Scoliosis Symptoms, Diagnosis and Treatment

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Scoliosis

  • Idiopathic Scoliosis
  • Adult Scoliosis
  • Neuromuscular Scoliosis
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Idiopathic Scoliosis

Idiopathic scoliosis develops in childhood and is classified according to the age of onset of scoliosis. It is generally classified as Early Onset Idiopathic Scoliosis (EOS) and Late Onset Idiopathic Scoliosis (LIS). Early-onset scoliosis consists of infantile scoliosis (birth to 3 or 4 years of age) and Juvenile scoliosis (4 to 9 years of age). Late-onset scoliosis is also called adolescent idiopathic scoliosis.

Adolescent scoliosis typically begins between the ages of 10 and 18. The period of rapid growth in children occurs from the moment of birth until the age of three or four and again in adolescence. Scoliosis progression reflects this growth pattern, with rapid curve progression during infancy (0-3 years), followed by slower progression during adolescence (4-9 years) and another rapid progression phase (10-18) in adolescence. The earlier the age of onset of scoliosis, the more progressive it can become.

Infantile Scoliosis

Infantile Scoliosis develops between birth and 3 years of age. Most of the curves in this age group can be resolved over time with molding. However, those that do can progress quickly and be difficult to manage. Scoliosis in this age group can also be caused by congenital defects of the spine called congenital scoliosis. Defects are malformed or partially formed vertebral bodies that can cause the spine to grow unevenly and result in scoliosis. Progressive scoliosis in this age group can cause significant lung problems due to the lack of normal lung development.

Juvenile Scoliosis

Juvenile Scoliosis develops in the 4-9 age group. Some curvatures in this age group can also be corrected with corset treatment. However, patients with this type of scoliosis may also have rapid progression leading to severe scoliosis. Congenital defects can also cause scoliosis in this age group. This group of patients is treated similarly to those in the infantile group. An MRI may be recommended to evaluate congenital defects of the spine and spinal cord. Progressive scoliosis in this age group can also cause significant lung problems due to the lack of normal lung development.

Adolescent Scoliosis (10 to 18 years)

Adolescent scoliosis develops during the pre-adolescent and teenage years. It is more common in women. It usually becomes evident during the growth spurt in adolescence. Unlike Infantile and Juvenile idiopathic scoliosis, the lungs usually develop at this age and lung problems are not as severe unless the scoliosis is larger (80 degrees). The most common type affects the thoracic spine (upper spine, rib cage).


Complaints

Idiopathic scoliosis is usually painless. It is often detected by parents or pediatricians who first notice the asymmetry of the spine. A protuberance or bump may develop in the affected spine area and may be the first sign or symptom of scoliosis.

Scoliosis Diagnosis

School nurses, pediatricians, and parents are often the first to detect scoliosis. Scoliosis is familial, meaning it runs in families, and parents with a history of scoliosis should screen their children for scoliosis.

The bending test is used to detect the asymmetry of the spine.

This is accomplished by having a child bring their hands together and bend the waist while lying on the floor.

If you have scoliosis, there will be a bulge on one side of the spine.

If scoliosis is suspected, x-rays are taken to evaluate.

The Cobb Angle is measured. Cobb angle is very important in the follow-up of the curvature of scoliosis.

It should be checked by taking a digital whole spine x-ray every 6 months.

An MRI may also be used to evaluate the spinal cord and vertebral bodies to detect any congenital defects that may be present.

Treatment

Early Onset Idiopathic Scoliosis (birth to 9 years of age)

Treatment recommendations are determined by the age of the patient and the severity of the scoliosis. In general, the younger the patient, the higher the chance of scoliosis progressing. If the curve is small, observation may be the first form of treatment.

Adolescent Idiopathic Scoliosis

Treatment recommendations depend on the extent of the curvature and the age of the child. Scoliosis progresses with growth. The larger the scoliosis and the younger the child, the greater the chance of the curvature progressing. If a child is 10 years old and still has not fully grown in height, treatment should be started as soon as possible.

Bracing is generally recommended for curves in the 25 to 35 degree range. If the curve reaches 50 degrees in a growing child, surgical treatment may be recommended. This recommendation is based on the knowledge that curves in this range have a better chance of progressing and that height growth may continue to progress into adulthood.

Treatment is typically screw and rod placement, straightening and fusion. The rods help reduce the extent of the curvature and prevent its progression as the body fuses the vertebral bodies into one piece. This happens through a process very similar to the healing of a broken bone. Most patients can return to their normal activities one year after surgery.

