Scoliosis

The most frequent abnormalities are: Lumbosacral transitional anomalies Scoliosis Hyperyphosis Hyperlordosis Rectification Spondylolysis Spondylolisthesis Vertebral arthritis Facet arthritis Spinal stenosis Fissure, protrusion and disc herniation Postoperative fibrosis Dislocation of the coccyx Atlantoaxial Dislocation Sprain Whiplash Syndrome

What it is

It is the lateral deviation of the spine.

How it takes place

In more than 85% of people with scoliosis, the cause is unknown. Those are the cases that can be considered as having a primary back condition. Curvature of the spine may also be due to defects of spine formation already present at birth or it may be a sign accompanying general disease, such as muscular dystrophy or Marfan's syndrome.

Symptoms

When observed from behind, a normal spine appears straight, so the back appears symetric. In a spine with scoliosis, a curvature is apparent and one or more of these signs may be seen:

• One hip appears higher or more prominent than the other,
• One shoulder blade ("scapula") is higher or more prominent than the other,
• One shoulder is higher than the other,
• The head is not centered over the hips,
• When standing with the arms hanging at the side, there is more space between the arm and the body on one side,
• When bending forward until the spine is horizontal, one side of the back is higher or more prominent than the other.

Approximately 70% of the population shows a certain degree of scoliosis. A spine deviation of less than 60º could be considered within normal limits and should not cause pain. If pain appears, it is due to other reasons. If the curvature is greater than 60º, it could elicit pain and be considered an organic spine abnormality.

Risk

In the growing adolescent, the degree of curvature may increase, specially among girls. That is why x-rays should be taken periodically in children and adolescents with scoliosis. In those cases, the number of X-rays to be taken must be defined in every case; it must be as few as possible taking into consideration the degree and worsening of the curvature, and the age and sex of the patient.

If scoliosis progresses to 60º or more, it may cause low back pain and require surgery to correct it. In extreme cases where the deviation is even more pronounced, there may be lung or cardio-circulatory problems caused by deformation of the thorax.

Diagnosis

Although for diagnosing scoliosis it is usually sufficient to see the subject from behind with the torso uncovered, plain X-rays are needed to accurately assess the degree of curvature.

Treatment

In more than 90% of cases, the spine deviation is less than 60º and it does not require any treatment.

An adequate exercise program, adapted by a physician to each specific case, is usually sufficient to prevent or treat it. In adolescents with progressive scoliosis, in addition to an exercise program, a corset (or brace) might be necessary. In those cases, muscle atrophy due to the constant use of the corset must be prevented: The corset must be removed as often as prescribed by the physician and the adolescent should exercise or swim while the corset is off. The corset will not make the spine straight, but it may stop the curve's progression in growing adolescents.

In cases of worsening of the spinal deformity, in spite of exercise and the corset, surgery may be necessary. Its goal is to correct the deviation and to prevent its progression. Fortunately, surgery is needed only exceptionally.

The most common surgical procedure is arthrodesis using a variety of metalic devices such as hooks, rods, wires and screws, and a bone graft to fuse the spine, thus correcting the deformity.