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Scoliosis (Curved Spine)

Scoliosis (Curved Spine)

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Published by Chow Mun Fai

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Published by: Chow Mun Fai on May 18, 2010
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Scoliosis
From Wikipedia, the free encyclopedia
(Redirected from Dextroscoliosis)
Scoliosis
(from Greek:
skolí 
ō
sis
meaning"crooked")
[1]
is a medical condition in which aperson's spine is curved from side to side, shapedlike an "s", and may also be rotated. To adults itcan be very painful. It is an abnormal lateralcurvature of the spine. On an x-ray, viewed fromthe rear, the spine of an individual with a typicalscoliosis may look more like an "S" or a "C" thana straight line. It is typically classified ascongenital (caused by vertebral anomalies presentat birth), idiopathic (sub-classified as infantile,uvenile, adolescent, or adult according to whenonset occurred) or as neuromuscular, havingdeveloped as a secondary symptom of anothercondition, such as spina bifida, cerebral palsy,spinal muscular atrophy or due to physicaltrauma.
Terminology
The condition can be categorized based on convexity, or curvature of the spinal column, withrelation 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 particularlypronounced, or is used simply to draw attention to the fact that scoliosis is a complex 3
Contents
1 Terminology
2 Cause
3 Prevalence
4 Symptoms
5 Associated conditions
6 Investigation
7 Prognosis
8 Management
9 Surgery
9.1 Spinal fusion withinstrumentation
9.2 Surgery without fusion
9.3 Alternatives
10 See also
11 References
Scoliosis
Classification and external resources
 A coronal X-ray of a person with thoracicdextroscoliosis and lumbar levoscoliosis. The X-rayis projected such that the right side of the subject ison the right side of the image, i.e. the subject isviewed from the rear. This projection is typicallyused by surgeons as it is how surgeons see theirpatients when they are on the operating table.
Page 1 of 7Scoliosis - Wikipedia, the free encyclopedia10/5/2009http://en.wikipedia.org/wiki/Dextroscoliosis
 
dimensional problem.
[5]
.
Cause
In the case of the most common form of scoliosis, adolescent idiopathic scoliosis, there is no clearcausal agent
[6]
. Various causes have been implicated, but none have consensus among scientists asthe cause of scoliosis. Scoliosis is more often diagnosed in females and is often seen in patients withcerebral palsy or spina bifida,which is a birth defect that involves the incomplete development of thespinal cord and its coverings.
[7]
although this form of scoliosis is different from that seen in childrenwithout these conditions. In some cases, scoliosis exists at birth due to a congenital vertebralanomaly. Occasionally, development of scoliosis during adolescence is due to an underlyinganomaly such as a tethered spinal cord, but most often the cause is unknown or idiopathic, havingbeen inherited through genetics
[8]
. Some therapists like the referenced Hanna Somatic therapistbelieve that trauma to an adult can cause, not just asymmetry but an actual curve to the spine visibleon x-ray, although no documentation is offered in her article. Scoliosis often presents itself, orworsens, 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 acutescoliosis.In April 2007, researchers at Texas Scottish Rite Hospital for Children identified the first geneassociated with idiopathic scoliosis, CHD7. The medical breakthrough was the result of a 10-yearstudy 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 lessthan 20° is about equal in males and females. 2% of women and 0.5% of men are affected byScoliosis.
Symptoms
Patients aged from 18 or older are less likely to worsen their case due to their mature spines andbody system. Pain is often common in adulthood, especially if the scoliosis is left untreated. Thoughdoctors do not always recommend surgery as the solution to scoliosis, it is still the most efficientway to completely strengthen the spine. Scoliosis surgery is often performed for cosmetic reasonsrather than pain alone as the surgery cannot guarantee pain loss but it can stabilize a curvature andprevent worsening therefore improving one's quality of life. Pain can occur because the muscles tryto conform to the way the spine is curving often resulting in muscle spasms. Some of the severecases of scoliosis can lead to diminishing lung capacity, putting pressure on the heart, and restrictingphysical 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 theribcage 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
Page 2 of 7Scoliosis - Wikipedia, the free encyclopedia10/5/2009http://en.wikipedia.org/wiki/Dextroscoliosis
 
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 determinewhether there is an underlying cause of the deformity. During a physicalexamination, the following is assessed:
Skin for café au lait spots indicative of neurofibromatosis
The feet for cavovarus deformity
Abdominal reflexes
Muscle tone for spasticityDuring the exam, the patient is asked to remove his shirt and bendforward (this is known as the Adam's Bend Test and is often performedon school students). If a hump is noted, then scoliosis is a possibility andthe 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 otherabnormalities (
e.g.
, Spina bifida as evidenced by a dimple, hairy patch,lipoma, or hemangioma). A thorough neurological examination is alsoperformed.It is usual when scoliosis is suspected to arrange for weight-bearing full-spine AP/coronal (front-back view) and lateral/sagittal (side view) xraysto be taken, to assess both the scoliosis curves and also the kyphosis andlordosis, as these can also be affected in individuals with scoliosis. Full-length standing spine X rays are the standard method for evaluating theseverity and progression of the scoliosis, and whether it is congenital oridiopathic in nature. In growing individuals, serial radiographs are obtained at 3-12 month intervalsto 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 uppermostvertebrae involved and the lower endplate of the lowest vertebrae involved. For patients who havetwo curves, Cobb angles are followed for both curves. In some patients, lateral bending xrays areobtained to assess the flexibility of the curves or the primary and compensatory curves.Mass-screening for scoliosis using posture photosIt has been suggested that entire populations be examined, for early detection. For example, in the1940s, American psychologist William Sheldon proposed mandatory physical examinations thatincluded nude photographs of each person being examined. One purpose of these photographs wasthe detection of rickets, scoliosis, and lordosis. His approach was implemented at a number of ivyleague schools in which all freshmen were examined (Ivy League nude posture photos). A similarprogram was implemented in Boston's prison system.
[12]
 
Cobb angle measurementof a levoscoliosis
Page 3 of 7Scoliosis - Wikipedia, the free encyclopedia10/5/2009http://en.wikipedia.org/wiki/Dextroscoliosis

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