Scoliosis

Overview

Scoliosis is a curvature of the spinal column and one of the most common skeletal disorders today. It is most often diagnosed in childhood or early adolescence. But it can affect people belonging to the older generation due to osteoporosis.

The spinal column of a healthy person in the frontal plane resembles a straight line. In the sagittal plane it has 4 curves – 2 forward (cervical and lumbar parts) and 2 backward (thoracic and sacral parts). The vertebral column consists of 33-34 vertebrae: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral and 4-5 coccygeal vertebrae. They are connected by ligaments, intervertebral joints and discs.

The figure shows the vertebral column in the frontal and sagittal planes

Scoliosis is characterized by curvature of the spine to the right or left, resulting in “S”- or “C”-shaped deformities of the spinal column. When the spine curves, the vertebrae change their position, which can manifest itself in two ways.

If the curvature is in the thoracic part of spine, the ribs in this part begin to bulge and form a “C”-shaped deformity.

If the curvature is at the lumbosacral part of spine, an “S”-shaped deformity is formed.

Don’t forget that scoliosis leads to a decrease in the volume of the chest. It can also harm organs such as the heart, lungs and etc., if not treated in time.

The figure shows an image of the spinal column of a healthy person, and scoliosis with “S”- or “C”-shaped deformities

Signs and symptoms

The symptoms of scoliosis, depending on the degree of curvature of the spine, can vary over a wide range.

In the early stages of curvature, the symptoms may be only cosmetic:

• Visible differences (asymmetry) in the height of the shoulders and pelvis
• Tilt of the person’s body to the right or left
• Different height of the shoulder blades
• Balance disorders
• Different height of hip joints (one higher than the other)
• Chest asymmetry
• Different length of the lower extremities (one leg may seem longer than the other)
• On the skin of the back in the affected area we can detect hairiness, spots, and recesses

In more severe curvatures there may be:

• Back pain
• Leg pain, weakness, and numbness
• Shortness of breath
• Weakness and fatigue

Causes and types of scoliosis

According to the Scoliosis Research Association, in 80% of cases the true cause of scoliosis can’t be identified. Birth trauma, neurological abnormalities, and genetic mutations can be considered as common causes of scoliosis.

Types of scoliosis according to etiological causes: idiopathic, degenerative, congenital, thoracogenic, syndromic and associated with neuromuscular diseases.

Idiopathic scoliosis: Mostly found in children and adolescents, in the appearance of which no cause has been identified. This type accounts for approximately 75-80% of all scoliosis. Despite the fact that it begins at an early age, the patient doesn’t have pain and there are no cosmetic imperfections. But as the patient grows older and taller, the curvature of the spine can cause various problems as well as pain. Depending on the age, idiopathic scoliosis is divided into: infantile, juvenile and adolescent.

Infantile scoliosis: Can occur in newborns and children under three years of age. Along with scoliosis, children may have hip dysplasia.

Juvenile scoliosis: This type of scoliosis occurs in children 3-10 years old. The development of curvature in this type is the most common.

Adolescent scoliosis: Observed in children aged 10-18 years. 80% of scoliosis seen in pediatrics is of this type.

Congenital scoliosis:

Congenital scoliosis begins and continues to develop while the child is in the womb. Infectious diseases, diabetes mellitus, cardiovascular disease, alcohol addiction, vitamin and mineral deficiencies, and valproic acid use can be causes of this condition. At the same time, it has been found that some hereditary diseases can accompany congenital scoliosis.

Although the child is born with congenital scoliosis, symptoms may not be observed for some time. The curvature of the spine becomes noticeable as the child begins to grow. In some cases, the curvature progresses quite slowly, before the child becomes a teenager.

Structural abnormalities can lead to the development of congenital scoliosis in several ways. They look like structural abnormalities as well as abnormalities of the spinal column developing in the womb. In some children, both types of abnormalities can be seen.

Structural abnormalities:

Formation of the half vertebra due to the development of only one part of the vertebra.

Fusion of the vertebral bodies, which results in disruption of the segmental structure of the spine.

Rib merger

The figure shows the spine of a healthy child as well as a child with congenital scoliosis

In congenital scoliosis, abnormalities of the spinal cord (41%), heart (7-12%), and kidneys (20%) also occur.

Neuromuscular scoliosis

Neuromuscular scoliosis is the result of abnormalities in the brain, spinal cord and muscles. Nerves and muscles can’t maintain the balance of the body, resulting in a curvature of the spine.

