Scoliosis. A deformity of the spine

Changes in the natural curvature of the spine.

In scoliosis, the natural curvature of the spine changes.

In scoliosis, the natural curvature of the spine changes.

Deviations of the natural curvature of the spine often changes the lives of affected people. Pain during movements, problems wearing tight-fitting clothes and sometimes unsettling looks from friends or work colleagues characterize everyday life. Patients with a pathological curvature of the spine, also known as scoliosis, often suffer from various facets of their spine disease.

A healthy spine has to guarantee a predefined structure, to ensure optimal performance of their duties as a central locomotor organ of the body. In the rear view, the so-called frontal plane, the healthy spine is straight up and without rotation of the vertebrae against each other. In the side view, the profile usually shows a double S-shape. In each case, the cervical and lumbar spine are curved forward (lordosis) and the thoracic spine and the coccyx backward (kyphosis).

 

Why the spine is S-shaped?

The special shape of the spine allows the cushioning of vibrations that occur during movement. In addition to these normal and necessary curvatures of the spine, also deformities, especially scoliotic changes, can be found - the spine deviates from its natural form.

 

Disease, symptoms & causes of scoliosis at a glance.

Definition. What is a scoliosis?

What is meant by scoliosis?

The deviations of the spine from the straight mid line can be clearly seen in the centre and on the left. On the right the spine is normal.

The deviations of the spine from the straight mid line can be clearly seen in the centre and on the left. On the right the spine is normal.

Scoliosis (derived from the Greek word „skolios = crooked&Idquo;) is in almost all cases a growth deformity of the spine, i.e. during growth in childhood and / or during the teenage years a pathological, multidimensional curvature of the spine occurs. The guiding and quintessential mark of the severity of scoliosis is the lateral curvature of one or several sections of the spine in the frontal plane. The deviation from the straight mid line can be clearly seen by looking at the back from behind. At the same time however this curvature is also associated with a more or less marked twisting of the vertebrae around their own axes (malrotation) and frequently also a deviation from the normal profile of the relevant sections of the spine. This makes scoliosis at least a two-dimensional and also frequently a three dimensional deformity.

 

Deviation of the spine's natural shape.

Individual or even several vertebrae and the related intervertebral discs, ligaments and joints of the scoliotic section of the spine are not only twisted towards each other, but also deformed and therefore no longer show their natural form. The deformation of the individual vertebrae are called torsion or twisting. These anatomical changes cause progressive curvature with increasing stiffness of the affected section of the spine, with the sufferer no longer being able to correct the malposition of the particular section of the spine on his own. Because of the torsion of the vertebrae in the cervical spine area, the ribs typically protrude backwards on the convex side of the scoliosis curve, (called „rib hump") as a result of the ribs being attached to the vertebrae. On the opposite side and analogous with this there is a flattening of the ribs forming the rib cage, the so-called „rib valley".

 

How frequent is the incidence of scoliosis?

The data on the incidence of the condition is subject to a broad variation ranging from 1% to 15%. The reason for this relates to the different criteria each examiner uses with respect to the smallest angle of curvature that is considered abnormal. Today 10 degrees is considered the minimum angle for a diagnosis of scoliosis to be made. As a consequence of concurring data from a large number of school medical examinations, the frequency of an angle of curvature of > 10° is given as approximately 2%. In general it is true that slight scoliosis with smaller angles of curvature occur obviously more frequently than higher grade scoliosis or scoliosis requiring treatment or even surgery.

 

Symptoms. Signs & discomforts of a scoliosis

What symptoms can occur in scoliosis?

The set of symptoms in patients with scoliosis depends among other things on how marked the symptoms are i.e. on the degree of severity of the condition. The more marked they are the more severe also the impairment may be. In childhood or the teenage years, scoliosis rarely causes physical symptoms. However really early on there is measurable limited lung function, even if the patient is not aware of this himself. However often even in the teenage years the deformation and asymmetry of the body can be cosmetically disfiguring, which often results in not inconsiderable psychological and/or psychosocial disadvantage. Patients are ashamed of their appearance and avoid for example visiting swimming pools.

