Causes and Symptoms of Scoliosis

Causes

• Idiopathic scoliosis: No known cause, accounts for 80% of cases
• Congenital scoliosis: Abnormalities present at birth, such as vertebral defects
• Neuromuscular scoliosis: Conditions like cerebral palsy, muscular dystrophy, and spina bifida
• Degenerative scoliosis: Age-related wear and tear on the spine
• Injury or infection: Trauma or infections like osteomyelitis or discitis

Symptoms

• Visible curvature: Asymmetrical waistline, uneven shoulders, or prominent ribs
• Back pain: Mild to severe, often worse at night or with activity
• Respiratory issues: Shortness of breath, coughing, or fatigue due to lung compression
• Neurological symptoms: Weakness, numbness, or tingling in the legs
• Poor posture: Leaning forward or to one side

Diagnosis

• Physical examination: Visual inspection, palpation, and range of motion tests
• Imaging studies: X-rays, CT scans, or MRI to assess curvature and spinal alignment
• Cobb angle measurement: Degree of curvature, with 10-20° considered mild, 20-40° moderate, and >40° severe
• Scoliometer measurement: Degree of trunk rotation or asymmetry

Treatment Options

• Observation: Monitoring for progression in mild cases
• Bracing: Rigid or soft braces to stabilize and correct the spine
• Physical therapy: Stretching, strengthening, and postural exercises
• Pain management: Medication or alternative therapies for back pain

Surgical Interventions

• Spinal fusion: Fusing vertebrae together to stabilize the spine
• Instrumentation: Implanting rods, screws, or hooks to correct curvature
• Vertebral column resection: Removing segments of the spine to correct severe deformities
• Minimally invasive surgery: Less invasive approaches to reduce tissue damage and scarring

Causes of Scoliosis

• Idiopathic scoliosis accounts for 80% of cases, with no known cause
• Congenital scoliosis results from vertebral defects present at birth
• Neuromuscular scoliosis is associated with conditions like cerebral palsy, muscular dystrophy, and spina bifida
• Degenerative scoliosis occurs due to age-related wear and tear on the spine
• Injury or infection, such as osteomyelitis or discitis, can also cause scoliosis

Symptoms of Scoliosis

• Visible curvature of the spine, resulting in an asymmetrical waistline, uneven shoulders, or prominent ribs
• Back pain, ranging from mild to severe, often worsened at night or with activity
• Respiratory issues, including shortness of breath, coughing, or fatigue, due to lung compression
• Neurological symptoms, such as weakness, numbness, or tingling in the legs
• Poor posture, characterized by leaning forward or to one side

Diagnosis of Scoliosis

• Physical examination involves visual inspection, palpation, and range of motion tests
• Imaging studies, including X-rays, CT scans, or MRI, are used to assess curvature and spinal alignment
• Cobb angle measurement determines the degree of curvature, with 10-20° considered mild, 20-40° moderate, and >40° severe
• Scoliometer measurement assesses the degree of trunk rotation or asymmetry

Treatment Options for Scoliosis

• Observation is recommended for mild cases, with monitoring for progression
• Bracing involves the use of rigid or soft braces to stabilize and correct the spine
• Physical therapy includes stretching, strengthening, and postural exercises
• Pain management involves medication or alternative therapies for back pain

Surgical Interventions for Scoliosis

• Spinal fusion involves fusing vertebrae together to stabilize the spine
• Instrumentation involves implanting rods, screws, or hooks to correct curvature
• Vertebral column resection involves removing segments of the spine to correct severe deformities
• Minimally invasive surgery reduces tissue damage and scarring

Classification of Scoliosis

• Idiopathic scoliosis: unknown causes
• Congenital scoliosis: present from birth
• Neuromuscular scoliosis: occurs due to other neuromuscular conditions

Types of Curvatures

• Lordosis: curvature of the spine
• Kyphosis: curvature of the spine
• Scoliosis: rotational and lateral curvature of the spine
• Structural scoliosis: involves rotated and malformed vertebrae
• Functional scoliosis: more common type, caused by poor posture, muscle spasms, or unequal leg length

Types of Scoliosis

• Thoracic scoliosis
• Lumbar scoliosis
• Thoraco-lumbar scoliosis
• Combined scoliosis

Diagnostics

• Adam's forward bend test
• X-ray
• Spinal radiograph
• CT Scan
• MRI (Cobb method)

Management

• Monitor progression of curvature
• Assess emotional status
• Braces for growing children
• Physical therapy (Schroth method)
• Promote mobility, prevent injury and skin irritation
• Promote positive body image and compliance to treatment
• Pain management (NSAID, massage, injections, nerve blocks, epidural steroid injections, radiofrequency)
• Surgery

Treatment Options

• Schroth method: a physical therapy approach tailored to each patient's spine curvature
• Electrical stimulation: an alternative to bracing for mild to moderate curvature
• Scoliosis brace: worn under clothing to improve curvature
• Localizer cast: holds the curve and prevents progression
• Halo traction: used for severe spinal curvature and cervical instability
• Pedicle screw instrumentation: used for children with growth potential
• Spinal fusion: helps support vertebrae fusion
• Growing rods: used without fusion until combined posterior and anterior fusion can be done