Scoliosis - Wikipedia, the free encyclopedia Page 1 of 7

Scoliosis
From Wikipedia, the free encyclopedia
(Redirected from Dextroscoliosis)

Scoliosis (from Greek: skolíōsis meaning Scoliosis

"crooked")[1] is a medical condition in which a Classification and external resources
person's spine is curved from side to side, shaped
like an "s", and may also be rotated. To adults it
can be very painful. It is an abnormal lateral
curvature of the spine. On an x-ray, viewed from
the rear, the spine of an individual with a typical
scoliosis may look more like an "S" or a "C" than
a straight line. It is typically classified as
congenital (caused by vertebral anomalies present
at birth), idiopathic (sub-classified as infantile,
juvenile, adolescent, or adult according to when
onset occurred) or as neuromuscular, having
developed as a secondary symptom of another
condition, such as spina bifida, cerebral palsy,
spinal muscular atrophy or due to physical
trauma.

Contents
A coronal X-ray of a person with thoracic

1 Terminology dextroscoliosis and lumbar levoscoliosis. The X-ray

2 Cause is projected such that the right side of the subject is

3 Prevalence on the right side of the image, i.e. the subject is

4 Symptoms
viewed from the rear. This projection is typically

5 Associated conditions

6 Investigation used by surgeons as it is how surgeons see their

7 Prognosis patients when they are on the operating table.

8 Management

9 Surgery

9.1 Spinal fusion with
instrumentation

9.2 Surgery without fusion

9.3 Alternatives

10 See also

11 References

Terminology
The condition can be categorized based on convexity, or curvature of the spinal column, with
relation to the central axis:

Dextroscoliosis is a scoliosis with the convexity on the right side.[2][3][4]

Levoscoliosis is a scoliosis with the convexity on the left side.[2][3][4]

Rotoscoliosis (may be used in conjunction with dextroscoliosis and levoscoliosis, e.g.
levorotoscoliosis) refers to scoliosis on which the rotation of the vertebrae is particularly
pronounced, or is used simply to draw attention to the fact that scoliosis is a complex 3

http://en.wikipedia.org/wiki/Dextroscoliosis 10/5/2009
Scoliosis - Wikipedia, the free encyclopedia Page 2 of 7

dimensional problem.[5].

Cause
In the case of the most common form of scoliosis, adolescent idiopathic scoliosis, there is no clear
causal agent [6]. Various causes have been implicated, but none have consensus among scientists as
the cause of scoliosis. Scoliosis is more often diagnosed in females and is often seen in patients with
cerebral palsy or spina bifida,which is a birth defect that involves the incomplete development of the
spinal cord and its coverings.[7] although this form of scoliosis is different from that seen in children
without these conditions. In some cases, scoliosis exists at birth due to a congenital vertebral
anomaly. Occasionally, development of scoliosis during adolescence is due to an underlying
anomaly such as a tethered spinal cord, but most often the cause is unknown or idiopathic, having
been inherited through genetics [8]. Some therapists like the referenced Hanna Somatic therapist
believe that trauma to an adult can cause, not just asymmetry but an actual curve to the spine visible
on x-ray, although no documentation is offered in her article. Scoliosis often presents itself, or
worsens, during the adolescence growth spurt. During adolescence, due to rapid growth of the body,
hip and leg proportions in the leg and thigh may become misaligned, causing temporary acute
scoliosis.

In April 2007, researchers at Texas Scottish Rite Hospital for Children identified the first gene
associated with idiopathic scoliosis, CHD7. The medical breakthrough was the result of a 10-year
study and is outlined in the May 2007 issue of the American Journal of Human Genetics.[9]

Prevalence
Scoliotic curves of 10° or less affect 3-5 out of every 1,000 people.[10] The prevalence of curves less
than 20° is about equal in males and females. 2% of women and 0.5% of men are affected by
Scoliosis.

