Scoliosis

Structural Scoliosis

a fixed curvature of the spine associated with vertebral rotation and asymmetry of ligamentous supporting structures. Possible causes of this type of scoliosis include vertebral body deformities (sometimes congenital - i.e., wedge deformities, rib deformities); musculoskeletal (i.e., osteoporosis, RA); neuromuscular (i.e., CP, polio, spina bifida, MD); and idiopathic (of unknown origin).

diagnosis of scoliosis

can be made through examination using Adam's forward bend test and measured with inclinometer. In this case, functional scoliosis straightens during forward bend. Examination should include a comparison of leg length to understand if scoliosis is related to a leg length discrepancy, and an examination of any other asymmetries across the two sides of the body, such as level pelvis and shoulders. An examination of sacral area for hair patches, nevi, pits, or abnormal skin pigmentation in midline will provide information about any unusual signs of underlying spinal abnormalities (such as spina bifida).

functional (postural) scoliosis

caused by factors that are not vertebral. Causative examples include pain, poor posture, leg-length discrepancy, or muscle spasm. In these cases, scoliosis is resolved when the cause of the functional scoliosis is remedied. If the functional problem persists and is not addressed, the scoliosis may become structural over time.

pathogenesis of scolioisis

depends upon cause of scoliosis. Congenital scoliosis is possibly the result of abnormal embryonic formation and segmentation of spinal column; whereas, neuromuscular scoliosis is probably an imbalance or asymmetry of muscle activity through trunk and along the spine.

neuromuscular scolosis

myopathic and neuropathic cases

pathogenesis of idiopathic scoliosis

the origin is uncertain. It is speculated that changes occur in soft tissue as muscles, ligaments, and other tissues are shortened on concave side of curve. Differences in length-tension relationships may set up abnormal forces across the spine (muscles along convexity are lengthened and those along concavity are shortened). Over time, bony deformities occur with compression forces on one side apply asymmetrical forces to epiphyseal ossification centers (increased bone density on the side with greatest compressive force).

incidence of scoliosis

•0.4%-5.5% of children present with scoliosis •Incidence increases with associated neuromuscular impairments

what is Scoliosis

•Abnormal lateral curvature of the spine •Direction is designated according to side of convexity •Accompanied by rotation of vertebral column around axis

prognosis of scoliosis

•Functional (postural) curves •resolve when cause of scoliosis is remedied •<40 degrees at skeletal maturity •low risk of progression •>50 degrees unstable spine

types of scoliosis

•Idiopathic •Osteopathic •Myopathic Neuropathic

age of onset for scoliosis

•Infantile onset (0-3 y) •Juvenile onset (3-10 y) •Adolescent onset (10y - bone maturity) •Adult onset (after bone maturity)

clinical manifestations of scoliosis

•Mild (<20 degrees) •rarely cause problems •Severe (>60 degrees) and untreated •pulmonary insufficiency •back pain •degenerative spinal arthritis •disk disease •vertebral subluxation •sciatica