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SCOLIOSISDefinition
A condition wherein the spine twists and develops an exaggerated "S" or “C” shapedlateral curvature of the backbone. It is also known as a lateral or sideways curvature of the spine, which is apparent when viewing from behind.
AKA
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It is also known as Spinal Curvature
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"Skoliosis" is used by Hippocrates to denote any curvature of the spinePaulAegina tried bandaging as a form of bracing in the 7
th
century.
INCIDENCE
According to one of the Studies in the United States, Females tend to develop scoliosisthan males its ratio is 1:6 (male: female)The overall incidence of scoliosis or curvature of the spine in the general population for kids in the United States greater than 14 years of age is about 1.5 percent. This figurerefers to curves that measure greater than 10 degrees. Severe curves of greater than30 degrees occur in about 0.2 percent of the general population. A closer look at thepopulation at risk indicates that the greatest risk of developing scoliosis occurs inadolescent females, who are five times more likely to have a curve that needs treatmentthan their male counterparts.A new study revealed a scoliosis rate of nearly 9% in adults 40 years of age or older and links race and increasing age with the prevalence of the condition.Investigators also found that blacks had nearly half the prevalence of scoliosis thanwhites. However, they found that gender was not a factor in the prevalence of thecondition.
RISK/PREDISPOSING FACTORS
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Genetic Inheritance
- People with scoliosis are more likely to have children withscoliosis like them; however, there is no correlation between the severities of thecurve from one generation to the next.
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Sex-
Curves in girls are more likely to worsen than are curves in boys.
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Age-
It can be seen at any age, but it is most common in those over 10 yearsold. The younger the child when scoliosis appears, the greater the chance thecurve will worsen.
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Size of the curve-
The greater the curve size, the higher the likelihood that it willworsen.
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Location-
Curves in the middle to lower spine are less likely to progress than arethose in the upper spine.
 
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Spinal problems at birth-
Children who are born with scoliosis (congenitalscoliosis) have a greater risk of worsening of the curve. Congenital scoliosis isthought of as a birth defect affecting the size and shape of the bones of thespine.
MANIFESTATIONS
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Lordosis, axial rotation, and lateral curvature
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Asymmetry of hips and shoulders, scapulae, flanks, and breasts
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Shortened trunk and unequal leg lengths
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Skin and soft-tissue changes
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Patches of hair in sacral area
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Malalignment of trunk and pelvis
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Clothes do not hang right
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A rib “hump”
CLASSIFICATION
There are three main types of scoliosis:
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Congenital scoliosis-
A result of a bone abnormality such as problem with theabnormal formation of vertebrae during prenatal period.
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Open types
are caused by myelomeningocele which can be severe.
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Closed types
can be classified according to etiology
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Neuromuscular scoliosis-
A result of abnormal muscles or nerves, frequentlyseen in people with spina bifida, muscular dystrophy, cerebral palsy and polio or in those with various conditions that are accompanied by, or result in, paralysis.
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Idiopathic scoliosis-
The most common type of scoliosis, idiopathic scoliosis,has no specific identifiable cause. There are many theories, but none have beenfound to be conclusive. There is, however, strong evidence that idiopathicscoliosis is inherited.
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Infantile
: Occurs between birth and 3 years of age. Usually noticed in thefirst year of life. More common in boys particularly from England. Leftthoracic curve occurs more common, and often resolves spontaneously.Few patients will have progressive curves which can be quite severerequiring early bracing and even surgery.
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Juvenile
: Occurs between 4-10 years of age. Incidence is equal for boysand girls. Most curves are right thoracic. Curves are progressive in natureand need close follow up.
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 Adolescent 
: Usually diagnosed at the age of 10. Most curves are rightthoracic and thoracolumbar. Curves have a strong tendency to progressduring adolescent growth spurt. Extremely active, athletic teenage girlswith delayed menses are most of risk for curve progression.
 
There are several types of scoliosis in adults:
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Degenerative scoliosis-
This may result from traumatic (from an injury or illness) bone collapse, previous major back surgery or osteoporosis (thining of the bones). Unlike the other forms of scoliosis that are found in children andteens, degenerative scoliosis occurs in older adults. . It is caused by changesin the spine due toarthritis. Weakening of the normal ligaments and other softtissues of the spine combined with abnormalbone spurscan lead to anabnormal curvature of the spine
.
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Paralytic Curve
- "Paralytic" means that muscles do not work. When musclesdo not work around the spine, the spine itself may be thrown out of balance.Over several years, this can result in a curvature of the spine developing. Thistype of scoliosis is often caused by spinal cord injuries that lead to paralysis.
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Myopathic Deformity
- "Myopathic" means muscle that does not workproperly. Like paralytic curves described above, this curve results from amuscular or neuromuscular disease, such as muscular dystrophy, cerebralpalsy, or polio.
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b – Scoliosis-
developed in adulthood can be a "secondary" cause of another spinal condition that affects the vertebrae, such as degeneration,osteoporosis (loss of bone mass), or osteomalacia (softening of the bones).Scoliosis can also appear following spinal surgery. The surgery may cause animbalance in the spine that leads to scoliosis.
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Functional-
: In this type of scoliosis, the spine is normal, but an abnormalcurve develops because of a problem somewhere else in the body. This couldbe caused by one leg being shorter than the other or by muscle spasms in theback.
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Neurofibromatosis-
First described by Kolliker in 1860, but vonRecklinghausen coined the term in 1882. Associated with peripheral nerves,causing cutaneous and subQmanifestations. High incidence of kyphosis andscoliosis. Etiologyis unknown but may be due to neurofibromas enlargementin the foramina between vertebral bodies. Spinal deformities must be treatedaggressively with anterior and posterior fusion.
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Others-
There are other potential causes of scoliosis, including spine tumorssuch as osteoid osteoma. This is a benign tumor that can occur in the spineand cause pain. The pain causes people to lean to the opposite side toreduce he amount of pressure applied to the tumor. This can lead to a spinaldeformity.
PATHOPHYSIOLOGY
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The vertebra turn toward the convex side and spinous processes rotatetoward the concave side in the area of the major curve.
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As the vertebra rotate, they push the ribs on the convex side posteriorly andat the same time, crowd the ribs on the concave side together as well as pushthem anteriorly. The posterior displaced ribs cause the characteristic hump inthe back with forward flexion. Young girls with scoliosis would often complain
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