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Scoliosis

life science Maturity 7-9 Next article →

Scoliosis is a medical condition defined by a three-dimensional deviation in the axis of the spine. Instead of a straight line, the spine develops an irregular curve in the coronal plane, which is the left-right plane of the body. These curves usually appear as S-shaped or C-shaped patterns across three dimensions.

Braus 1921 84
Braus 1921 84

While mild cases often do not cause significant problems, severe curves can impact a person's ability to breathe or move. In adults, the condition often leads to back pain that may worsen with age. Because severe progression can alter a person's daily life, it is sometimes considered a disability.

Doctors classify scoliosis into different types based on the nature of the curve. Structural scoliosis occurs when the spinal curve is fixed in place. In contrast, functional scoliosis occurs when the underlying spine is actually normal.

There are also specific categories based on when the condition begins. Early-onset scoliosis develops before age ten, which can sometimes be a life-threatening condition due to its effect on pulmonary function. Adolescent idiopathic scoliosis develops after age ten and is the most common form. Degenerative scoliosis, or de novo scoliosis, develops later in life due to age-related changes in the vertebral column.

Understanding the causes of scoliosis requires looking at several different factors. Approximately 65% of cases are idiopathic, meaning the exact cause remains unknown. About 15% of cases are congenital, which means the spine malformed during weeks three to six in utero. This can happen due to a failure of formation or segmentation of the vertebrae. Another 10% of cases are secondary to neuromuscular diseases. In these instances, a loss of muscular support causes the spinal column to be pulled in abnormal directions.

Research into the origins of idiopathic scoliosis suggests a complex, multifactorial process. Scientists believe that about 38% of the variance in risk is due to genetic factors. The remaining 62% is attributed to environmental factors. While specific genes have not been conclusively identified, studies have found links to genes that manage bone formation and connective tissue. For example, in 2006, researchers linked the condition to the MATN1 gene, which encodes for a cartilage matrix protein. Additionally, some studies report lower bone mass in adolescents with idiopathic scoliosis compared to those without it.

Diagnosis involves a careful physical and neurological examination to rule out other conditions. Doctors may check for signs like skin spots that indicate neurofibromatosis or assess a patient's gait. A common screening method is the Adams forward bend test, where a student bends forward to check for spinal prominence.

Scoliosis cobb
Scoliosis cobb

To confirm a diagnosis, doctors use X-rays to view the spine from both the front and the side. The standard method for measuring the severity of the curve is the Cobb angle. This is calculated by drawing lines perpendicular to the top and bottom vertebrae of the curve.

Scoliosis cobb
Scoliosis cobb

In growing children, doctors may use serial radiographs every 3 to 12 months to monitor the curve.

Scoliosis affects about 3% of the population, though prevalence among adolescents is cited between 1% and 2%. It most commonly develops between the ages of ten and twenty, often during growth spurts near puberty. There is a significant difference in how the condition affects different genders. Females are typically more severely affected than males, with a reported ratio of 4:1.

Milwaukee brace - with neck ring and mandible pad
Milwaukee brace - with neck ring and mandible pad

For those with an adolescent curve measuring less than 20 degrees, the likelihood of the curve progressing is about 10% to 20%.

Treatment strategies are chosen based on the curve's location, cause, and the patient's age. Minor curves may only require periodic observation by a doctor. For larger curves in growing individuals, bracing is a common treatment. A brace must be custom-fitted and worn daily until the patient stops growing.

Scoliosis patient in cheneau brace correcting from 56 to 27 deg
Scoliosis patient in cheneau brace correcting from 56 to 27 deg

Core-focused exercises may also be used to help decrease the risk of the curve worsening. In severe cases, surgery such as Posterior Spinal Fusion (PSF) can be used to correct deformities. This procedure can allow patients to return to physical activities in about six months.

Beyond the spine, scoliosis can cause various physical symptoms. Because the ribs wrap around to the chest, thoracic scoliosis can cause rib prominence or chest pain. In severe cases, the curvature can lead to diminished lung capacity or pressure on the heart. It can also cause constipation if the curvature causes the stomach or intestines to tighten.

Abnormal bone growth
Abnormal bone growth

While some believe that certain supplements or chiropractic manipulation can prevent worsening, evidence for these methods remains weak. However, general exercise is still recommended for its many health benefits.

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🖼️ Images & Media (8)
File:Braus 1921 84.png
Braus 1921 84.png
Yakovlev and thoracal spine asymmetries.pdf
File:Scoliosis cobb.svg
Scoliosis cobb.svg
File:Scoliosis patient in cheneau brace correcting from 56 to 27 deg.png
Scoliosis patient in cheneau brace...
File:Milwaukee brace - with neck ring and mandible pad.jpg
Milwaukee brace - with neck ring and...
File:Diseases of infancy and childhood (1914) (14772101745).jpg
Diseases of infancy and childhood (1914)...
File:The King In The Car Park - Page 15 - Figure 12.png
The King In The Car Park - Page 15 - Figure 12.png
File:Abnormal bone growth.jpg
Abnormal bone growth.jpg
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