Symptoms
Patients aged from 18 or older are less likely to worsen their case due to their mature spines and
body system. Pain is often common in adulthood, especially if the scoliosis is left untreated. Though
doctors do not always recommend surgery as the solution to scoliosis, it is still the most efficient
way to completely strengthen the spine. Scoliosis surgery is often performed for cosmetic reasons
rather than pain alone as the surgery cannot guarantee pain loss but it can stabilize a curvature and
prevent worsening therefore improving one's quality of life. Pain can occur because the muscles try
to conform to the way the spine is curving often resulting in muscle spasms. Some of the severe
cases of scoliosis can lead to diminishing lung capacity, putting pressure on the heart, and restricting
physical activities. The symptoms of scoliosis can include:

Uneven musculature on one side of the spine

A rib "hump" (Pectus carinatum) and/or a prominent shoulder blade, caused by rotation of the
ribcage in thoracic scoliosis

Uneven hip, rib cage, and shoulder levels

Asymmetric size or location of breast in females

Unequal distance between arms and body

Slow nerve action (in some cases)

Different heights of the shoulders

Associated conditions

http://en.wikipedia.org/wiki/Dextroscoliosis 10/5/2009
Scoliosis - Wikipedia, the free encyclopedia Page 3 of 7

Scoliosis is sometimes associated with other conditions such as Ehler-Danlos Syndrome

(hyperflexibility, 'floppy baby' syndrome, and other variants of the condition), Charcot-Marie-Tooth,
kyphosis, cerebral palsy, spinal muscular atrophy, familial dysautonomia, CHARGE syndrome,
Friedreich's ataxia, proteus syndrome, Spina bifida, Marfan's syndrome, neurofibromatosis,
connective tissue disorders, congenital diaphragmatic hernia, and craniospinal axis disorders (e.g.,
syringomyelia, mitral valve prolapse, Arnold-Chiari malformation).

Investigation
Patients who initially present with scoliosis are examined to determine
whether there is an underlying cause of the deformity. During a physical
examination, the following is assessed:

Skin for café au lait spots indicative of neurofibromatosis

The feet for cavovarus deformity

Abdominal reflexes

Muscle tone for spasticity

During the exam, the patient is asked to remove his shirt and bend
forward (this is known as the Adam's Bend Test and is often performed
on school students). If a hump is noted, then scoliosis is a possibility and
the patient should be sent for an x-ray to confirm the diagnosis.
Alternatively, a scoliometer may be used to diagnose the condition.[11]
The patient's gait is assessed, and there is an exam for signs of other
abnormalities (e.g., Spina bifida as evidenced by a dimple, hairy patch,
lipoma, or hemangioma). A thorough neurological examination is also
performed.

It is usual when scoliosis is suspected to arrange for weight-bearing full-

spine AP/coronal (front-back view) and lateral/sagittal (side view) xrays
to be taken, to assess both the scoliosis curves and also the kyphosis and Cobb angle measurement
lordosis, as these can also be affected in individuals with scoliosis. Full- of a levoscoliosis
length standing spine X rays are the standard method for evaluating the
severity and progression of the scoliosis, and whether it is congenital or
idiopathic in nature. In growing individuals, serial radiographs are obtained at 3-12 month intervals
to follow curve progression. In some instances, MRI investigation is warranted.

The standard method for assessing the curvature quantitatively is measurement of the Cobb angle,
which is the angle between two lines, drawn perpendicular to the upper endplate of the uppermost
vertebrae involved and the lower endplate of the lowest vertebrae involved. For patients who have
two curves, Cobb angles are followed for both curves. In some patients, lateral bending xrays are
obtained to assess the flexibility of the curves or the primary and compensatory curves.

Mass-screening for scoliosis using posture photos

It has been suggested that entire populations be examined, for early detection. For example, in the
1940s, American psychologist William Sheldon proposed mandatory physical examinations that
included nude photographs of each person being examined. One purpose of these photographs was
the detection of rickets, scoliosis, and lordosis. His approach was implemented at a number of ivy
league schools in which all freshmen were examined (Ivy League nude posture photos). A similar
program was implemented in Boston's prison system. [12]

http://en.wikipedia.org/wiki/Dextroscoliosis 10/5/2009
Scoliosis - Wikipedia, the free encyclopedia Page 4 of 7

Prognosis
The prognosis of scoliosis depends on the likelihood of progression. The general rules of progression
are that larger curves carry a higher risk of progression than smaller curves, and that thoracic and
double primary curves carry a higher risk of progression than single lumbar or thoracolumbar curves.
In addition, patients who have not yet reached skeletal maturity have a higher likelihood of
progression.

