for idiopathic scoliosis is usually recommended if:

  • The curve has progressed despite bracing.
  • The curve is greater than 40–50° before growth has stopped in an adolescent.
  • The curve is greater than 50° and continues to increase in an adult.
  • There is significant pain.

Orthopedic surgery for neuromuscular scoliosis is often done earlier. The goals of surgery are to correct the deformity as much as possible, to prevent further deformity, and to eliminate pain as much as possible. Surgery can usually correct 40–50% of the curve, sometimes as much as 80%. Surgery cannot always completely remove pain.

The surgical procedure for scoliosis is called spinal fusion, because the goal is to straighten the spine as much as possible, and then to fuse the vertebrae together to prevent further curvature. To achieve fusion, the involved vertebra are first exposed, and then scraped to promote regrowth. Bone chips are usually used to splint together the vertebrae to increase the likelihood of fusion. To maintain the proper spinal posture before fusion occurs, metal rods are inserted alongside the spine and attached to the vertebrae by hooks, screws, or wires. Fusion of the spine makes it rigid and resistant to further curvature. The metal rods are no longer needed once fusion is complete but are rarely removed unless their presence leads to complications.

Spinal fusion leaves the involved portion of the spine permanently stiff and inflexible. While this stiffness leads to some loss of normal motion, most functional activities are not strongly affected, unless the very lowest portion of the spine (the lumbar region) is fused. Normal mobility, exercise, and even contact sports are usually all possible after spinal fusion. Full recovery takes approximately six months.

Expected Results

The prognosis for a person with scoliosis depends on many factors, including the age at which scoliosis begins and the treatment received. More importantly, mostly unknown individual factors affect the likelihood of progression and the severity of the curve. Most cases of mild adolescent idiopathic scoliosis need no treatment and do not progress. Untreated severe scoliosis often leads to spondylosis and may impair breathing.

Prevention

There is no known way to prevent the development of scoliosis. Progression of scoliosis may be prevented through bracing or surgery.

Resources

Books

Neuwirth, Michael, and Kevin Osborn. The Scoliosis Handbook. New York: Henry Holt & Co., 1996.

Periodicals

Justice, C.M., N. H. Miller, B. Marosy, et al. "Genetic Heterogeneity Comprising Both X-Linked and Autosomal Dominant Forms of Inheritance in Families with Familial Idiopathic Scoliosis." American Journal of Human Genetics 69 (October 2001): 384.

Splete, Heidi. "Catch Curves Like Scoliosis in Time for Bracing (Watch Your Patients' Backs)." Pediatric News 35 (November 2001): 42–43.

Organizations

National Scoliosis Foundation. 5 Cabot Place Stoughton, MA 02072. (800) 673-6922. NSF@scoliosis.org. .

The Scoliosis Association. PO Box 811705 Boca Raton, FL 33481-1705. (407) 368-8518. normlipin@aol.com. .

Scoliosis Research Society. 611 East Wells Street Milwaukee, WI 53202. (414) 289-9107. Tjackson@execinc.com. .

[Article by: Paula Ford-Martin; Rebecca J. Frey, PhD]

Children's Health Encyclopedia: Scoliosis
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Definition

Scoliosis is a side-to-side curvature of the spine.

Description

When viewed from the rear, the spine usually appears perfectly straight. Scoliosis is a lateral (side-to-side) curve in the spine, usually combined with a rotation of the vertebrae. (The lateral curvature of scoliosis should not be confused with the normal set of front-to-back spinal curves visible from the side.) While a small degree of lateral curvature does not cause any medical problems, larger curves can cause postural imbalance and lead to muscle fatigue and pain. More severe scoliosis can interfere with breathing and lead to arthritis of the spine (spondylosis).

Demographics

Approximately 10 percent of all adolescents have some degree of scoliosis, although fewer than 1 percent have curves that require medical attention beyond monitoring. Scoliosis is found in both boys and girls, but a girl's spinal curve is much more likely to progress than a boy's. Girls require scoliosis treatment about five times more often than boys. The reason for these differences as of 2004 was not known.

Causes and Symptoms

Four out of five cases of scoliosis are idiopathic, meaning the cause is unknown. While idiopathic scoliosis tends to run in families, no specific genes responsible for the condition have been identified. Children with idiopathic scoliosis appear to be otherwise entirely healthy and have not had any bone or joint disease early in life. Scoliosis is not caused by poor posture, diet, or carrying a heavy book bag on one shoulder.