Adult Scoliosis

Scoliosis is defined as a 10-degree curvature of the spine. Adult scoliosis is generally defined as a curve of 10 degrees or more in your spine in a person 18 years of age or older. Adult scoliosis is divided into 2 general categories:

Adult Idiopathic Scoliosis patients have had scoliosis since childhood or adolescence and have grown into adulthood. We do not yet know the cause of idiopathic scoliosis, but there are numerous genetic studies to answer this question.

Adult "De Novo" or Degenerative Scoliosis develops in adulthood. Degenerative scoliosis develops as a result of disc degeneration. As the disc degenerates, it loses height. If one side of the disc deteriorates faster than the other, the disc will begin to warp.

As you bend, more pressure is placed on one side of your spine, and gravity causes the spine to bend and curve. The more discs degenerate, the more the spine begins to bend.

Symptoms

Both types of adult scoliosis can progress over time. If the curves reach 30 to 40 degrees, the deformity can be noticed by a hump or protrusion in the area of ​​​​the spine involved. Curves of 50 degrees or more can progress faster than curves of less than 50 degrees.

Adults with large bends may have symptoms of back pain and may complain of shortness of breath with activity if it rises above 80 degrees in the thoracic spine. Shortness of breath results from the effect on lung function.

Rarely, adult scoliosis alone causes paralysis or other serious neurological problems, but if accompanied by lumbar stenosis (narrowing of the spinal canal or the tube where the nerves are located), leg pain and muscle weakness may occur due to pressure on the nerve.

Patients may also develop a forward-leaning posture and be unable to stand upright. This condition can occur with scoliosis and as you age because the discs degenerate. This is also called a lying spine.

Diagnosis

Scoliosis can be recognized and diagnosed with a clinical examination, but x-rays are necessary to fully assess the size and type of scoliosis present. A full-length, entire spine X-ray should be taken for an appropriate scoliosis assessment. An MRI should also be performed if there are symptoms of leg pain that may be associated with the stenosis, or if there is possible spinal cord compression or abnormalities.

Treatment

Treatment of adult scoliosis is very individual and depends on the specific symptoms and age of the patient. Many patients have scoliosis and have very minor symptoms and live with it without treatment. Patients with predominant symptoms of low back pain are typically treated with physical therapy. Patients with back pain and leg pain may find some benefit from injection therapy to help relieve leg pain.

If there is lumbar stenosis (narrowing of the spinal canal) and does not respond to non-surgical treatment, decompression (removal of bones and ligaments pressing on the nerves) may be recommended. If the scoliosis is greater than 30 degrees, a fusion procedure with decompression will likely be recommended. Fusion is recommended to prevent progression of the curvature when the spine becomes unstable by removing the bone needed to decompress the nerves.

Fusions are often accompanied by the insertion of metal rods and screws into the spine to correct and stabilize the scoliosis and to help the bone heal or fuse. The length of the fusion, or the number of spine levels involved, depends on the type of scoliosis and the area of the spine involved. The aim of adult scoliosis surgery is to first remove the pressure on the nerves, and secondly, to prevent further progression of the scoliosis.

Neuromuscular Scoliosis

Neuromuscular scoliosis develops as a result of an imbalance in the muscle and nerve pathways of the spine. This type of scoliosis progresses more frequently than other types of idiopathic scoliosis. The corset does not prevent the progression of the curvature and the curvatures are more severe in patients who cannot maintain their balance.

The underlying disorders that develop neuromuscular scoliosis include:

  • cerebral palsy
  • myelodysplasia
  • spinal cord muscle atrophy
  • Freidreich's ataxia
  • Duchenne muscular dystrophy
  • traumatic paraplegia

Adults can also develop neuromuscular scoliosis with disorders such as Parkinson's Disease and Multiple Sclerosis.

Symptoms

Neuromuscular scoliosis is typically painless unless it develops into a very large curvature. The first signs of scoliosis may be a change in posture, which means that the patient leans forward or to the side while standing or in a wheelchair. Patients in a wheelchair may not be able to sit upright in the chair and may slump to one side. Walking patients may have difficulty standing and may begin to bend over while walking.

Diagnosis

Diagnosis is made by clinical examination and a long, complete, spine X-ray. X-rays will typically show an elongated C-shaped scoliosis that affects the entire spine.

Treatment

Surgical treatment is indicated in patients with a Cobb angle greater than 50 degrees, progressive curvatures, inability to sit in a wheelchair, pain and cardiopulmonary problems. Smaller curves can be treated by molding the wheelchair to help correct it.

If surgery is required, the procedure is typically a long fusion with rod and screw instrumentation.

Neuromuscular scoliosis usually affects the entire spine and requires a longer rod and fusion to properly treat and prevent further deformity. The aim of the treatment is to stop the progression of scoliosis if the patient is confined to a wheelchair and to improve his/her walking balance if the patient can walk.

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Comments

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