Scoliosis is not a disease, rather it is a term used to describe any abnormal curvature, to the sides of the spine.
Seen from the back, a typical spine is straight. When scoliosis occurs, the curve of the spine can vary in one of three ways:
- Spine aside as a single curve to the left (shaped letter C), called levoscoliosis.
- The spine to the side as a single curve to the right (shaped like an inverted letter C), called dextroescoliosis.
- The spine has two curves (in the shape of the letter S).
Index
Idiopathic scoliosis
This article focuses on the most common way, idiopathic scoliosis, what happens in about the 2% of the population. The term idiopathic means a condition or disease that has no known cause..
Idiopathic scoliosis is by far the most common cause of scoliosis in children.. (Degenerative scoliosis is the most common form of scoliosis in adults.)
Idiopathic scoliosis rarely causes pain, and in most cases the curve is small enough to be considered an asymmetry and does not require any treatment. Nevertheless, once scoliosis is detected it should be closely monitored by a medical professional in case the curve progresses and treatment is needed.
Because the skeletons of children and young adults grow rapidly, there is a reasonable chance that if a spinal curve is detected, the grade may get worse as the spine continues to grow.
In those cases, scoliosis treatment may be advisable. Rarely (at 0,2 al 0,5 % of all cases), untreated scoliosis can progress to block the space in the rib cage necessary for the heart and optimal lung function.
It is important to note that idiopathic scoliosis is not caused by any activity such as exercise., the sport, or carry heavy objects; nor does it come from the position, sleeping posture, or slight differences in leg length.
Detection, Diagnosis and Monitoring
Scoliosis most typically occurs in individuals of 10 a 18 years of age and is often detected by school exams or regular doctor visits. A medical professional will seek:
- The curvature of the spine
- Uneven shoulders, the protrusion of a scapula
- The asymmetry of the waist
- One hip higher than the other.
Once scoliosis is detected, the doctor will continue to monitor the curvature. The progression of the curvature of the spine is very well studied and is measured in degrees.
In a slight curvature that is kept in 20 degrees or less most likely requires follow-up and observation, but more treatment is seldom needed.
In a curvature greater than 20 degrees may require intervention non-surgical or surgical, including treatments such as an orthopedic brace for scoliosis or scoliosis surgery which will prevent progression of the curve.
Prevention of severe curvature is important for the physical appearance and health of the patient. Curves greater than 50 grades are more likely to progress into adult life. If a curve is allowed to progress from 70 a 90 degrees, a disfiguring deformity will occur.
A high degree of curvature you can also put the patient in risk of cardiopulmonary compromise since the curvature of the spine rotates the chest and closes the space available for the lungs and the heart.
Scoliosis rarely causes back pain
It is important to note that the results of idiopathic scoliosis are deformity of the spine, but it is not usually one of the causes of back pain.
Of course, people with scoliosis can develop back pain, like most of the adult population can develop back pain.
Nevertheless, people with idiopathic scoliosis have never been found to be more likely to develop back pain than the rest of the population.
Other types of scoliosis
While adolescent scoliosis is the most common, there are other common types of scoliosis which include:
- Congenital scoliosis, that is present in infants.
- Neuromuscular scoliosis, which is the result of neuromuscular conditions.
- Degenerative scoliosis, that occurs later in life.
Scoliosis symptoms
In children and adolescents, scoliosis often has no noticeable symptoms. The curvature of the spine does not cause pain, and if it is mild, can go unnoticed.
While a healthy spine, when viewed from the side, has natural curvature, and when viewed from the back of the spine it appears as a straight line.
A person with scoliosis, Nevertheless, appears to have a side curve (from side to side) on your spine when viewed from the back.
Signs of scoliosis
Without an X-ray examination of the spine, there are several common physical signs that can indicate scoliosis.
One of the most common tests to detect scoliosis is called: “Adam's test or essay”, where the patient is asked to stand, bending forward with arms outstretched as if touching toes.
The medical professional will observe below, looking for one or more of the following signs of scoliosis:
- One shoulder is higher than the other
- One scapula sticks out more than the other
- One side of the rib cage appears higher than the other
- One hip appears higher or more prominent than the other
- The waist is irregular
- The body leans to one side
- One leg may look shorter than the other
- Any type of back pain is not generally considered a symptom of scoliosis..
If there is pain, more research is needed
Pain is not a typical symptom of scoliosis. Back pain in a child or adolescent who has scoliosis may indicate another problem and the child should be evaluated by a pediatrician and / or spinal specialist..
If a child or adolescent has back pain and also has scoliosis, it is very important that he or she see a doctor to find out what is causing the pain, as there is likely something other than scoliosis causing the back pain and may require treatment.
Girls are most at risk
The risk of curvature progression increases during puberty, when the body's growth rate is the fastest.
Scoliosis with a significant curvature of the spine is much more common in girls than in boys, and girls are eight times more likely to need scoliosis treatment, as they tend to have curves that have a higher probability of progression.