Idiopathic scoliosis is further classified according to age of onset:

  • Infantile: Curvature appears before age three. This type is quite rare in the United States but is more common in Europe.
  • Juvenile: Curvature appears between ages three and ten. This type may be equivalent to the adolescent type, except for the age of onset.
  • Adolescent: Curvature usually appears between ages of ten and 13, near the beginning of puberty. This is the most common type of idiopathic scoliosis.
  • Adult: Curvature begins after physical maturation is completed.

Causes are known for three other types of scoliosis:

  • Congenital scoliosis is due to abnormal formation of the bones of the spine and is often associated with other organ defects.
  • Neuromuscular scoliosis is due to loss of control of the nerves or muscles that support the spine. The most common causes of this type of scoliosis are cerebral palsy and muscular dystrophy.
  • Degenerative scoliosis may be caused by breaking down of the discs that separate the vertebrae or by arthritis in the joints that link them.

Scoliosis causes a noticeable asymmetry in the torso when viewed from the front or back. The first sign of scoliosis is often seen when a child is wearing a bathing suit or underwear. A child may appear to be standing with one shoulder higher than the other or to have a tilt in the waistline. One shoulder blade may appear more prominent than the other due to rotation. In girls, one breast may appear higher than the other or larger if rotation pushes one side forward.

Curve progression is greatest near the adolescent growth spurt. Scoliosis that begins early is more likely to progress significantly than scoliosis that begins later in puberty.

When to Call the Doctor

If the parent notices that a child's posture is abnormal, if when the child stands one hip appears to be higher than the other, if one shoulder blade appears to be sticking out, or the child appears to lean regularly to one side, the doctor should be notified. If the child is screened at school and the screener reports a suspicion of scoliosis, a doctor should be seen to follow up on this suspicion.

Diagnosis

Diagnosis for scoliosis is done by an orthopedist. A complete medical history is taken, including questions about family history of scoliosis. The physical examination includes determination of pubertal development in adolescents, a neurological exam (which may reveal a neuromuscular cause), and measurements of trunk asymmetry. Examination of the trunk is done while the patient is standing, bending over, and lying down and involves both visual inspection and use of a simple mechanical device called a scoliometer.

If a curve is detected, one or more x rays will usually be taken to define the curve or curves more precisely. An x ray is also used to document spinal maturity, any pelvic tilt or hip asymmetry, and the location, extent, and degree of curvature. The curve is defined in terms of where it begins and ends, in which direction it bends, and by an angle measure known as the Cobb angle. The Cobb angle is found by taking an x ray of the spine. Lines are then projected out parallel to the vertebrae at the top and bottom of the curve. Then perpendicular lines are projected from these lines and the angle at which the lines intersect is measured. These angles are referred to when the angle of the curvature is discussed. To properly track the progress of scoliosis, it is important to project from the same points of the spine each time a measurement is made; otherwise, there is a risk of getting misleading measurements.

Occasionally, magnetic resonance imaging (MRI) is used as a diagnostic tool, primarily to look more closely at the condition of the spinal cord and nerve roots extending from it if neurological problems are suspected.

Treatment

Treatment decisions for scoliosis are based on the degree of curvature, the likelihood of significant progression, and the presence of pain, if any.

Curves less than 20 degrees are not usually treated, except by regular follow-up for children who are still growing. Watchful waiting is usually all that is required in adolescents with curves of 20 to 30 degrees as long as there is no pain.

For children or adolescents whose curves progress to 30 degrees and who have a year or more of growth left, bracing may be required. Bracing cannot correct curvature but may be effective in halting or slowing progression.

Two styles of braces are used for daytime wear. The Milwaukee brace consists of metal uprights attached to pads at the hips, rib cage, and neck. The other kind of brace is the underarm brace, which uses rigid plastic to encircle the lower rib cage, abdomen, and hips. Both these brace types hold the spine in a vertical position. Because it can be worn out of sight beneath clothing, the underarm brace is better tolerated and often leads to better compliance. A third style, the Charleston bending brace, is used at night to bend the spine in the opposite direction. Braces are often prescribed to be worn for 22 to 23 hours per day, though some clinicians allow or encourage removal of the brace for exercise.

