What is scoliosis?
Scoliosis is an abnormality that occurs on the spine, causing it to become curved sideways and rotated.
The abnormality is shown on an x-ray that measures at least 10 degrees of abnormal sideways curvature. Scoliosis is not a disease, and only in special cases it can be caused by a disease. Scoliosis develops from an unknown cause during adolescence or from spinal degeneration during adulthood.
Scoliosis could also be developed because of the loss of control of the muscles or nerves that support the spine. This is known as neuromuscular scoliosis and is usually caused by muscular dystrophy or cerebral palsy.
Two general categories for scoliosis
Non-structural scoliosis
It is known as functional scoliosis, which results from a temporary cause and involves a side-to-side curvature of the spine without any spinal rotation. Hence, the spine’s structure remains normal.
Structural scoliosis
However, structural scoliosis involves the spine becoming rotated in addition to the side-to-side curvature of it. This affects the spine and is a permanent restructuring to it. This is usually more serious because the spine does not straighten out on its own and can result in spinal deformity over time and space.
Signs and symptoms of scoliosis
- Sideways curvature observed – This can be seen while changing or being in swimming wear where an adolescent or parent could observe the curvature
- Clothes may fit awkwardly and unevenly
- Affects walking gait – when the spine twists and bends abnormally, it can result in the hips being out of alignment. The extra compensation from having to maintain balance for the uneven hips and legs can affect the muscles becoming tired quicker. The person might also observe that one hand does brushed against the hip while walking and the other doesn’t.
- Difficulty in breathing – If the spine over rotates, the rib cage can be tightened due to the twisting movement, affecting the thoracic expansion space for the lungs. Hence, this might push against the lungs and causing breathing difficulty.
- Pain – when the curvature of the spine worsens, the back muscles could be more prone to pain. This is due to local inflammation developing around the strained muscles, as well as the possibility of the intervertebral discs and facet joints degenerating because of higher load.
Diagnosis of scoliosis
Scoliosis is usually identified during a regular screening or routine check-up at school, where the nurse or doctor notice or observed the possible sideways curvature of the spine.
A X-ray confirmation is required to diagnose scoliosis for the spinal rotation and abnormal curvature. This is done by measuring the Cobb angle by drawing a perpendicular line from the spine’s most tilted vertebrae beneath the apex.
A healthcare professional could also use the Adam’s forward bend test to assess by looking for any abnormal spine rotation. The patient will bend forward at the wait 90 degrees with arms stretched downwards and knees straight.
The positive signs are:
- If one shoulder or shoulder blade is raised higher than the other
- The rib cage or hip of one side appears higher than the other
- Waist appears uneven when comparing both sides
- Body is tilted to one side
- The other leg may appear shorter than the other
Though the Adam’s forward bend test can be helpful in detecting scoliosis on the upper mid back, it is not effective at detecting scoliosis in the lower back as the rib rotation cannot be detected.
A scoliometer can also be used to estimate the angle of trunk rotation. This is usually used in school routine check-ups by the nurses. When the patient is bending forward, the nurse can place the scoliometer flat on the back of the patient where the asymmetry is.
If there’s an angle of trunk rotation for more than 5 degrees, the patient will be referred for X-ray imaging to further measure the degree of the curve and confirm scoliosis.
Treatment of scoliosis
Non-surgical management
Observe
To observe the progress of the scoliosis with regular check-ups and follow-up of X-rays. Curves that are less than 25 degrees can be observed at a 4 to 6 months period.
Bracing
However, if an adolescent or patient has a curve which is greater than 25 degrees, bracing is recommended to stop the progression of the spinal curve.
The bracing options available are to use a thoraco-sacral orthosis which are designed to be worn. For curves that are less than 35 degrees, the recommendations are for either night time or during the day. For curves that are greater than 35 degrees, full-time bracing is recommended.
Surgical management for scoliosis
If bracing does not work for the patient, and the curves are greater than 40 degrees, then surgery may be considered for it.
The objectives of scoliosis surgery are to stop the curve’s progression, reduce the deformity in the spine due to the twisting, as well as to maintain trunk balance by maintaining as much of the spine’s natural front and back curvature.
Spinal Fusion
The spinal fusion surgery is to fuse two or more adjacent vertebrae permanently so that grow together at the spinal joint, forming a solid bone that no longer moves.
Modern surgical approaches and instrumentation by using rods, screws, hooks and wires have enabled the spinal fusion surgeries to achieve better outcomes and curvature correction, with faster recovery times.
This can be done through minimal invasive techniques such as thoracoscopic keyhole that requires only 4 to 5 small openings on the side of the chest. Most scoliosis patients who have undergone this, can lead normal and independent lives, participating in most forms of sports, except in the first few months after surgery during recovery, they need to be careful with physical activities.
