Introduction
Scoliosis refers to an abnormal curvature of the spine, characterized by side-to-side deviations that may also involve rotational changes. A healthy spine typically displays natural curves from front to back. Scoliosis can be present at birth or develop due to neuromuscular disorders, osteoporosis, or for unknown reasons, termed idiopathic scoliosis. The condition can progress over time, and untreated severe cases may lead to significant health complications. Treatment options include monitoring, back bracing, or surgical interventions.
Anatomy
A child’s spine consists of a series of vertebrae organized into different regions based on curvature and formation. The spine features natural front-to-back curves, supported by ligaments and muscles that provide stability and enable movement. The cervical spine comprises seven small vertebrae in the neck, while the thoracic spine consists of twelve vertebrae in the chest area. The lumbar spine, located at the waist, has five larger vertebrae. The lower vertebrae may be fused or uniquely shaped in conjunction with the hip and pelvis bones.
Causes
Scoliosis results from an abnormal sideways curvature of the spine. This condition can arise from various factors, including congenital deformities such as malformed vertebrae, unequal leg lengths, or fused ribs. Neuromuscular conditions—like cerebral palsy, muscular dystrophy, spina bifida, and polio—can lead to muscle weakness or paralysis, increasing the risk of scoliosis. When the cause is unknown, it is classified as idiopathic scoliosis, which commonly develops during growth spurts in children. Adults may experience scoliosis due to degenerative changes in the spine, often associated with osteoporosis.
Symptoms
Individuals with scoliosis may notice a noticeable curvature of the spine, leading to uneven shoulders or hips. This condition can cause one side of the body to lean, with protruding shoulder blades. Symptoms may also include back pain and fatigue, while severe curvatures can result in breathing difficulties or pressure on the spinal cord and nerves. Additionally, arthritis in the spine may occur as a person ages.
Diagnosis
Diagnosis begins with a comprehensive medical history and a physical examination of the spine, including a neurological assessment of the limbs. X-rays are essential for visualizing the spine's curvature and measuring its degree. In some cases, advanced imaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT) scans may be employed for more detailed insights.
Treatment
Curvatures measuring less than 20 degrees typically require regular monitoring without treatment. For curvatures between 25 and 30 degrees, back bracing may be recommended. Various types of braces apply pressure to help realign the spine, especially in children with idiopathic scoliosis who are still growing. However, bracing is generally less effective for congenital or neuromuscular scoliosis.
Surgery
For curves exceeding 40 degrees, surgical intervention is often necessary due to the high risk of further deterioration and associated complications. Spinal fusion surgery aims to correct the spinal curvature by fusing vertebrae together using surgical hardware, such as rods and screws. A back brace may be required during the healing process, and additional surgeries might be needed over time.
Recovery
Recovery from bracing or surgical procedures is highly individualized and influenced by factors such as the degree of curvature, age, and any pre-existing medical conditions. Your healthcare provider will guide you on what to expect during the recovery phase.