Bracing may be appropriate for scoliosis due to some types of neuromuscular disease, including spinal muscular atrophy, before growth is finished. Duchenne muscular dystrophy is not treated by bracing. Surgery is likely to be required.

Surgery is usually the option of last resort in cases of scoliosis. Surgery for idiopathic scoliosis is usually recommended if one of the following conditions is present:

  • The curve has progressed despite bracing.
  • The curve is greater than 40 to 50 degrees before growth has stopped in an adolescent.
  • There is significant pain.

Orthopedic surgery for neuromuscular scoliosis is often done earlier. The goals of surgery are to correct the deformity as much as possible, to prevent further deformity, and to eliminate pain as much as possible. Surgery can usually correct 40 to 50 percent of the curve, and sometimes as much as 80 percent. Surgery cannot always completely remove pain.

The surgical procedure for scoliosis is called spinal fusion, because the goal is to straighten the spine as much as possible and then to fuse the vertebrae together to prevent further curvature. To achieve fusion, the involved vertebra are first exposed and then scraped to promote regrowth. Bone chips are usually used to splint together the vertebrae to increase the likelihood of fusion. To maintain the proper spinal posture before fusion occurs, metal rods are inserted alongside the spine and are attached to the vertebrae by hooks, screws, or wires. Fusion of the spine makes it rigid and resistant to further curvature. The metal rods are no longer needed once fusion is complete but are rarely removed unless their presence leads to complications.

Spinal fusion leaves the involved portion of the spine permanently stiff and inflexible. While this leads to some loss of normal motion, most functional activities are not strongly affected, unless the very lowest portion of the spine (the lumbar region) is fused. Normal mobility, exercise, and even contact sports are usually all possible after spinal fusion. Full recovery takes approximately six months. Physical therapy is part of standard treatment as well.

Alternative Treatment

Numerous alternative therapies have been touted to provide relief and help for individuals with scoliosis, but none has been proven beneficial in clinical trials. These include massage and electrical stimulation. In addition, alternatives such as rolfing or chiropractic manipulation of soft tissue to improve alignment may provide improved flexibility, stronger muscles, and pain relief but cannot prevent or correct the curvature of the spine or its progression.

Although important for general health and strength, exercise has not been shown to prevent or slow the development of scoliosis. It may help relieve pain from scoliosis by helping to maintain range of motion. Aquatic exercise, in particular, can increase flexibility and improve posture, balance, coordination, and range of motion. Because it decreases joint compression, it can lessen the pain caused by scoliosis or surgery.

Good nutrition is also important for general health, but no specific dietary regimen has been shown to control scoliosis development. In particular, dietary calcium levels do not influence scoliosis progression.

Chiropractic treatment may relieve pain, but it cannot halt scoliosis development and should not be a substitute for conventional treatment of progressing scoliosis. Acupuncture and acupressure may also help reduce pain and discomfort, but these treatments cannot halt scoliosis development either.

Prognosis

The prognosis for a child with scoliosis depends on many factors, including the age at which scoliosis begins and the treatment received. More importantly, mostly unknown individual factors affect the likelihood of progression and the severity of the curve. Most cases of mild adolescent idiopathic scoliosis need no treatment and do not progress. Untreated severe scoliosis often leads to spondylosis and may impair breathing. Degenerative arthritis of the spine, sciatica, and severe physical deformities can also result if severe scoliosis is left untreated. Finally, scoliosis can also poorly affect the individual's self-esteem and cause serious emotional problems.

Prevention

There is no known way to prevent the development of scoliosis. Progression of scoliosis may be prevented through bracing or surgery. More than 30 states have screening programs in schools for adolescent scoliosis, usually conducted by trained school nurses or physical education teachers. These programs can help to catch scoliosis early, so that treatment can begin and progression can often be halted or slowed.

Parental Concerns

Children with scoliosis often have a negative self-image associated with irregular posture or having to wear a brace. This problem is being combated with new braces that can be worn under the clothing and are more discreet than traditional braces. Scoliosis can be life threatening if it is not treated and progresses to a point at which breathing is impaired. This is very rare, however. Scoliosis should be watched carefully by a physician for signs of worsening, but it usually does not progress to the point at which treatment is needed.

Resources

Books

Hooper, Nancy J. Stopping Scoliosis: The Whole Family Guide to Diagnosis and Treatment. East Rutherford, NJ: Penguin Group, 2002.

