Scoliosis and generally spine deformities are known to man ever since standing upright became one of his particular characteristics. It is Hippocrates who introduced the terms ‘kyphosis’ and ‘scoliosis’ to describe the pathological curvatures of the spine
More specifically, the words “scoliosis” and “skoliaenesthae”, from skolios, in other words tortuous, were used to render the concept of ‘distortion’ of the vertebrae.
What is Scoliosis?
Scoliosis is a three-dimensional deformity of the spine
We call scoliosis every sideways curvature of the spine exceeding 10° Cobb, while changes occur both on a transversal and sagittal level.
There is no normal sideways curvature of the spine.
Its most current appearance occurs during adolescence, (80% of cases are found in teenagers, 1 in 33 in children), but it can also occur earlier, even in toddlers.
In adulthood, the severe degeneration of the spine may lead to adult scoliosis.
Forms of scoliosis
Idiopathic scoliosis in adolescents, (above 10yrs), is the most frequent of all, representing 80% of the cases. Diagnosis is often effected during a school screening, (it may be roughly detected by parents) by examining the anterior curvature of the trunk and with the child bent forward with his hands on the floor (in which case the deformity of the spine appears clearly, looking from the back), the asymmetry of the pelvis or the shoulders and uneven limb length (different length of the lower limbs) – Adam’s Test.
The main types of idiopathic scoliosis in adolescents according to the area of the body where it is located, are:
- Thoracic lumbar and
- Double scoliosis (usually right thoracic and left lumbar)
Idiopathic scoliosis in adolescents may follow a person into adulthood. It is slowly and steadily aggravated. Research shows an increase in the scoliosis angle of 0.5-1 degree annually.
(Degenerative) Scoliosis in adults may appear also as a new condition due to degenerative lesions of the spine, either caused by osteoporosis or even post-operatory.
Prognosis and the eventual aggravation of scoliosis depend on gender, hormonal factors, the degree of “skeletal maturity”, namely how much time remains for the child’s skeleton to grow as well as other factors. Generally speaking, scoliosis appearing in children with a greater margin of growth and scoliosis with big angles, will have a much higher probability to worsen and demand some kind of treatment.
In small curvatures (inferior to 20 degrees) or even larger ones where, however, growth has been completed, it is necessary, in order to make sure that there will be no aggravation, to do regular follow-up controls of the spine
Scoliosis can appear at any age (infants, toddlers, children, and adolescents). Even in adulthood, we encounter cases of idiopathic scoliosis (because of a neglected scoliosis during adolescence)
11% of idiopathic scoliosis cases have some family history of scoliosis. The incidence of scoliosis is 3%.
Apart from the deformity of the spine, scoliosis usually has no other symptoms, as a result, there is often a delay in its diagnosis. Medically, it can be verified with a clinical examination and then confirmed by X-rays. In addition, there are state-of-the-art diagnostic methods that can complement the clinical examination, without subjecting the person to radiation for no reason and, in consideration of the clinical assessment, lead to X-rays in cases that really need it.
Functional or non worsening
It is considered the scoliosis, where the spine structure remains normal, no rotation is observed and usually does not worsen. It has full recovery when the cause that causes it disappears and as long as no permanent changes have been created.
Such types of scoliosis are:
Antalgic scoliosis, (caused by an intervertebral disc herniation), where, in order to avoid pain and numbness, a person voluntarily shifts the spine to the side while standing up. When bending, no hump results.
Compensatory scoliosis, which is usually present in persons who have uneven limb length.
Hysterical scoliosis,which is a very rare condition.
Organic, primary or worsening scoliosis
It is characterised by a steady curvature created by the rotational deformity of the vertebrae, pursuant to a disorder in the vertebral structure and is worsening. It is encountered in adults but mainly in children.
According to the cause, it is distinguished in:
Congenital, (where children are born with vertebral deformities)
It presents abnormalities in the vertebrae formation, usually during the pregnancy, between the 4th ad 6th week. Incomplete vertebrae, separated ones, with the form of a wedge, over numbered or even missing vertebrae are located.
The number of vertebrae presenting abnormalities, as well as the dynamic of growth thereof, will determine the severity of the condition.
Severe abnormalities are usually detected at birth, or at a very early age of the infant. In other cases, of a less severe form, these are detected by x-rays at a very early age. It is mainly due to genetic or chromosomal abnormalities.
Neuromuscular, (due to neuromuscular diseases)
Neurological disorder, causing scoliosis. Diseases such as Parkinson, Multiple Sclerosis, myopathies et.al., besides the practical difficulties i.e. walking difficulty, can also cause deformities of the spine, as a parallel symptom of the neurological or muscular system disease.
A severe deformity of the spine is possible as well as the worsening of the condition, even after reaching adulthood. In many cases, there is also an onset of pain.
The mechanism causing scoliosis in this disease has not been determined. In approximately 1/3 of the cases, scoliosis develops, which is usually thoracic.
Also known as adult scoliosis, it appears usually in individuals over 55-60 years old.
It can be a congenital, neuromuscular or idiopathic scoliosis worsening because of the lesions and distress of the discs, or because of the degeneration of the articulations, stenosis of the intervertebral discs, osteoarthritic lesions resulting from the changes in tissues caused by age, or even neuromuscular problems in adulthood.
Pain is often experienced in some patients, but not in all, and is similar to the pain of osteoarthritis, which is caused by the same joints’ alteration process. There may be stiffness and pain in the middle as well as the lower back and/or pain, numbness and weakness of the tibias and feet.
Unlike adolescent idiopathic scoliosis, degenerative scoliosis has a known cause: the joints’ alteration due to ageing. Therefore, the treatment does not focus on slowing the curvature but on relieving pain.
All of the aforesaid forms and types of scoliosis are of known causes and constitute only 10-15% of scoliosis.
How is Scoliosis treated?
The treatment of scoliosis depends on many factors, (type, rate of deterioration, etc.), but mainly on the degree of deformation of the spine, which is measured in degrees (Cobb angle).
When the scoliosis is mild, it usually does not cause pain, nor does it restrict movements and it may be addressed conservatively, with Physiotherapeutic Scoliosis Specific Exercises- PSSE.
Moderate scoliosis is treated with the application of an orthopaedic brace, or even Physiotherapeutic Scoliosis Specific Exercises- PSSE, in order to stop the deterioration, but also to correct the problem, in cases where this is possible
At this stage, the cooperation of the doctor with the specialist professional orthotist, (the one who manufactures aids such as braces), in special centers where braces are manufactured, is necessary, there is relevant knowledge and experience, to find the best type of brace that is suitable for each case since this depends on several factors (the spinal point where the curvature is located, number of curvatures, flexible curvature, position and rotation of vertebrae, other possible medical problems, family history of scoliosis, etc.) as well as with the specialist physical therapist, certified for the Physiotherapeutic Scoliosis Specific Exercises- PSSE.
The brace is effective as long as it is used as required. It is important that the child is followed up by the specialists until the treatment is completed, to avoid complications, such as a recurrence of scoliosis.
Conversely, when the degree of scoliosis is large, it may affect both respiratory and cardiac function. In these cases, it is treated surgically.