Scoliosis

DR PABITRA KUMAR SAHOO, ASSISTANT PROFESSOR (PMR)

Scoliosis fromAncient Greek means “obliquity, bending is a medical condition in which a

person's spine is curved from side to side. Although it is a complex three-dimensional deformity,
on an X-ray, viewed from the rear, the spine of an individual with scoliosis can resemble an "S"
or a "?", rather than a straight line

Classification

1.Idiopathic- The most common type of scoliosis, idiopathic scoliosis, has no specific
identifiable cause. There are many theories, but none have been found to be conclusive. There is,
however, strong evidence that idiopathic scoliosis is inherited. According to the age of onset can
be sub-classified as

1. Infantile
2. Juvenile
3. Adolescent
4. Adult

2.Congenital- caused by vertebral anomalies present at birth

3.Neuromuscular scoliosis-Secondary to a primary conditions like-

-Spina bifida

- Spinal muscular dystrophy

- Cerebral palsy

- Syndromes- chiari malformation

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 4. Degenerative scoliosis. This may result from traumatic (from an injury or illness) bone
collapse, previous major back surgery, or osteoporosis (thining of the bones).

Clinical manifestations

Scoliosis is more marked in girls than boys. Idiopathic scoliosis is most commonly a condition
of adolescence affecting those aged 10 through 16. Idiopathic scoliosis may progress during the
"growth spurt" years, but usually will not progress during adulthood. Most scoliosis curves are
initially detected on school screening exams, by a child's pediatrician or family doctor, or by a
parent. Some clues that a child may have scoliosis include uneven shoulders, a prominent
shoulder blade, uneven waist, or leaning to one side

The typical non rigid curve occurs as single, however rigid primary curves associated with an
secondary curve. Curves in dorsal or lumber area are usually to left. As viewed from behind the
body appears asymmetrical . Ribs on concave side are closure together and the lower border of
the thoracic cage on this side approximates to ileum. Progression of the curve is variable. The
vertebral bodies usually turns towards convex side and the spinousprocess in the opposite
direction.

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Investigations:

Radiological evaluation is important to assess nature of progression, angle of the curve. Erect
film, recumbent films & lateral bending films are required to determine degree of flexibility of
the spine. Angle of curvature measured by Cobbsmethod. Radiological fusion of iliac apophysis
suggest no more further progression of the curve.

Treatment:

Recent longitudinal studies reveal that the most common form of the condition, late-onset
idiopathic scoliosis, is physiologically harmless and self-limiting even without treatment

Strengthening of the musclesdone on convex side of the curve. Stretching on concave side
musculature by head halter, pelvic halo cast, halo femoral distraction

Braces. Bracing is the usual treatment choice for adolescents who have a spinal curve between
25 degrees to 40 degrees -- particularly if their bones are still maturing and if they have at least 2
years of growth remaining. Milwaukee brace is the common brace used in scoliosis

The purpose of bracing is to halt progression of the curve. It may provide a temporary correction,
but usually the curve will assume its original magnitude when bracing is eliminated.

Surgery. Those who have curves beyond 40 degrees to 50 degrees are often considered for
scoliosis surgery.Other indications are painful spine in elderly patients, decreased
cardiopulmonary function. The goal is to make sure the curve does not get worse, but surgery
does not perfectly straighten the spine. During the procedure, metallic implants are utilized to
correct some of the curvature and hold it in the correct position until a bone graft, placed at the
time of surgery, consolidates and creates a rigid fusion in the area of the curve. Scoliosis surgery
usually involves joining the vertebrae together permanently-- called spinal fusion. Anterior
instrumentation and interbody fusion is common surgical procedure done for scoliosis correction.

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