Lenke, Lawrence, et al. Modern Anterior Scoliosis Surgery. St. Louis, MO: Quality Medical Publishing, 2002.

Newton, Peter O. Adolescent Idiopathic Scoliosis. Rosemont, IL: Academy of Orthopaedic Surgeons, 2004.

Schommer, Nancy. Stopping Scoliosis: The Complete Guide to Diagnosis and Treatment, 2nd ed. New York: Avery, 2002.

Silverstein, Alvin. Scoliosis. Minneapolis, MN: Sagebrush Education Resources, 2003.

Spray, Michelle L., et al. Growing Up with Scoliosis: A Young Girl's Story. Stratford, CT: Book Shelf Inc., 2002.

Periodicals

Sullivan, Michele G. "Surgical Stapling Can Halt Curve of Scoliosis: Orthotics Can Be Helpful." Family Practice News 33 (December 15, 2003): 35.

Wachter, Kerry. "Prognosis for Scoliosis Better than Once Thought." Family Practice News 33 (July 1, 2003): 59.

Weomstoem. Stuart, et al. "Health and Function of Patients with Untreated Idiopathic Scoliosis: a 50-Year Natural History Study." The Journal of the American Medical Association 289 (February 5, 2003): 559.

Organizations

National Scoliosis Foundation. 5 Cabot Place, Stoughton, MA 02072. Web site: www.scoliosis.org.

Scoliosis Research Society. 55 East Wells St. Suite 1100. Milwaukee, WI 53202–3823. Web site: www.srs.org.

[Article by: Tish Davidson, A.M. Liz Meszaros]


Sports Science and Medicine: scoliosis
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An abnormal lateral curvature of the spine that occurs most often in the thoracic region. It may be congenital or acquired, for example, from poor posture or an unequal muscle pull on the spine. Mild cases of scoliosis may have no adverse symptoms, but severe scoliosis can he painful and deforming, and usually requires bracing and/or surgery. See also tennis shoulder.

Veterinary Dictionary: scoliosis
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Lateral deviation in the normally straight vertical line of the spine; it may or may not include rotation or deformity of the vertebrae.

Wikipedia: Scoliosis
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Scoliosis
Classification and external resources

A coronal X-ray of a person with thoracic dextroscoliosis and lumbar levoscoliosis. The X-ray is projected such that the right side of the subject is on the right side of the image, i.e. the subject is viewed from the rear. This projection is typically used by surgeons as it is how surgeons see their patients when they are on the operating table.
ICD-10 M41.

Scoliosis (from Greek: skolíōsis meaning "crooked")[1] is a medical condition in which a person's spine is curved from side to side, shaped like an "s" or "c", and may also be rotated. To adults it can be very painful. It is an abnormal lateral curvature of the spine. On an x-ray, viewed from the rear, the spine of an individual with a typical scoliosis may look more like an "S" or a "C" than a straight line. It is typically classified as congenital (caused by vertebral anomalies present at birth), idiopathic (sub-classified as infantile, juvenile, adolescent, or adult according to when onset occurred) or as neuromuscular, having developed as a secondary symptom of another condition, such as spina bifida, cerebral palsy, spinal muscular atrophy or due to physical trauma.

Contents

Cause

In the case of the most common form of scoliosis, adolescent idiopathic scoliosis, there is no clear causal agent [2]. Various causes have been implicated, but none have consensus among scientists as the cause of scoliosis. The role of genetic factors in the development of this condition is widely accepted[3]. Scoliosis is more often diagnosed in females and is often seen in patients with cerebral palsy or spina bifida,which is a birth defect that involves the incomplete development of the spinal cord and its coverings[4][citation needed], although this form of scoliosis is different from that seen in children without these conditions. In some cases, scoliosis exists at birth due to a congenital vertebral anomaly. Occasionally, development of scoliosis during adolescence is due to an underlying anomaly such as a tethered spinal cord, but most often the cause is unknown or idiopathic, having been inherited through genetics [5].[citation needed] Some therapists like the referenced Hanna Somatic therapist believe that trauma to an adult can cause, not just asymmetry but an actual curve to the spine visible on x-ray, although no documentation is offered in her article. Scoliosis often presents itself, or worsens, during the adolescence growth spurt. During adolescence, due to rapid growth of the body, hip and leg proportions in the leg and thigh may become misaligned, causing temporary acute scoliosis.