Management
The traditional medical management of scoliosis is complex and is determined by the severity of the
curvature, skeletal maturity, which together help predict the likelihood of progression.

The conventional options are, in order:

1. Observation
2. Bracing
3. Surgery

Bracing is normally done when the patient has bone growth remaining, and is generally implemented
in order to hold the curve and prevent it from progressing to the point where surgery is indicated.
Braces are sometimes also prescribed for adults to relieve pain. Bracing involves fitting the patient
with a device that covers the torso, and in some cases it extends to the neck. The most commonly
used brace is a TLSO, a corset-like appliance that fits from armpits to hips and is custom-made from
fiberglass or plastic. It is usually worn 22–23 hours a day and applies pressure on the curves in the
spine. The effectiveness of the brace depends not only on brace design and orthotist skill, but on
patient compliance and amount of wear per day. Typically, braces are used for idiopathic curves that
are not grave enough to warrant surgery, but they may also be used to prevent the progression of
more severe curves in young children, in order to buy the child time to grow before performing
surgery, which would prevent further growth in the part of the spine affected. Bracing may cause
emotional and physical discomfort. Physical activity may become more difficult because the brace
presses against the stomach, making it difficult to breathe. Children may lose weight from the brace,
due to increased pressure on the abdominal area.

In infantile, and sometimes juvenile scoliosis, a plaster jacket applied early may be used instead of a
brace. It has been proven possible [13] to permanently correct cases of infantile idiopathic scoliosis
by applying a series of plaster casts (EDF-elongation, derotation, flexion) applied on a specialized
frame under corrective traction, which helps to "mould" the infant's soft bones and work with their
infantile growth spurts. This method was pioneered by UK scoliosis specialist Min Mehta.

Conventional chiropractic and physical therapy have some degree of anecdotal success in treating
scoliosis that is primarily neuromuscular in nature. Non-surgical approaches will not address severe
bone deformities associated with some cases of scoliosis. Chiropractors and physical therapists
utilize joint mobilization techniques and therapeutic exercise to increase a scoliosis patient's
flexibility and strength, theorizing that this better enables the brace to influence the curvature of the
spine. Electrical muscle stimulation (EMS) is another therapeutic modality commonly utilized by
chiropractors and physical therapists to reduce muscle spasms and strengthen atrophied muscles.

A growing body of scientific research testifies to the efficacy of specialized treatment programs of
physical therapy, which may include bracing.[14] Debate in the scientific community about whether
chiropractic and physical therapy can influence scoliotic curvature is partly complicated by the
variety of methods proposed and employed: some are supported by more research than others.

The so-called Schroth Method is a non-invasive, physiotherapeutic treatment for scoliosis used

http://en.wikipedia.org/wiki/Dextroscoliosis 10/5/2009
Scoliosis - Wikipedia, the free encyclopedia Page 5 of 7

successfully in Europe since the 1920s. [15] Originally developed in Germany by scoliosis sufferer
Katharina Schroth, this method is now taught to scoliosis patients in clinics specifically devoted to
Schroth therapy in Germany, Spain, England, and, most recently, the United States. The method is
based upon the concept of scoliosis as resulting from a complex of muscular asymmetries (especially
strength imbalances in the back) that can be at least partially corrected by targeted exercises.[16]

Surgery
Surgery is usually indicated for curves that have a high likelihood of progression, curves that cause a
significant amount of pain with some regularity, curves that would be cosmetically unacceptable as
an adult, curves in patients with spina bifida and cerebral palsy that interfere with sitting and care,
and curves that affect physiological functions such as breathing.

Surgery for scoliosis is usually done by a surgeon who specializes in spine surgery. For various
reasons it is usually impossible to completely straighten a scoliotic spine, but in most cases very
good corrections are achieved.

Surgery is usually required with a curve of 40 to 50 degrees.

