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What is Scoliosis

Scoliosis is described as a progressive 3-dimensional curvature of the spine into sideway bending and twisting with Cobb angle more than 10 degrees.

In a normal spine when seen from the back through to the front, there is no or slight sideway curve of the spine over no more than than 10 degree. This curve angle is referred to as the Cobb angle. (see Measuring the Cobb Angle)

The abnormal curvature can occur at either the upper back (thoracic spine), middle back (thoracolumbar area), lower back (lumbar spine) or in combination. Depending on area of curvature, the clinical presentation will differ.

If the curve arises at Appearance
Upper Back (nearer the neck or upper thoracic spine) Uneven shoulder level (shoulder tilted and twisted), shoulder blade looks more prominent at one side (scapula winging).
Upper Mid-Back (lower thoracic spine) Shoulder tilted, the thoracic spine will twist to the opposite side.
Lower Mid-Back or thoracolumbar spine Sideway bending of the spine with or without shoulder tilt/twist and thoracic spine twist.
Low-Back (Lumbar spine) Sideway bending and trunk shift to the side leading to uneven level of the pelvis, uneven leg length (leg length discrepancy).

 

Examples of Curves

Apart from the abnormal curvature of the spine, this deformity can cause psychological distress (example, decrease self-esteem due to their “uneven” posture), physical disability (example, leg length discrepancy can lead to abnormal walking pattern) if it is left untreated.

Other physical issues will include tight muscles at some areas whilst having weak muscles at other areas, stiff joints and nerves, poor movements and poor postural orientation that can lead to neuro- musculoskeletal pain (such as low back pain, hip pain) in the long run.

What are the causes of Scoliosis?

There are many causes of Scoliosis and they are mainly contributed by congenital, developmental or degenerative conditions. However, most causes of Scoliosis still remain unknown; this is known as Idiopathic Scoliosis. Though recent studies suggest that it is genetic in nature.

Who are at risk of having Idiopathic Scoliosis?

Idiopathic scoliosis starts during the childhood phase. It is usually categorized into three main groups

  1. infantile scoliosis (from birth to 3 years old),
  2. juvenile scoliosis (from 3 to 9 years old) and
  3. adolescent scoliosis (from 10 to 18 years old).

Most idiopathic scoliosis cases develop during the adolescent stage. The progression of the curve usually occurs during puberty when the growth rate speeds up.

Girls and boys have about the same chance of getting Idiopathic Scoliosis. Unfortunately, girls are more prevalent in having curvature that is more likely to progress.

How is idiopathic scoliosis diagnosis?

There are many medical tests to diagnose idiopathic scoliosis:

  1. Postural observation that looks at the clinical presentation of the body. For example, possible tilt/ twist of the shoulder, shoulder blade prominence, curvature of spine, level of the pelvis, leg length discrepancy etc.
  2. Adam’s forward bend test – One of the most common test used. The client bends his back over with both hands together. Elevation on one side of the rib cage higher than another will denote presence of scoliosis.
  3. Trunk rotation angle using a scoliometer – a tool to measure the amount of rotation.
  4. Trunk lateral shift using a plumb line – to measure the side shift from the trunk with respect to the pelvis.
  5. X-rays taken at the pelvis and hand to identify the bone maturity. This helps the prognosis of the scoliosis. X-rays taken of the side and back of the spine are crucial for classification of the scoliosis that is important for treatment.

Is it reversible?

The prognosis of the idiopathic scoliosis depends mainly on a few factors which include amount of Cobb’s angle and stages of bone maturity.

The smaller the cobb’s angle, the better the prognosis of the outcome.

Stages of bone maturity play an important role in determining the aim of the treatment.

  • If the idiopathic scoliosis is identified before main growth spurt, it is possible to reverse the curvature.
  • If the idiopathic scoliosis is identified during/ after the main growth spurt, the aim of the treatment is to reduce/ stabilise the curvature.
  • If the idiopathic scoliosis happens in an adult who is when the bones are all matured, the aim of the treatment will aim to reduce neuro-musculoskeletal pain contributed by the abnormal curvature.
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