In April 2007, researchers at Texas Scottish Rite Hospital for Children[6] identified the first gene associated with idiopathic scoliosis, CHD7. The medical breakthrough was the result of a 10-year study and is outlined in the May 2007 issue of the American Journal of Human Genetics.[7]

Prevalence

Scoliotic curves of 10° or less affect 3-5 out of every 1,000 people.[citation needed] The prevalence of curves less than 20° is about equal in males and females. 2% of women and 0.5% of men are affected by Scoliosis.[citation needed]

Symptoms

Patients aged from 18 or older are less likely to worsen their case due to their mature spines and body system. Pain is often common in adulthood, especially if the scoliosis is left untreated.[citation needed] Though doctors do not always recommend surgery as the solution to scoliosis, it is still the most efficient way to completely strengthen the spine. Scoliosis surgery is often performed for cosmetic reasons rather than pain alone as the surgery cannot guarantee pain loss but it can stabilize a curvature and prevent worsening therefore improving one's quality of life. Pain can occur because the muscles try to conform to the way the spine is curving often resulting in muscle spasms. Some of the severe cases of scoliosis can lead to diminishing lung capacity, putting pressure on the heart, and restricting physical activities. The symptoms of scoliosis can include:

  • Uneven musculature on one side of the spine
  • A rib "hump" (Pectus carinatum) and/or a prominent shoulder blade, caused by rotation of the ribcage in thoracic scoliosis
  • Uneven hip, rib cage, and shoulder levels
  • Asymmetric size or location of breast in females
  • Unequal distance between arms and body
  • Slow nerve action (in some cases)
  • Different heights of the shoulders

Associated conditions

Scoliosis is sometimes associated with other conditions such as Ehler-Danlos Syndrome (hyperflexibility, 'floppy baby' syndrome, and other variants of the condition), Charcot-Marie-Tooth, kyphosis, cerebral palsy, spinal muscular atrophy, muscular dystrophy, familial dysautonomia, CHARGE syndrome, Friedreich's ataxia, proteus syndrome, Spina bifida, Marfan's syndrome, neurofibromatosis, connective tissue disorders, congenital diaphragmatic hernia, and craniospinal axis disorders (e.g., syringomyelia, mitral valve prolapse, Arnold-Chiari malformation).

Investigation

Cobb angle measurement of a levoscoliosis

Patients who initially present with scoliosis are examined to determine whether there is an underlying cause of the deformity. During a physical examination, the following is assessed:

During the exam, the patient is asked to remove his shirt and bend forward (this is known as the Adam's Bend Test and is often performed on school students). If a hump is noted, then scoliosis is a possibility and the patient should be sent for an x-ray to confirm the diagnosis. Alternatively, a scoliometer may be used to diagnose the condition.[8] The patient's gait is assessed, and there is an exam for signs of other abnormalities (e.g., Spina bifida as evidenced by a dimple, hairy patch, lipoma, or hemangioma). A thorough neurological examination is also performed.

It is usual when scoliosis is suspected to arrange for weight-bearing full-spine AP/coronal (front-back view) and lateral/sagittal (side view) xrays to be taken, to assess both the scoliosis curves and also the kyphosis and lordosis, as these can also be affected in individuals with scoliosis. Full-length standing spine X rays are the standard method for evaluating the severity and progression of the scoliosis, and whether it is congenital or idiopathic in nature. In growing individuals, serial radiographs are obtained at 3-12 month intervals to follow curve progression. In some instances, MRI investigation is warranted.

The standard method for assessing the curvature quantitatively is measurement of the Cobb angle, which is the angle between two lines, drawn perpendicular to the upper endplate of the uppermost vertebrae involved and the lower endplate of the lowest vertebrae involved. For patients who have two curves, Cobb angles are followed for both curves. In some patients, lateral bending xrays are obtained to assess the flexibility of the curves or the primary and compensatory curves.

Genetic testing for AIS, which has become available in 2009, greatly improves the ability of physicians to accurately predict the likelihood of curve progression[9].

Mass-screening for scoliosis using posture photos

It has been suggested that entire populations be examined, for early detection. For example, in the 1940s, American psychologist William Sheldon proposed mandatory physical examinations that included nude photographs of each person being examined. One purpose of these photographs was the detection of rickets, scoliosis, and lordosis. His approach was implemented at a number of ivy league schools in which all freshmen were examined (Ivy League nude posture photos). A similar program was implemented in Boston's prison system. [10]

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.