Spinal fusion with instrumentation

Spinal fusion is the most widely performed surgery for scoliosis. In this
procedure, bone (either harvested from elsewhere in the body autograft,
or donor bone allograft) is grafted to the vertebrae so that when it heals,
they will form one solid bone mass and the vertebral column becomes
rigid. This prevents worsening of the curve at the expense of spinal
movement. This can be performed from the anterior (front) aspect of the
spine by entering the thoracic or abdominal cavity, or performed from
the back (posterior). A combination of both is used in more severe cases.

Originally, spinal fusions were done without metal implants. A cast was
applied after the surgery, usually under traction to pull the curve as
straight as possible and then hold it there while fusion took place.
Unfortunately, there was a relatively high risk of pseudarthrosis (fusion
failure) at one or more levels and significant correction could not always
be achieved. In 1962, Paul Harrington introduced a metal spinal system
of instrumentation which assisted with straightening the spine, as well as
holding it rigid while fusion took place. The original, now obsolete
Harrington rod operated on a ratchet system, attached by hooks to the
spine at the top and bottom of the curvature that when cranked would Coronal X-ray of the
above spine after having
distract, or straighten, the curve. A major shortcoming of the Harrington undergone successful
method was that it failed to produce a posture where the skull would be fusion and
in proper alignment with the pelvis and it didn't address rotational instrumentation
deformity. As a result, unfused parts of the spine would try to
compensate for this in the effort to stand up straight. As the person aged,
there would be increased wear and tear, early onset arthritis, disc degeneration, muscular stiffness
and pain with eventual reliance on painkillers, further surgery, inability to work full-time and
disability. "Flatback" became the medical name for a related complication, especially for those who
had lumbar scoliosis. Modern spinal systems are attempting to address sagittal imbalance and
rotational defects unresolved by the Harrington rod system. They involve a combination of rods,
screws, hooks and wires fixing the spine and can apply stronger, safer forces to the spine than the
Harrington rod. This technique is known as the Cotrel-Dubousset instrumentation, currently the most
common technique for the procedure.

http://en.wikipedia.org/wiki/Dextroscoliosis 10/5/2009
Scoliosis - Wikipedia, the free encyclopedia Page 6 of 7

Modern spinal fusions generally have good outcomes with high degrees of correction and low rates
of failure and infection. Patients with fused spines and permanent implants tend to have normal lives
with unrestricted activities when they are younger, it remains to be seen whether those that have
been treated with the newer surgical techniques will develop problems as they age. They are able to
participate in recreational athletics, have natural childbirth and are generally satisfied with their
treatment. A notable limitation of spinal fusions is that patients who have undergone surgery for
scoliosis are ineligible for service in the military of countries such as the United Kingdom, Sweden
and the United States.

In cases where scoliosis has caused a significant deformity resulting in a rib hump, it is often
possible to perform a surgery called a costoplasty (also called a thorocoplasty) in order to achieve a
more pleasing cosmetic result. This procedure may be performed at any time after a fusion surgery,
whether as part of the same operation or several years afterwards. It is usually impossible to
completely straighten and untwist a scoliotic spine, and it should be noted that the level of cosmetic
success will depend on the extent to which the fused spine still rotates out into the ribcage. A rib
hump is evidence that there is still some rotational deformity to the spine. Specific weight training
techniques can be used to influence this rotational deformity in the unfused parts of the spine. This
leads to a marked decrease in pain and to some improvement in organ function depending on the
person's particular case and is to be recommended over any cosmetic surgical procedure.

Surgery without fusion

New implants have been developed that aim to delay spinal fusion and to allow more spinal growth
in young children. For the youngest patients, whose thoracic insufficiency compromises their ability
to breathe and applies significant cardiac pressure, ribcage implants that push the ribs apart on the
concave side of the curve may be especially useful. These Vertical Expandable Prosthetic Titanium
Ribs (VEPTR) provide the benefit of expanding the thoracic cavity and straightening the spine in all
three dimensions while allowing the spine to grow. Although these methods are novel and
promising, these treatments are only suitable for growing patients. Spinal fusion remains the "gold
standard" of surgical treatment for scoliosis. Surgery is usually required if the spine has a curve of 40
to 50 degrees.

