Scoliosis
Lateral curvature of the spine

Scoliosis is a condition in which the spinal column has one or two lateral curvature(s). In addition, the spinal column often rotates around its longitudinal axis, causing the chest to deform.

Scoliosis affects 6 to 9 million people in the US, more of them women. The severity of the condition and the associated symptoms may vary greatly from one person to another.

Description of condition

A normal spine is straight when viewed from the back or front. The separate vertebrae are properly aligned. This is not the case in people suffering from scoliosis. The spine is deformed because of sideways curvatures and twisting.

If the spine bends to one side, the person has a tilted posture. This is often compensated by the spine bending in the other direction elsewhere. This makes the person stand up "straight" again. When the thoracic vertebrae start rotating, the ribs rotate along with them and this can create a hump (gibbus) deformity. This may then result in the organs in the chest cavity coming under pressure.

One important symptom that develops in case of scoliosis is obviously back pain. However, this is often not prominent in the beginning. Shame and insecurity about their appearance is a big problem in children during puberty. In addition, breathing can become problematic because the lungs have less space due to the deformed chest cavity.

Cause and history

The cause of the development of scoliosis is categorized into four different forms. These include the congenital variant (1), scoliosis as a result of aging or a muscular or nerve disorder (2) and the form in which the cause is unknown (3). These are sometimes also referred to as the structural scoliosis. These often manifest between the ages of 10 and 18. Finally, there is non-structural scoliosis (4). This may develop when a person tries to compensate for a difference in leg length or poor posture.

In most cases, this is a form of scoliosis of which the cause is (still) unknown. Genetic factors likely play a role in this. Initially, the shape of the spine is normal, but something goes wrong while growing and the spine becomes deformed.

Scoliosis can be present as early as birth, but is often only detected when the child is about ten years old. The congenital variant usually means that the vertebrae developed incorrectly. For example, there may be half vertebrae or vertebrae that have fused together on one side. As the child continues to grow, the abnormalities often increase.

When scoliosis is caused by a muscular or nerve disorder, it is because some muscles pull on the spine too hard. Or alternatively too little. As a result, the spine distorts.

When a person’s spine only deforms at a later age, this is usually the result of aging. Things like osteoporosis or flattening of an inter-vertebral disc that let the spine collapse unevenly.

Signs & symptoms

Symptoms associated with scoliosis can be very variable. They depend on the severity and extent of the deformity. Possible symptoms are:

• Pain in the back.
  
• Reduced mobility of the spine.
  
• Reduced mobility in the spine.
  
• Shoulder hanging lower on one side.
  
• A "gibbus" in the area of the thoracic spine.
  
• Breathing difficulties.
  
• Fatigue.

Diagnosis

Parents are often the first to notice that their child's back is not perfectly straight. During a visit, a doctor or (pediatric) physiotherapist will ask about the symptoms and perform a physical examination.

The physician will assess the spinal column for any curvatures. One way of identifying this better is to ask the patient to bend forward. This makes any hump more visible. After this, an x-ray is usually taken and the Cobb angle measurement is used to examine the extent of the curvature. An MRI can visualize the three-dimensional character of the disorder. These additional examinations also allow for the doctor to make a decision on the cause of the scoliosis.

Treatment

Generally speaking, the earlier the condition is discovered, the greater the chances of a good treatment outcome. There is a choice between a conservative and a surgical approach.

In terms of the conservative approach, the (possible) worsening of the scoliosis is closely monitored. During this period, a (pediatric) physiotherapist can help improve posture. A brace or corset can also prevent the symptoms from worsening. If the scoliosis is the result of a discrepancy in leg length, this may be corrected with a custom-made insole.

Unfortunately, a conservative approach does not always help and sometimes an operation is necessary to correct or reduce the symptoms. An orthopedic surgeon will correct the position of the spine as much as possible using screws and rods. This is a significant surgery that is always followed by an intensive rehabilitation process with the physiotherapist.

Exercises

Take a look here at the online exercise program with exercises for scoliosis.

You can check your symptoms using the online physiotherapy check or make an appointment with a physiotherapy practice in your locality.

References
Magee, D.J. (2014). Orthopedic physical assessment. Elsevier saunders: St. Louis.
Verhaar, J.A.N. & Linden, A.J. van der (2005). Orthopedie. Houten: Bohn Stafleu van Loghum.