Genetic Testing for Adolescent Idiopathic Scoliosis

Through a genome-wide association study, geneticists have identified single nucleotide polymorphism markers in the DNA that are significantly associated with Adolescent Idiopathic Scoliosis. Genetic testing for AIS now allows many AIS patients to find out, with great accuracy, their own likelihood of progression to a severe curve[11].

Management

The traditional medical management of scoliosis is complex and is determined by the severity of the curvature and skeletal maturity, which together help predict the likelihood of progression.

The conventional options are, in order:

  1. Observation
  2. Bracing
  3. Surgery

Bracing is normally done when the patient has bone growth remaining and is generally implemented to hold the curve and prevent it from progressing to the point where surgery is indicated. Braces are sometimes prescribed for adults to relieve pain. Bracing involves fitting the patient with a device that covers the torso; in some cases it extends to the neck. The most commonly used brace is a TLSO, a corset-like appliance that fits from armpits to hips and is custom-made from fiberglass or plastic. It is usually worn 22–23 hours a day and applies pressure on the curves in the spine. The effectiveness of the brace depends not only on brace design and orthotist skill, but on patient compliance and amount of wear per day. Typically, braces are used for idiopathic curves that are not grave enough to warrant surgery, but they may also be used to prevent the progression of more severe curves in young children, to buy the child time to grow before performing surgery, which would prevent further growth in the part of the spine affected. Bracing may cause emotional and physical discomfort. Physical activity may become more difficult because the brace presses against the stomach, making it difficult to breathe. Children may lose weight from the brace, due to increased pressure on the abdominal area.

In infantile and sometimes juvenile scoliosis, a plaster jacket applied early may be used instead of a brace. It has been proven possible[12] to permanently correct cases of infantile idiopathic scoliosis by applying a series of plaster casts (EDF: elongation, derotation, flexion) applied on a specialized frame under corrective traction, which helps to "mould" the infant's soft bones and work with their growth spurts. This method was pioneered by UK scoliosis specialist Min Mehta.

Conventional chiropractic and physical therapy have some degree of anecdotal success in treating scoliosis that is primarily neuromuscular in nature. Non-surgical approaches will not address severe bone deformities associated with some cases of scoliosis. Chiropractors and physical therapists use joint mobilization techniques and therapeutic exercise to increase a scoliosis patient's flexibility and strength, theorizing that this better enables the brace to influence the curvature of the spine. Electrical muscle stimulation (EMS) is another therapeutic modality commonly used by chiropractors and physical therapists to reduce muscle spasms and strengthen atrophied muscles.

A growing body of scientific research testifies to the efficacy of specialized treatment programs of physical therapy, which may include bracing.[13] Debate in the scientific community about whether chiropractic and physical therapy can influence scoliotic curvature is partly complicated by the variety of methods proposed and employed: Some are supported by more research than others.

The Schroth Method is one non-invasive, physiotherapeutic treatment for scoliosis which has been used successfully in Europe since the 1920s.[14] Originally developed in Germany by scoliosis sufferer Katharina Schroth, this method is now taught to scoliosis patients in clinics specifically devoted to Schroth therapy in Germany, Spain, England and, most recently, the United States. The method is based upon the concept of scoliosis as resulting from a complex of muscular asymmetries (especially strength imbalances in the back) that can be at least partially corrected by targeted exercises.[15]

Surgery

Surgery is usually indicated for curves that have a high likelihood of progression, curves that cause a significant amount of pain with some regularity, curves that would be cosmetically unacceptable as an adult, curves in patients with spina bifida and cerebral palsy that interfere with sitting and care, and curves that affect physiological functions such as breathing.

Surgery for scoliosis is usually done by a surgeon who specializes in spine surgery. For various reasons it is usually impossible to completely straighten a scoliotic spine, but in most cases very good corrections are achieved.

Surgery is usually required with a curve of 40 to 50 degrees.

Spinal fusion with instrumentation

Coronal X-ray of the above spine after having undergone successful fusion and instrumentation

Spinal fusion is the most widely performed surgery for scoliosis. In this procedure, bone (either harvested from elsewhere in the body autograft, or donor bone allograft) is grafted to the vertebrae so that when it heals, they will form one solid bone mass and the vertebral column becomes rigid. This prevents worsening of the curve at the expense of spinal movement. This can be performed from the anterior (front) aspect of the spine by entering the thoracic or abdominal cavity, or performed from the back (posterior). A combination of both is used in more severe cases.