Neuromuscular scoliosis is often accompanied by pelvic asymmetry, in which the child has one part of the pelvis higher than the other. In these patients, the curvature progresses further with age, and particularly severe in people who lead sedentary lifestyles. Neuromuscular scoliosis is more common in diseases such as:

• Cerebral paralysis
• Spinal muscular atrophy
• Angelman syndrome (“happy doll syndrome”)
• Arnold-Chiari malformation and spinal cord injury

Degenerative scoliosis

Degenerative scoliosis occurs in mature individuals. It is caused by osteoporosis, which leads to curvature of the spine, as well as degeneration of the intervertebral discs and arthrosis of the small joints of the spine. Reduced spacing between the vertebrae due to disc compaction leads to asymmetry, and in some cases to the displacement of the vertebrae in relation to each other. This misalignment is most commonly seen in the lumbar spine.

Thoracogenic scoliosis

As the name of the pathology indicates, this type of scoliosis develops as a result of damage and surgery to the thoracic part of spinal column. Surgeries performed to correct congenital heart defects and malignant lymphoma, which progresses over time, can also lead to the development of spinal curvature.

Syndromic scoliosis

A syndrome is an amalgamation of several clinical symptoms. This type of scoliosis is part of such syndromes as:

• Muscular dystrophy.
• Arthrogryposis, Spina Bifida, Marfan syndrome, and Euler-Danlos syndrome
• Neurofibromatosis
• Clippel-Feil syndrome

Diagnostics

Early diagnosis of scoliosis leads to the prevention of the development of deformities and progression of the curvature of the spine. If a patient goes to the doctor with complaints of back pain and curvature of the spine, the patient’s personal and family history should be carefully collected. The patient’s age, the adolescence period and the age of the first menstruation in women should be taken into account, because of they determine the risk of curvature and development of scoliosis.

The comprehensive physical examination of the patient provides information about the health and structure of the patient’s spine. During the examination you should pay attention to: balance maintenance, shoulder and crest height levels of the pelvic bones, curvature of the spinal column, and deformities of the thorax. Perform a “patient” forward tilt test and a tilt test with the patient’s knees unbent in order to detect asymmetry of the vertebral column. If a convexity is detected, the angle should be measured with a Scoliometer. A thorough examination of the spinal cord and nerves should also be performed, checking muscle strength and sensitivity, normal and abnormal reflexes.

X-Ray

If signs of scoliosis are detected during the clinical examination, an X-ray is taken at the doctor’s instruction. In order to determine the degree of curvature of the spine, the examination is done in frontal and lateral projections. The patient must be standing during the examination, and the skull and pelvic bones must be visible on the x-ray picture. After evaluating the x-ray, the doctor determines if there are congenital abnormalities, degenerative changes, and measures the angle of curvature.

Measurement of scoliosis angle

The degree of curvature of the spine is measured using the “Cobb method”. In order to diagnose scoliosis, the curvature must exceed 10 degrees. A curvature of less than 10 degrees is not scoliosis, but is considered asymmetry of the spine.

A distinction is made between mild, moderate, and severe degrees of scoliosis.

Light degree – the level of curvature is less than 20 degrees.

Intermediate degree – the level of curvature is 20-40 degrees.

Severe degree – the level of curvature is more than 40 degrees.

MRI

If severe back pain and neurological abnormalities are detected, an MRI of the spinal column should be performed. It is necessary to find out whether the patient has spinal cord damage.

CT scan

Patients who are preparing for surgery should definitely have a CT scan. Once the results are available, the distance between the vertebrae should be measured and the locations of the screws should be determined.

Treatment

Observation

When a patient is found to have mild scoliosis, or idiopathic scoliosis is detected, the best method of treatment is observation. The patient is advised to come in for a follow-up examination after 4-6 months. Along with this, it is advised to do exercises for the back, physiotherapy and swimming. For moderate scoliosis in children aged 10-15 years, it is recommended to wear an individually selected corset, physiotherapy and physical exercises.

Corset

It is used in adolescents with a curvature angle of 20-40 degrees. Wearing a corset for 16-20 hours during the day, significantly reduces the risk of surgery. With congenital scoliosis, wearing a corset is not recommended because these curvatures are not elastic. Using a corset with this curvature can lead to tissue damage, chest deformities, and impaired lung function.

Surgery

If accelerated progression of the curvature is detected during observation, and if wearing a corset doesn’t improve the situation, then surgical intervention should be performed.

In congenital and syndromal scoliosis, surgical treatment is mandatory. Diagnosis of congenital scoliosis should be very careful. Parents should consult a doctor immediately when changes in the cervical, thoracic and lumbar spine are detected. Early surgical treatment leads to good results.

We use the latest methods for surgical treatment. With transpedicular fixation of the spine, scoliosis is corrected in all three projections. During surgery we use neuromonitoring to prevent any damage. Patients return to normal life 1 month after surgery. After the surgery, the patient can bend forward and pick things up from the floor. Women after surgery can get pregnant and become a mother. There are no contraindications for this.

If you go to the video below, you can watch the report about scoliosis provided by orthopedic trauma surgeon Dr. Elviz Gasimov.