Scoliosis is an abnormal curvature of the spine. This condition tends to occur during adolescence, more often in girls. The curve may be convex to the right or to the left.. Rotation of the vertebral column around the axis occurs and may cause rib cage deformity. Scoliosis is often associated with kyphosis (humpback) and lordosis (swayback).
CAUSES
Scoliosis may be functional or structural. Functional scoliosis usually results from poor posture or a discrepancy in leg length, not fixed deformity of the spinal column. In structural scoliosis, curvature results from a deformity of the vertebral bodies.
structural scoliosis may be one of three types:
- Congenital scoliosis is usually related to a congenital defect, such as wedge vertebrae, fused ribs or vertebrae, or hemivertebrae (incomplete development of vertebrae).
- Paralytic or musculoskeletal scoliosis develops several months after asymmetric paralysis of the trunk muscles from polio, cerebral palsy, or muscular dystrophy.
- Idiopathic scoliosis (the most common form) may be transmitted as autosomal dominant or multifactorial trait. This forms appears as a previously straight spine during the growing years. Idiopathic scoliosis can be classified as infantile, which affects mostly male infants between birth and age 3; juvenile which affects both sexes between ages 4 and 10 and causes varying types of curvature; and adolescent, which generally affects girls between age 10 and achievement of skeletal maturity and causes varying types of curvature
SIGNS & SYMPTOMS
Scoliosis rarely produces symptoms until it's well established; when symptoms do occur, they include backache, fatigue, and difficulty breathing. Because many teenagers are shy about their bodies, their parents suspect that something is wrong only after they notice uneven hemlines, pantlegs that appear unequal in length, or subtle physical signs like one hip appearing higher than the other.
TREATMENT
The severity of the deformity and potential spine growth determine appropriate treatment, which may include such noninvasive measures as close observation, exercise, or a brace. For more serious deformities, surgery or a combination of methods may be needed. To be most effective, treatment should begin early, when spinal deformity is still subtle.
A curve of less than 25 degrees is mild and can be monitored by X-rays and an examination every 3 months. An exercise program that includes sit-ups, pelvic tilts, spine hyperextension, puchups, and breathing exercises may strengthen torso muscles and prevent curve progression. A heel lift may help.
A curve of 30 degrees requires management with spinal exercises and a brace. A brace halts progression in most patients but doesn't reverse the establishes curvature. Such devices passively strenghten the patient's spine by applying symmetric pressure to skin, muscles, and ribs.
A curve of 40 degrees or more requires surgery, because a lateral curve continues to progress at the rate of 1 degree a year even after skeletal maturity.