What is Scoliosis ?

This is a question asked by many people, some might of heard of the condition some may not. In answer to this question Scoliosis is what is known as a lateral curvature of the spine that can occur in children and adults. However the condition can found in families, if someone in your family has Scoliosis then the likehood of a family member also having the condition is quite high.

Watch a presentation about the Psychosocial Perspectives of Scoliosiss - left click and "open to watch the slideshow".

When a normal spine is viewed from:

• Behind the back looks straight - the trunk symmetrical
• The side - curves are seen in the neck, upper and lower trunk
• Upper trunk - rounded contour called kyphosis
• Lower trunk - reverse direction of the rounded contour called lordosis

Certain amounts of lordosis (neck & low back) and upper back kyphosis is normal - needed to maintain trunk balance over the pelvis

Deviations may reflect abnormal kyphosis or lordosis or, more commonly, SCOLIOSIS

Types of Scoliosis

There are different types of scoliosis and they are as follows:

Idiopathic

This type of scoliosis is where the cause is unknown

Congenital

This type is an abnormal vertebral formation present at birth.

Neuromuscular

This type of scoliosis can be a result of a neuromuscular condition for example Cerebral Palsy, Spina Bifida and Muscular dystrophy.

Download the article about Neuromuscular Scoliosis in a Post-Polio Patient - right click and "save target as".

The condition is not caused by:

• Carrying heavy items
• Athletic involvement
• Sleeping/standing postures

Types of Curve

Watch the presentation - left click and "open to watch the slideshow".

When a patient has been diagnosed with curvature of the spine, the curve can occur different areas of the spine.

Double Major This type of curve is made up of two curves of nearly equal angles.

Lumbar Curve

This is the lower part of the spine

Thoracic Curve This affects the upper body.

Thoracic lumbar Curve This type extends from the upper to the lower spine.

Early detection

Scoliosis is not preventable, but detection and treatment during a child’s growing years is the best way to prevent an existing problem from getting worse

Idiopathic scoliosis can go unnoticed in a child because it is rarely painful in the formative years. Therefore, parents should watch for the following "tip-offs" to scoliosis beginning when their child is about 8 years of age.

• uneven shoulders
• prominent shoulder blade/s
• uneven waist
• elevated hips
• leaning to one side

Any one of these signs warrants an examination by the family G.P., paediatrician or orthopaedist. Although only a professional can accurately confirm and diagnose scoliosis, school screenings can help alert parents of its warning signs in their child.

Investigation

Cobb angle measurement in scoliosis

Patients who initially present with scoliosis are examined to determine if 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's gait is assessed, and there is an exam for signs of other abnormalities (e.g., dysraphism as evidenced by a dimple, hairy patch, lipoma, or hemangioma). A thorough neurological examination is also performed.

Full-length standing spine X rays are the standard method for evaluating curve severity and progression. 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.