Originally, spinal fusions were done without metal implants. A cast was applied after the surgery, usually under traction to pull the curve as straight as possible and then hold it there while fusion took place. Unfortunately, there was a relatively high risk of pseudarthrosis (fusion failure) at one or more levels and significant correction could not always be achieved. In 1962, Paul Harrington introduced a metal spinal system of instrumentation which assisted with straightening the spine, as well as holding it rigid while fusion took place. The original, now obsolete Harrington rod operated on a ratchet system, attached by hooks to the spine at the top and bottom of the curvature that when cranked would distract, or straighten, the curve. A major shortcoming of the Harrington method was that it failed to produce a posture where the skull would be in proper alignment with the pelvis and it didn't address rotational deformity. As a result, unfused parts of the spine would try to compensate for this in the effort to stand up straight. As the person aged, there would be increased wear and tear, early onset arthritis, disc degeneration, muscular stiffness and pain with eventual reliance on painkillers, further surgery, inability to work full-time and disability. "Flatback" became the medical name for a related complication, especially for those who had lumbar scoliosis.[vague] Modern spinal systems are attempting to address sagittal imbalance and rotational defects unresolved by the Harrington rod system. They involve a combination of rods, screws, hooks and wires fixing the spine and can apply stronger, safer forces to the spine than the Harrington rod. This technique is known as the Cotrel-Dubousset instrumentation, currently the most common technique for the procedure.

Modern spinal fusions generally have good outcomes with high degrees of correction and low rates of failure and infection.[citation needed] Patients with fused spines and permanent implants tend to have normal lives with unrestricted activities when they are younger, it remains to be seen[vague] whether those that have been treated with the newer surgical techniques will develop problems as they age. They are able to participate in recreational athletics, have natural childbirth and are generally satisfied with their treatment[citation needed]. A notable limitation of spinal fusions is that patients who have undergone surgery for scoliosis are ineligible for service in the military of countries such as the United Kingdom, Sweden and the United States.

In cases where scoliosis has caused a significant deformity resulting in a rib hump, it is often possible to perform a surgery called a costoplasty (also called a thorocoplasty) in order to achieve a more pleasing cosmetic result.[vague] This procedure may be performed at any time after a fusion surgery, whether as part of the same operation or several years afterwards. It is usually impossible to completely straighten and untwist a scoliotic spine, and it should be noted that the level of cosmetic success will depend on the extent to which the fused spine still rotates out into the ribcage. A rib hump is evidence that there is still some rotational deformity to the spine. Specific weight training techniques can be used to influence this rotational deformity in the unfused parts of the spine.[vague] This leads to a marked decrease in pain and to some improvement in organ function depending on the person's particular case and is to be recommended over any cosmetic surgical procedure[citation needed].

Surgery without fusion

New implants have been developed that aim to delay spinal fusion and to allow more spinal growth in young children. For the youngest patients, whose thoracic insufficiency compromises their ability to breathe and applies significant cardiac pressure, ribcage implants that push the ribs apart on the concave side of the curve may be especially useful. These Vertical Expandable Prosthetic Titanium Ribs (VEPTR) provide the benefit of expanding the thoracic cavity and straightening the spine in all three dimensions while allowing the spine to grow. Although these methods are novel and promising, these treatments are only suitable for growing patients. Spinal fusion remains the "gold standard" of surgical treatment for scoliosis. Surgery is usually required if the spine has a curve of 40 to 50 degrees.

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.[16].

