Scoliosis

Lordosis, Kyphosis, Curvature of the Spine

What is Scoliosis?

The spine normally has curves. When viewed from the side (mid-sagittal), the anterior convexity of the cervical and lumbar spines is called lordosis. If this is increased beyond normal, it is called increased lordosis. Similarly, the thoracic spine normally has the opposite curvature (convex posteriorly when viewed from the side) or kyphosis.

Scoliosis is a lateral deviation in the normally straight vertical line of the spine when viewed from the front. It may or may not include rotation or deformity of the vertebrae. Abnormal curvatures may be congenital or acquired. Most cases are acquired. Scoliosis may be fixed or compensated. A fixed scoliosis is the result of change in the structure of the vertebrae. The associated rotation is in the direction of the convexity of the curve. Fixed scoliosis may be C-shaped or S-shaped. It cannot be eliminated by movement. Fixed scoliosis is further classified as to the cause (congenital, neuromuscular and idiopathic) and deformity present.

Neuromuscular and idiopathic are acquired forms of the disorder. Idiopathic scoliosis is the most common. There is no known cause. It may occur at any age. It is further divided according to age (infantile, juvenile, adolescent, or adult) of onset. It tends to run in families. Neuromuscular scoliosis results from muscular weakness, muscular imbalance or neurologic dysfunction and paralysis. Progression of the disease results in a more pronounced, rigid curve. Scoliosis occurs in both sexes. Females are affected more than males are.

Approximately one percent of the general population have some amount of scoliosis. It can occur at any age, but is most often noted during adolescence. Scoliosis may be associated with other abnormal curvatures such as kyphoscoliosis or lordoscoliosis.

A compensated scoliosis has a flexible segment above or below the major curve and tends to maintain normal body alignment. In many instances, it can be corrected by exercise. Large curvatures are associated with cardiopulmonary impairment and secondary restrictive lung disease.

Scheuermann's kyphosis is an abnormal curvature in the thoracic spine. Abnormal curvatures may be associated with other diseases. Neurofibromatosis, Marfan's syndrome and Ehlers - Danlos syndrome are associated with scoliosis. The abnormal curvatures tend to progress. The progression of the curve is related to the age of the individual, gender, the underlying cause and the degree of the curvature. The greatest progression tends to occur during the accelerated growth spurt of puberty.

How is it diagnosed?

Scoliosis signs and symptoms

Early stages:

  • No obvious symptoms or signs, but scoliosis can be detected by a doctor or school nurse with a simple screening test.

Later stages:

  • Visible curving of the upper body. The spinebecomes S-shaped or rotated.
  • Shoulders become uneven and rounded.
  • Sunken chest.
  • Swayback.
  • One side of the pelvis thrusts forward.
  • Back pain.

History: Individuals with scoliosis may report asymmetry of the hips and/or shoulders and an abnormal waistline tilt with pronounced indentation on one side. Signs of kyphosis include a rounded back, while individuals with lordosis will display a sway back. Information to be collected during history should include the age when the deformity was first noted, the manner in which it was noted, who noted it, the perinatal history, developmental milestones, and if other family members have scoliosis or other diseases that affect the musculoskeletal system.

Physical exam: An individual with scoliosis may have asymmetry of the hips, shoulders or pelvis. Any axillary freckles, caf' au lait spots, hairy patches or dimples over the spine, or skin tags should be noted. The flexibility of the curve, the person's gait, ability to walk on toes and heels, reflexes and presence of asymmetry or pathologic reflexes should be noted. Any signs of cardiopulmonary impairment such as clubbing of the fingers should be noted.

Tests: Use of the Plumb test to evaluate decompensation, evaluation of rib hump, x-rays of the spine, with individual standing and bending, should be done. MRI or myelogram with CT scan may be used in individuals with neurological abnormalities, atypical curve patterns or rapidly progressive curvatures. Pulmonary function tests are used for individuals with curvature greater than 60 degrees or with signs and symptoms consistent with respiratory problems. Preoperative CT scan and MRI is usually performed. X-rays of the spine with measurement of the Cobb angle is used for kyphosis.

How is Scoliosis treated?

Treatment will depend upon the extent and severity of the curvature, the age of the individual, and the underlying cause of the curvature. Several methods are available. Mild curvatures (those less than ten degrees) are treated conservatively. Treatment may consist of observation only or it may include passive and active exercises. Very young individuals with neuromuscular scoliosis, however, are not usually treated conservatively.

More severe forms of scoliosis require either immobilization or surgery. Bracing may be used for adolescents. Individuals usually will be reexamined four to six months after bracing. Idiopathic scoliosis with pain and progression in an adult is an indication for surgery. Adults are not normally put into a back brace, as they do not have any growth remaining and, therefore, their curves do not progress or "grow crooked. " They may also be treated with nonsteroidal anti-inflammatory drugs and exercise if pain is not present.

Various surgical techniques may be used to realign the spine. The type of surgery is dependent on the type, severity, and extent of the curvature, the age of the individual, and whether previous attempts at corrections have been made. Most curves greater than forty degrees is usually corrected with surgery. Individuals with kyphosis are treated with bracing. Surgery may be done in individuals with increasing curvatures, and significant symptoms.

Medications

Soma (Carisoprodol)

What might complicate it?

Complications include progressive curvature, postural and neuromuscular problems, and heart and lung problems.

Predicted outcome

Most cases of scoliosis or kyphosis can be corrected with proper treatment.

Alternatives

No other conditions are indicated.

Appropriate specialists

Orthopedic surgeon, radiologist, physical therapist, cardiologist, and pulmonologist.

Last updated 6 August 2011


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