Alternatives

In children with immature skeletons and remaining growth potential, Schroth-method physical
therapy is used in combination with the Rigo System-Cheneau brace, not only to prevent progression
of (and often reduce) the abnormal curvature, but also to train and strengthen patients in holding
their bodies in a corrected position after completion of the bracing treatment (i.e., when the skeleton
has reached maturity). A patient’s consistent practicing of an individualized Schroth program has
been clinically shown to inhibit the mechanical forces, exacerbated by poor postural habits and
gravity, that otherwise perpetuate the progression of the curvature over time (the so-called “vicious
cycle”), even after the cessation of physical growth.[17].

See also

Kyphosis

Hyperkyphosis

Kyphoscoliosis

Lordosis

Pott's disease

References

http://en.wikipedia.org/wiki/Dextroscoliosis 10/5/2009
Scoliosis - Wikipedia, the free encyclopedia Page 7 of 7

1. ^ Online Etymology Dictionary. Douglas Harper, Historian. Accessed 27 December 2008.

Dictionary.com http://dictionary.reference.com/browse/scoliosis
2. ^ a b Richardson ML. Approaches to differential diagnosis in musculoskeletal imaging. Univ. of
Washington School of Medicine. URL: http://www.rad.washington.edu/mskbook/scoliosis.html.
Accessed on: January 8, 2006.
3. ^ a b Morningstar M, Joy T (2006). "Scoliosis treatment using spinal manipulation and the Pettibon
Weighting Systemtrade mark: a summary of 3 atypical presentations". Chiropr Osteopat 14: 1.
doi:10.1186/1746-1340-14-1. PMID 16409627. Free Full Text.
4. ^ a b Chief Pediatric Resident. Scoliosis. Univ. of Chicago. URL:
http://pediatrics.uchicago.edu/chiefs/documents/Scoliosis-Gina.pdf. Accessed on: January 8, 2006.
5. ^ eMedicine - Idiopathic Scoliosis : Article by Charles T Mehlman
6. ^ Kouwenhoven, J & Castelein, R, 2008, 'The Pathogenesis of Adolescent Idiopathic Scoliosis', Spine,
vol. 33, no. 26, pp. 2898-2908. 10.1097/BRS.0b013e3181891751
7. ^ [1]
8. ^ [2]
9. ^ Texas Scottish Rite Hospital for Children Research: Scoliosis Research
10. ^ National Scoliosis Foundation
11. ^ [3]
12. ^ All about Criminal Motivation, by Mark Gado - Crime Library on truTV.com
13. ^ Mehta MH (2005). "Growth as a corrective force in the early treatment of progressive infantile
scoliosis". J Bone Joint Surg Br 87 (9): 1237–47. doi:10.1302/0301-620X.87B9.16124. PMID
16129750.
14. ^ Negrini S, Fusco C, Minozzi S, Atanasio S, Zaina F, Romano M (2008). Exercises reduce the
progression rate of adolescent idiopathic scoliosis: results of a comprehensive systematic review of the
literature.=Disabil Rehabil. 30. pp. 772–85. PMID 18432435.
15. ^ Lehnert-Schroth, Christa (2007). Three-Dimensional Treatment for Scoliosis: A Physiotherapeutic
Method for Deformities of the Spine. (Palo Alto, CA: The Martindale Press): pp. 1-6.
16. ^ Lehnert-Schroth, Christa (2007). Three-Dimensional Treatment for Scoliosis: A Physiotherapeutic
Method for Deformities of the Spine. (Palo Alto, CA: The Martindale Press): passim.
17. ^ Weiss HR, Lohschmidt K, el-Obeidi N, Verres C, (1997). "Preliminary results and worst-case analysis
of in-patient scoliosis . True". Pediatr Rehabil 1 (1): 35–40.
Retrieved from "http://en.wikipedia.org/wiki/Scoliosis"
Categories: Musculoskeletal disorders | Congenital disorders | Greek loanwords | Skeletal disorders

This page was last modified on 2 October 2009 at 17:46.

Text is available under the Creative Commons Attribution-ShareAlike License; additional
terms may apply. See Terms of Use for details.
Wikipedia® is a registered trademark of the Wikimedia Foundation, Inc., a non-profit
organization.

http://en.wikipedia.org/wiki/Dextroscoliosis 10/5/2009