What is Scoliosis?
Scoliosis is an abnormal curvature in the spine. It can appear as a C-shaped curve or an S-shaped curve in the spine. It may develop secondary to a range of developmental, neurological, muscular and bone disorders. In the majority of cases, however, it is considered idiopathic (of unknown cause). No single factor has been identified as being responsible for idiopathic scoliosis development. For most patients, the cosmetic appearance of such a curve is the primary concern with this condition.
The three primary predictors of idiopathic scoliosis progression are as follows:
- The severity of the curve
- The location of the apex
- The skeletal maturity (level of growth) of the child.
The level of skeletal maturity can be measured using an x-ray and assessing what is known as the Risser sign. When the individual has attained most of their adult height then there is significantly less potential for progression of the spinal curve.
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The baby is born with this condition; however, it does not appear to be genetic. It usually occurs due to failure of the spinal bones to form properly. The level of progression will vary significantly between cases. Twenty percent of patients with congenital scoliosis will also suffer from genitourinary abnormalities. Heart defects are also common.
Scoliosis can be categorised according to the age of the individual at onset. These are as follows:
- Infantile: Manifests from birth to age 3.
- Juvenile: Developing between 4-9 years of age.
- Adolescent: Adolescent idiopathic scoiiosis is directly linked to adolescent spinal growth spurt which commences around the age of 11 onwards and affects 3% of the population worldwide (Hayes et al 2014). It normally ceases at the end of the growth phase.
What causes Scoliosis?
A genetic factor has been proposed for scoliosis as recurrence among relatives has been demonstrated in certain individuals (Czeizel et al. 1978). It has been shown that curves greater than 30 degrees are more likely to progress than smaller curves (Bunnell 1988). Scoliosis is also more common in males than females.
It is important to determine whether a curve is functional or structural in nature. Functional curves will increase or decrease with changes in posture. Functional curves occur secondary to compensation for muscle imbalance or biomechanical factors. Structural curves on the other hand are present due to changes in bony alignment
Management of Scoliosis
Recognising the presence of scoliosis as early as possible is key in its long-term management. Most cases of congenital scoliosis will require an orthopaedic evaluation. Idiopathic forms can be managed as long as it has not exceeded a certain angle of curvature and once it is not progressive in nature. X-ray analysis of curve angle may be carried out every 3-4 months in cases where progression is suspected. The Society of Scoliosis Orthopaedic Rehabilitation and Treatment guidelines recommend physiotherapeutic scoliosis specific exericses (PSSE) as a key component of overall management of scoliiosis management.
Surgery for Scoliosis
The aim of surgery is straighten the spinal curve as much as possible & to stabilise the spine. Traditionally, Harrington rods, which are stainless steel rods, were inserted next to the spinal column to provide stability. These rods have been adapted over the years to include the use of wiring to increase stability.
Bracing for Scoliosis Management
In the BrAIST Study, several medical centres joined together to perform a randomised controlled trial to investigate whether bracing was effective in managing scoliosis in adolescents (Weinstein et al. 2013). They wanted to determine the factors that determined successful outcome from the use of a brace.
The findings reported that when bracing therapy was applied correctly with patients who are at a high risk of requiring surgery, 72% of brace wearers could avoid surgery, compared to only 48% of patients in the observation group.
One of the primary findings was that the degree of compliance was vital and that as brace wear time increased, so did the success rate.
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