Scoliosis is a condition wherein the spine curves abnormally away from its usual straight line. It can vary in severity from being a cause of frequent posture problems, to preventing proper breathing due to the spine curvature taking up space in the chest cavity. In the worst cases, scoliosis becomes disabling. Scoliosis has been known to affect females more than males and manifests itself fully in adolescence.
The condition can cause the spine to curve in three ways: in a single C-shaped curve facing the left, in a C-shaped curve to the right, or in two curves like an S-shape. The three major types of scoliosis are congenital, idiopathic, and secondary. Scoliosis is commonly idiopathic, affecting 2% of women and only 0.5% of men. It can also develop among children as young as 3 years old, known as infantile idiopathic scoliosis. There is much information on the pathology of scoliosis, as well as its treatment and on helping patients cope with it.
Causes of Scoliosis
Up to 65% of all cases of scoliosis are idiopathic. No clear cause has been established as to why such instances of scoliosis are acquired. Congenital cases account for 15%, while 10% are attributed to instances secondary to neuromuscular disease. There are many factors that are theorized as causing idiopathic scoliosis. It is believed that genetics is an influencing factor, with the CHD7 gene having a known role in the condition. The MATN1 gene has microsatellite polymorphisms that have also been discovered to be linked to idiopathic scoliosis.
In congenital scoliosis, an abnormal spine formation begins developing after six weeks in the womb. It results from either the spine failing to form or segment properly, or a combination of both factors. Secondary scoliosis commonly develops from myopathic and neuropathic conditions, leading to muscular weakening and a lack of support for the spinal column. Other conditions that can lead to secondary scoliosis are trauma to the spinal cord, cerebral palsy, muscular atrophy of the spine, and muscular dystrophy.
Symptoms of Scoliosis
The bodies of people with scoliosis appear to tilt toward one side. It leads to uneven positioning of the shoulders and waist. One of the shoulders will appear higher and to stick out more than the other as the condition causes the bone to rotate slightly. One side of the hip will appear to go up higher than the other side. The legs and arms may also become uneven in length, with some growing shorter than the others. In worse cases, the spine begins to rotate in addition to spinal curving. This causes the rib to stick out from the body in an abnormal manner, which is known as thoracic scoliosis.
Other severe conditions include limited capacity in the lungs, chest pain, added pressure on the heart, and in rare cases, slower and impaired nerve activity. Scoliosis patients do not normally suffer from back pain, and such a symptom could be caused by another condition. Pain and numbness may result in certain areas of the body, however, if the scoliosis was caused by injuries to the spine.
Making a Diagnosis For Scoliosis
Patients are advised to seek a doctor immediately once they perceive any scoliosis symptoms. Doctors usually ask them if they have any history of scoliosis in the family, as well as whether they had any previous notable pains and physical symptoms. They are first examined to see if the spinal deformity is caused by another underlying condition. Patients are given a gait analysis as well as a neurological examination. Their skin, feet, and muscles are also tested for any abnormal signs.
The Adams forward bend test is normally performed on adolescents, wherein the patient must bend forward as far as he or she can. If the doctor notices any unusual prominences, the patient is advised to have an X-ray to confirm scoliosis. The standard procedure is to conduct a full-length X-ray for a suspected case of any kind of scoliosis. An MRI may also be performed in order to carry out a more thorough investigation of the spinal cord. The extent of any observed spinal curvature is measured through Cobb angles from the top to the lowest vertebra, where two curves are measured with two angles. Adolescent idiopathic scoliosis can also now be diagnosed through genetic testing.
Types of Treatment For Scoliosis
Congenital scoliosis in children is normally not severe and they may not even need to seek treatment. They are advised to have regular checkups to check for any changes in their spinal conditions. As they grow older, their spine would have reached skeletal maturity and have less of a chance of any conditions worsening. There is no known cure for scoliosis, though there are several forms of physical therapy and management techniques that can help patients deal with the symptoms.
Patients with mild scoliosis are advised to engage in the exercise regularly, especially practices like yoga that are helpful for stretching the spine. Physical therapy for idiopathic scoliosis from injuries help patients move properly and carry out different kinds of normal activities. Braces or casts can help keep the spine in place and relieve any painful symptoms, like those present in scoliosis among adults. In severe cases or those likely to progressively worsen, surgeries, such as a spinal fusion, are available to help stabilize the spinal column and keep it more rigid.
Other Types of Scoliosis
Besides congenital and idiopathic scoliosis, there are also other kinds of scoliosis types. Scoliosis can be identified based on the orientation of the curvature of the spine. A C-shape facing the right along the thoracic spine is referred to as dextroscoliosis, while a curve to the left in the lumbar is known as levoscoliosis. Idiopathic scoliosis can be infantile, juvenile, or adolescent, depending on what age it manifests. Lumbar scoliosis refers to the curvature in the lumbar or lower, region of the spine.
Thoracolumbar scoliosis is located in both the lower thoracic and upper lumbar areas of the spine. Taking into account both the curvature and the location of the deformation, scoliosis can further be classified into thoracic dextroscoliosis and lumbar levoscoliosis. Neuromuscular scoliosis, also known as myopathic scoliosis, is a consequence of abnormalities in bone and muscular development, as in cerebral palsy or muscular dystrophy. Degenerative, or adult, scoliosis strikes adults approaching old age as their spinal joints slowly begin to degenerate. Abnormalities in different parts of the body, such as in the legs, lead to functional scoliosis.
Further Research For Scoliosis
Experts are conducting further research into finding the exact cause of scoliosis. They are attempting to establish a definitive link to genetic factors, though many studies have failed to discover any conclusive information. Gene studies are currently being conducted to continue the search for the genetic source of scoliosis. Other experts are suggesting that scoliosis is a phenomenon related to biological evolution, and may be a necessary consequence of bipedalism.
The physiological development of the spine to support bipedalism may have made it susceptible to developing scoliotic abnormalities. To continue supporting scoliosis research, several organizations and institutions have been founded, such as the Scoliosis Research Society. The focus is now being targeted as well toward developing more therapeutic techniques for scoliosis and to help improve the lives of its patients.