See also

Search Wikimedia Commons Wikimedia Commons has media related to: Scoliosis

References

  1. ^ Online Etymology Dictionary. Douglas Harper, Historian. Accessed 27 December 2008. Dictionary.com http://dictionary.reference.com/browse/scoliosis
  2. ^ Kouwenhoven, J & Castelein, R, 2008, 'The Pathogenesis of Adolescent Idiopathic Scoliosis', Spine, vol. 33, no. 26, pp. 2898-2908. 10.1097/BRS.0b013e3181891751
  3. ^ Ogilvie JW, Braun J, Argyle V, Nelson L, Meade M, Ward K, 2006, 'The Search for Idiopathic Genes', Spine, vol. 31, no. 6, pp. 679-81. March 2006
  4. ^ [1]
  5. ^ [2]
  6. ^ Texas Scottish Rite Hospital for Children: [3]
  7. ^ Gao X, Gordon D, Zhang D, Browne R, Helms C, Gillum J, Weber S, Devroy S,Swaney S, Dobbs M, Morcuende J, Sheffield V, Lovett M, Bowcock A, Herring J, Wise C (2007). "[http://www.ncbi.nlm.nih.gov/pubmed/17436250?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum CHD7 gene polymorphisms are associated with susceptibility to idiopathic scoliosis.]". Am J Hum Genet 80 (5): 957-65. PMID 17436250. http://www.ncbi.nlm.nih.gov/pubmed/17436250?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum. 
  8. ^ [4]
  9. ^ Nelson L, Ward K, Ogilvie J "Adolescent Idiopathic Scoliosis and Genetic Testing" Current Opinion in Pediatrics, August 2009 (submitted)
  10. ^ All about Criminal Motivation, by Mark Gado - Crime Library on truTV.com
  11. ^ Nelson L, Ward K, Ogilvie J "Adolescent Idiopathic Scoliosis and Genetic Testing" Current Opinion in Pediatrics, August 2009 (submitted)
  12. ^ Mehta MH (2005). "Growth as a corrective force in the early treatment of progressive infantile scoliosis". J Bone Joint Surg Br 87 (9): 1237–47. doi:10.1302/0301-620X.87B9.16124. PMID 16129750. 
  13. ^ Negrini S, Fusco C, Minozzi S, Atanasio S, Zaina F, Romano M (2008). Exercises reduce the progression rate of adolescent idiopathic scoliosis: results of a comprehensive systematic review of the literature.=Disabil Rehabil. 30. pp. 772–85. PMID 18432435. 
  14. ^ Lehnert-Schroth, Christa (2007). Three-Dimensional Treatment for Scoliosis: A Physiotherapeutic Method for Deformities of the Spine. (Palo Alto, CA: The Martindale Press): pp. 1-6.
  15. ^ Lehnert-Schroth, Christa (2007). Three-Dimensional Treatment for Scoliosis: A Physiotherapeutic Method for Deformities of the Spine. (Palo Alto, CA: The Martindale Press): passim.
  16. ^ Weiss HR, Lohschmidt K, el-Obeidi N, Verres C, (1997). "Preliminary results and worst-case analysis of in-patient scoliosis . True". Pediatr Rehabil 1 (1): 35–40. 
v • d • e
Dorsopathies / spinal disease (M40-M54, 720-724,737)
Deforming dorsopathies
Kyphosis · Lordosis · Scoliosis
Other
Spondylopathy
Back pain
Intervertebral disc disorder
joint navs: anat, non-congenital arthropathies/deformities/dorsopathies/soft tissue arthropathy/congenital, eponymous signs, proc
v • d • e
Congenital malformations and deformations of musculoskeletal system / musculoskeletal abnormality (Q65-Q76, 754-756.3)
Limb/
dysmelia
Either/both
Craniofacial
Other axial
joint navs: anat, non-congenital arthropathies/deformities/dorsopathies/soft tissue arthropathy/congenital, eponymous signs, proc

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Translations: Scoliosis
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Home > Library > Literature & Language > Translations

Dansk (Danish)
n. - skoliose, sidekrumning af hvirvelsøjlen

Nederlands (Dutch)
scoliose

Français (French)
n. - scoliose

Deutsch (German)
n. - Skoliose, seitliche Rückgratverkrümmung

Ελληνική (Greek)
n. - (παθολ.) σκολίωση

Italiano (Italian)
scoliosi

Português (Portuguese)
n. - escoliose (f) (Med.)

Русский (Russian)
сколиоз

Español (Spanish)
n. - escoliosis

Svenska (Swedish)
n. - skolios

中文（简体）(Chinese (Simplified))
脊柱侧凸

中文（繁體）(Chinese (Traditional))
n. - 脊柱側凸

한국어 (Korean)
n. - 척추 만곡, 척추 측만

日本語 (Japanese)
n. - 側湾

العربيه (Arabic)
‏(الاسم) ألجنف, ميلان جانبي‏

עברית (Hebrew)
n. - ‮עקמת (עמוד) השדרה‬

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