Scoliosis

Scoliosis is a spine curvature disorder that is most commonly diagnosed in teens. The spine has a natural forward-and-backward bend that commonly resembles an S or a C shape.

Associated Anatomy

Spine or Vertebrae

Causes

Scoliosis is caused due to several factors, the majority of which are unknown. Some of the likely causes are as follows:

  • Genetics- Approximately 30% of adolescent idiopathic scoliosis patients have a family history of the illness
  • Neuromuscular scoliosis is caused by a neurological system disorder affecting the muscles, such as muscular dystrophy, myasthenia gravis, and polio.
  • Congenital scoliosis is a birth abnormality that affects the development of a baby's ribs or spine bones.
  • Infections or injuries to the spine
  • Abnormalities of the spinal cord

Signs or Symptoms

  • If there is pressure on the nerves in the lumbar spine, pain, numbness, and weakness may occur.
  • Loss of height
  • An uneven waistline resulting from a misalignment of the pelvis and hips
  • Prominent ribs on one side
  • Tilted, unequal shoulders with one shoulder blade protruding more than the other due to a discrepancy in shoulder height
  • One hip is slightly higher than the other
  • The back is bulged or shows signs of deformities

Possible Scoliosis Treatment

There are two types of treatments, which are surgical & nonsurgical.

Non-Surgical treatments- Includes physical therapy to strengthen muscles, analgesic medications, weight maintenance, postural training, staying active, striving to improve posture, daily stretching, etc.

Bracing and Surgical treatments- The use of back braces and surgical intervention are two options.

  • Back braces- A back brace is a holding device that prevents a curve from worsening. There are two types of braces:
    • Full-time bracing entails wearing the braces for at least 16-23 hours every day.
    • Nighttime bracing must be worn for at least eight hours each night. ​
  • Surgery- When the spinal curve is larger than 40 degrees, and there are symptoms of advancement, most doctors advocate spinal fusion surgery.

Risk Factor

The following are some risk factors that can make a person's scoliosis worsen:

  • Excess weight—being overweight can put a strain on your back.
  • Smoking—reduces blood flow to the spine, depriving your back of the nutrients it requires to keep healthy.
  • Large lateral curve—the greater the Cobb angle of the curve, the more probable it is to worsen.
  • Gender- women are more than 7 times as likely as men to develop moderate or severe scoliosis due to their spinal curves.
  • Thoracic spine curvature- the curve in the upper back is more likely to progress than the curve in the lower back.
  • Significant skeletal growth remaining- the potential for the spine's lateral curve(s) to grow and worsen is much greater in an adolescent with less skeletal growth.

Stages

Mild, moderate, and severe are the stages of this disorder.

  • Mild scoliosis is defined as a spinal curve of less than 25 degrees. In the future, there is less of a chance of advancement. But if it rises above 25 degrees, the chances of progression rise.
  • Moderate scoliosis is defined as a spinal curve between 26 to 40 degrees. It has a greater probability of progressing.
  • Severe scoliosis is defined as a curvature of more than 40 degrees. These are severe cases that more often than not my require correction surgery.

Typical Tests

A physical examination, x-ray, spinal radiograph, CT scan, or MRI are commonly used to diagnose scoliosis. MRI scan offers detailed images of the body's organs and structures. X-rays are used to create a picture of your spine. A CT scan may produce a detailed image of any body portion, including bones, muscles, fat, and organs. It has more information than standard X-rays.

Primary Prevention

  • Regular exercise, excellent posture, back muscle strengthening exercises, yoga, and other similar activities will not prevent scoliosis. They may, however, aid in the relief of symptoms in persons who already have scoliosis.
  • However, one type of scoliosis, scoliosis caused by osteoporosis, can be avoided. This can be avoided with adequate nutrition, a healthy diet, and regular exercise.

Secondary Prevention

  • Adhere to the dietician's nutritional advice.
  • After spinal fusion surgery, Modulate physical activities as per specialist’s advice.
  • Avoid strenuous activities of contact sports for at least three months.
  • Carefully follow the surgeon's medication instructions.
  • Make a bathroom layout plan.
  • Maintain a hygienic living environment.

Epidemiology

  • Scoliosis can develop during childhood or infancy. On the other hand, scoliosis usually appears between the ages of 10 to 15 years and affects both men and women equally. Women are eight times more likely than males to reach a curve magnitude requiring treatment.
  • According to studies, the scoliosis rate in a healthy adult population with an average age of over 70 years is 68 per cent.

Expected Prognosis

Most persons with scoliosis may lead regular lives and participate in most activities, including sports and exercise. Adult scoliosis prognosis varies based on the kind of scoliosis (idiopathic or degenerative) and the severity of symptoms. Untreated scoliosis can cause pain and deformity in the spine, which might impede one's ability to work and walk.

Natural Progression

Scoliosis usually does not cause significant pain, risk, or other health issues. Most persons with this illness have normal lives, are physically active, and participate in sports. Braces work effectively for people with moderate scoliosis, and painkillers and regular exercise can be used as the first line of treatment. The doctor may propose surgical treatment depending on the degree of spine curvature/ Spinal balance/ propensity to worsen.

Pathophysiology

Scoliosis is a condition in which the vertebrae bend instead of straightening out. They can also rotate (twist) and produce a corkscrew-like side-to-side curvature. Small curves, or those with a lesser than 25 degrees diagnosis, rarely cause difficulties. Curves of 50 degrees and above are deemed severe.

Possible Complications

Breathing problems, back problems, prolonged back pain, cosmetic concern are a few to enumerate. Lower self-esteem is also one of the complications. The person may become self-conscious about their appearance due to unequal hips and shoulders, noticeable ribs, and a shift in the waist and trunk.

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