Scoliosis
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Scoliosis is a disease which involves a lateral curvature of the spine; that is, the spine is bent sideways. Scoliosis is incurable, but its natural course can be affected with treatments such as surgery or back braces.
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Prevalence
Scoliosis curves greater than 10° affect 2-3% of the population, often children between the ages of seven and ten, with a greater incidence among girls. Curves greater that 20° affect about 1 in 2500 people. Different etiologic theories point to genetic, neuromuscular, hormonal and growth factors, though it appears that the cause is multifactorial. The vast majority of cases (85%) have unknown causes or are idiopathic.
In one out of every 1000 cases, surgery may be necessary. Females are 9 times more likely to require treatment than males, mostly since they are also more likely to have larger, progressive curves.
Symptoms
Those with scoliosis rarely complain of pain, and their condition is often discovered incidentally. During a visit, a physician should be careful to take a family history and good medical history, and perform a proper physical examination.
The symptoms of scoliosis are:
- Prominent shoulder blade
- Uneven hip and shoulder levels.
- Unequal distance between arms and body
- Clothes that do not "hang right"
- Muscle mass that causes a "hump" on one side of the spine
- A rib "hump"
Shoulders that have a lack of spine reinforcement can hurt if large amounts of weight are placed upon them.
Associated conditions
Scoliosis is often associated with other conditions such as neuromuscular disorders (e.g., cerebral palsy, spinal muscular atrophy, Freiderichs ataxia); skeletal dysplasias; neurofibromatosis; connective tissue disorders; and craniospinal axis disorders (e.g., syringomyelia).
Investigation
Those suspected of having scoliosis should undergo a thorough physical examination. During a physical examination, the following should be assessed:
- Skin for café au lait spots indicative of neurofibromatosis
- The feet for cavovarus deformity
- The height of the iliac crests while standing
- Magnitude of the curve and rib hump both while standing and while leaning forward
- Asymmetrical shoulder levels
- Asymmetrical superficial abdominal reflexes
- Inequality of lengths of the upper limbs from the floor when leaning forward
During the exam, the patient's gait should be assessed, and there should be a search for signs of spinal abnormalities (e.g., dysraphism as evidenced by a dimple, hairy patch, lipoma, or hemangioma). There should also be a thorough neurological examination. Ultimately, however, the main goal should be the assessment of curve severity and flexibility.
Radiograghic investigation such as X ray or computed tomography (CT) should also be carried out to assess the location, levels of involvement, direction and magnitude of the curves. One method for assessing the curvature is the calculation of the Cobb angle, which assesses the curve from the top endplate of the topmost involved vertebra to the bottom endplate of the bottommost involved vertebra.
A note here is that most patients will be unaware that they are afflicted with scoliosis even when curves exceed 30°.
Management
Spinal curvature is best dealt with when a young person's body is still growing and can respond to treatments. Sometimes a body brace is used in such circumstances. Mild cases may not need treatment, but must be monitored.
A now defunct surgery to install a Harrington implant was performed for a short time. This process consisted of screwing the 1.5-foot-long implant to two points on the spine: the base and the area between the shoulders. Bone was also sometimes fused in between the vertebrae to further restrict bending of the spine. Since the Harrington Implant was often present in a patient's body for his or her entire lifetime, the spine was slowly forced to be straight. This surgery has been performed on only a few hundred people, due to the high risk of paralysis.
Spinal fusion is now the most widely performed surgery for scoliosis. In this procedure, bone from elsewhere in the body is fused in between the vertebrae to restrict spinal movement.
Prognosis
The prognosis of scoliosis depends on the progression of the condition. Since the best outcome is the disruption or arrest of the natural history of the scoliosis, prognosis is contingent on the likelihood of progression – a factor assessed with the assignment of a Risser stage and grade. 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.
External links
- What is Scoliosis? (http://members.optusnet.com.au/physio/scoliosis.html)
- Scoliosis in Children (http://www.spineuniverse.com/displayarticle.php/article1424.html)
- Scoliosis in Adults (http://www.spineuniverse.com/displayarticle.php/article1436.html)
- Scoliosis: Can Diet and Exercise Help? (http://www.ctds.info/scoliosis.html)
- Scoliosis World (http://www.scoliosis-world.com/)
- eMedicine Health: Scoliosis (http://www.emedicinehealth.com/articles/5648-1.asp)
- National Scoliosis Foundation (http://www.scoliosis.org)de:Skoliose