Even so, most cases of scoliosis are mild and do not require treatment.
Neurological pain and numbness
Leg pain and / or numbness signals a neurological injury, it is also a very rare symptom of scoliosis.
In this case, spinal curvature is caused by a spinal injury or tumor. Signs that scoliosis is caused by a spinal injury are:
- The patient is a little younger, (8-11) than a typical scoliosis patient.
- The patient is experiencing pain and numbness indicating neural compression.
- The thoracic or thoracolumbar curve that leans to the left (levoescoliosis)
A patient with any or a combination of these symptoms should receive diagnostic tests., like MRI, to find out if a neurological injury is present; if so, immediate treatment is generally recommended.
Scoliosis treatment
Decisions about scoliosis treatment are based primarily on two factors:
- The skeletal maturity of the patient (O, rather, How much more growth can you expect)
- The degree of curvature of the spine.
Although the cause of idiopathic scoliosis is unknown, the way scoliosis curves behave is well understood. In essence:
A lesser degree curvature in a patient near skeletal maturity, treatment is unlikely.
Conversely, a younger patient with a larger curve is likely to have a curve that will continue to advance and treatment will be necessary.
There are three main options for treating adolescent scoliosis:
- Observation
- Back supports
- Scoliosis surgery
There are no exercises for scoliosis that have been shown to reduce or prevent curvature..
Nevertheless, exercise is highly recommended for both scoliosis and non-scoliosis patients, to maintain the back muscles, strong and flexible.
Below we will discuss the non-surgical options for the treatment of scoliosis.
Observation
Once scoliosis is detected, observation by a doctor is the next step. The doctor will measure the curve in degrees over certain time frames on an agenda and make decisions about treatment, based on the progression of curvature.
Measurement and monitoring of scoliosis curves
El cirujano ortopédico puede ordenar una radiografía de la columna vertebral y utilizar el “método de Cobb” – una técnica de medición extremadamente precisa – para calcular la curvatura de la columna vertebral y su progresión.
The curves that are less than 10 degrees are not considered to diagnose scoliosis, but they are considered asymmetry of the spine. These types of curves have extremely unlikely progress and generally no treatment is necessary., but the doctor should continue to monitor the curve during regular check-ups.
The curves beyond 20 a 30 degrees in a growing child should be observed at intervals of 4 a 6 months by an orthopedic surgeon experienced in scoliosis.
In a patient who continues to grow, Treatment will be needed if the following factors are present:
- The curve of the spine progresses more than 5 degrees during a typical observation period.
- The curve of the spine has already reached 30 degrees or more.
- If the curve progresses less than 5 degrees during a given period of observation, the doctor may determine that the curve is not getting worse quickly enough to cause deformity, and treatment may not be necessary.
Back supports for scoliosis
Treatment of scoliosis in patients with progressing curves, or curves of more than 25 degrees in a patient with an immature skeleton (for instance, girls with around 11 a 13 year old, and children around 12 a 14 years) usually focus on wearing a back support.
Braces are not normally used in adolescents who already have a mature or near-mature skeleton. If an older child has a curve greater than 30 degrees and its skeleton is almost mature, its curvature is treated only with observation, as there is very little growth left and wearing a brace is unlikely to do well.
These devices do not straighten the curve that is already present. Instead, the purpose of a back support is to stop the progression of the curvature of the spine as the child continues to grow.
The child should continue to use the appliance until it reaches skeletal maturity. Once the patient stops growing, there is little probability of progression of a curve.
The curves that are greater than 50 degrees can continue to progress after skeletal maturity, so the goal of back support treatment is to try to keep the child with a curve of less than 50 grades to adulthood.
Assembling and using a back support
Working under the direction of an orthopedic surgeon, an orthopedist will mold a brace for the patient. The supports are generally molded plastic and fit snugly around the body and are worn under clothing every day. Some are worn overnight and some are worn 23 hours a day.
Although today scoliosis devices are more comfortable than ever, they still have a low acceptance rate for various reasons: children and teenagers feel different from their peers when they have to use them, and in some cases they actually cause discomfort and perhaps shortness of breath.
The use of back supports in children is key to their effectiveness. Studies clearly show that the more closely patients adhere to their prescribed use regimen, the scoliosis curve has less progression.
There are two types of scoliosis braces commonly used:
The TLSO (Thoraco-lumbo-sacral support corset for scoliosis), which includes a popular model called Boston Brace, is a back-molded brace that applies three-point pressure to the curvature to prevent progression. Can be worn under loose clothing, and it is usually used 23 hours a day.
This type of scoliosis brace can be removed for swimming or sports.
The Charleston Corset apply more pressure against the curve, It is used in children. This type of scoliosis brace is worn only at night, while the child sleeps.
Unfortunately, even with the right gadgets, some curves of the scoliosis spine will follow your progress.
For these cases, especially if the child is very young, the use of supports must still continue to allow the child to grow before the fusion of the spine.