 

When and why do physical symptoms occur?

Physical symptoms such as backache do not usually occur until adulthood.

Physical symptoms such as backache do not usually occur until adulthood.

Physical symptoms usually only occur in adulthood. Because of continuous incorrect posture and poor physiological loading, back pain occurs more and more because of the progressive changes in the spinal column caused by wear and tear together with overload of the stabilising musculature. Furthermore increasing stiffness in the curvatures can lead to limited mobility. Severe curvature of the spine causes deformity and shortening of the torso and therefore also leads to a reduction in the thoracic and abdominal cavities. In the most severe cases of scoliosis the internal organs such as the lungs, heart or abdominal organs can also be restricted perceptibly in their functions, which for instance can cause breathlessness or heart problems because of right heart strain.

 

Causes. How does scoliosis develop?

How does scoliosis develop?

There are various causes of scoliosis. It is vital here to differentiate between so-called idiopathic scoliosis and those types of scoliosis which develop because of a known underlying disease. Known causes can for instance be congenital malformations of the vertebrae. Other reasons are certain diseases of the muscles or nerves and certain diseases of the connective tissue and metabolic disorders. The most frequent causes of such scoliosis are:

  • Congenital types of scoliosis - e.g in the case of half, cuneiform or block vertebrae 
  • scoliosis in muscular or neurological disorders (neuromyopathic scoliosis) -  e.g. because of amyotrophia, paralysis, the consequences of infantile lack of oxygen
  • scoliosis in diseases of the connective tissue -  e.g. Marfan- Syndrom
 

Usually the cause of scoliosis is unknown.

The predisposition to scoliosis can also be genetic, according to recent studies.

The predisposition to scoliosis can also be genetic, according to recent studies.

In most cases in this country however (> 80%) the cause is unknown and then it is called idiopathic scoliosis. This type of scoliosis is what is known as growth deformity, i.e. it develops in childhood and the teenage years and mostly progresses during the phases of the greatest physical growth, i.e. in particular during puberty. Girls are around 7-8 times more frequently affected than boy by idiopathic scoliosis requiring treatment with the exact causes are still unknown. The latest genetic tests on idiopathic scoliosis patients suggest that certain „chromosomal markers“, i.e. certain protein structures form the characteristics of our genetic make-up and are responsible for the development of idiopathic scoliosis.

 

Classification of idiopathic scolioses.

Therapy for scolioses requires the knowledge about its natural progression. This is particularly important for an optimum evaluation of the likelihood that the scoliosis will progress and for starting in good time any necessary treatment measures as a result of the evaluation. Therefore it is important to recognise the start of scoliosis because the earlier in childhood or adolescence idiopathic scoliosis occurs, the more time is left for progressive incorrect growth during this time of growth. The earlier progressive scoliosis occurs, the less favourable the prognosis.

 

Classification according to the time of the occurrence of the idiopathic scoliosis.

  • Infantile idiopathic scoliosis: 0. - 3. year of life
  • juvenile idiopathic scoliosis: 4. – 10th year of life
  • Adolsescent idiopathic scoliosis: 11. 11th year of life until growth has finished
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Different types of scoliosis are differentiated all depending on which section of the spine is affected.

 

The most frequent types of scoliosis.

  • Thoracic scoliosis: In the region of the thoracic spine
  • Lumbar scoliosis: In the region of the lumbar spine
  • Thoracolumbar scoliosis: Transition area between the thoracic and lumbar spine
  • Thoracic and lumbar (double curvature) scoliosis: Thoracic and lumbar spine regions

All depending on the direction of the spinal curvature, differentiation is made between a left-sided rib hump (left-sided convex) scoliosis and a right-sided rib hump (right-sided convex) scoliosis. At the same time the spine, in addition to the major curve itself, also forms compensatory curves on the opposite side to the major curve located above or below it. This happens to allow an overall plumb line posture i.e. the body tries spontaneously to centre the head above the pelvis by the formation of compensatory curves.

 

Scoliosis. Therapy

How is scoliosis treated?

Treatment

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