Scoliosis is a deviation of the spine which results in a curve. The severity, prognosis and symptoms depend on the magnitude of the curve, the age of onset, and the location and characteristics of the lesion.
Types of scoliosis
Among the main types of scoliosis we can be found:
Idiopathic scoliosis of unknown cause. It is the largest type, for groups 80% of cases. The age of peak incidence is between 10 and 14 years. It is more common in women (80%) than men (20%). The incidence is higher in whites (6%) than the black (2%). It is classified as:
Children if it diagnosed before 3 years of age
Youth, if diagnosed in children between 4 and 10 years
Teenager if diagnosed in over 10 years.
Congenital Scoliosis secondary to malformation of the spine by improper development of the vertebrae before birth
Neuromuscular scoliosis associated with a wide variety of neurological or muscular disorders including cerebral palsy, meningomyelocele, spinal muscular atrophy, muscular dystrophy, etc.
Scoliosis by other causes: trauma, tumors, bone infections, neurofibromatosis, connective tissue diseases.
Scoliosis can also be classified by their location according affect, cervical, thoracic, thoracolumbar, lumbar or cervical spine.
For its laterality, scoliosis may be right or left according to the convexity of the curve.
Finally, scoliosis may have a single master curve or a double major curve.
The attitude scoliosis (lateral deviation of the corrected voluntarily column) is usually due to causes beyond the spine. By correcting these causes, the curvature of the spine is corrected. It is classified in different ways according to their cause. Can be:
Postural: corrected when the patient lies.
Hysterical: it is very rare, has an underlying psychological component.
Compensatory: caused by discrepancies in leg length.
Analgesic: when, for example, a herniated disc, the patient takes a stand called “antalgic posture ‘to try to reduce ache.
Inflammatory neighborhood, for example appendicitis
It is important to address the root causes of scoliosis attitude then, with time; it can be transformed into a structured scoliosis due to shrinkage of the ligaments and joint capsules.
Diagnosis of scoliosis
A reference to school after a routine examination, a family history of scoliosis, a curved back, an asymmetry waist or shoulders, the main question should be: is it a postural or structural deformity?
The most common way to detect scoliosis is by Adams test, which detects the hump (“hump”) sack with trunk flexion in structural deformities. If a difference is found in the length of the lower limbs or pelvic imbalance, these data suggest the possibility of a positional attitude.
Typically, thoracic idiopathic scoliosis curves are straight (right apex vertebra) are left thoracolumbar, lumbar and also left.
Clinical diagnosis of scoliosis
The deformity occurs in both children and adults, but these also expressed the scoliotic curve with pain. Clinical examination should determine the following:
- Dermographism (skin disorders) over the area of the vertebrae to determine the curve
- Shoulder height.
- Toracobraquial angle (relative to the chest and arm)
- Location of the shoulder blades or blades
- Hump or hump in the side view with trunk inclination.
- Height of the iliac crests
- Radiological diagnosis of scoliosis
- The radiological scoliosis series includes:
- Teleradiography (x-ray of the entire column) column standing
Bending test: dynamic radiography supine (lying face up) at maximum right / left lateral tilt to assess the degree of flexibility of the curve
Side of the lumbosacral legion for detecting spondylolisthesis (forward slippage of one vertebra over another, usually a vertebra immediately below or on the sacrum) associated radiography.
Ray of the left hand
Always measure the angle of Lippmann-Cobb to establish the degree of scoliosis curvature after drawing a line on the plate or top surface of the upper end vertebra and another for the lower vertebra of the lower limit, are drawn perpendicular to both . This perpendicular drawn when crossed the angle of the curve. In subsequent scans, measurements must be made available using the same vertebrae. Depending on the magnitude in degrees, mild, moderate, severe, and very severe curves differ.
Actually, severity, and clinical prognosis of scoliosis also depend on the age of onset and the location and characteristics of the deformity.
Treatment of scoliosis
In treatment decisions for vertebral deformities are considered several factors: patient age, severity and location of the curve, etiology (cause) of the same, and the presence of other associated diseases. The basic goals of treatment for scoliosis include:
Monitoring progression until skeletal maturity, in which the stops or considerably limited.
Correction of existing deformity
Avoidance of local or general consequences of the deformity
Treatment by physiotherapy and swimming. Placing a corset is an indication that must be evaluated in each case.
Treatment may lean toward surgery or had a prescription from a Milwaukee brace.
Requiring arthrodesis (surgical fixation of a joint)
Conservative treatment of scoliosis
No conservative treatment has been shown conclusively to have a decisive impact on the development of scoliosis. Some, however, contribute to temporarily correct the curve and above all, serve to prevent progression of the deformity in patients that have not yet reached skeletal maturity and have aesthetically acceptable curves.
The most popular method is the Milwaukee brace, based on the correction principle of support in three areas: a cervical, and an intermediate pelvic thrust immediately beneath and behind the rib area. The three areas are connected by longitudinal bars, which are attached straps necessary to exert pressure. The brace should be used, in principle, for 23 hours a day (the rest of the day is used for washing) and maintained until testing by radiography skeletal maturity.
Corsets limitations are:
They try correcting forces through limited extent since otherwise would cause pain and pressure ulcers.
Such excessive forces are applied to the distance and soft tissue deformity.
They do not consider the three dimensional character of the curve.
Rarely keep patients (in a particularly sensitive phase of their emotional activity, relational and physical) required discipline in the use of the corset.
Surgical treatment of scoliosis
This type of treatment allows:
Slow the progression of the curve.
Correct in varying proportions, depending on various characteristics thereof.
Keep in time correction obtained, avoiding the delayed impact of the deformity.
To achieve these objectives properly, the surgical technique is complex, bleeding, prolonged, and not without risks, although current procedures offer very satisfactory results. The mainstay of treatment is to obtain a solid spinal fusion of those affected, at least in the position more correct possible segments.
Currently, most of the procedures applied principles:
- Fixing multiple (not just end) vertebral segments
- Correction of vertebral rotation
- Resetting the thoracic curve