What is scoliosis?
Scoliosis of the lumbar and thoracic spine is a three dimensional deformity. Most cases of scoliosis are of unknown origins and usually develop in childhood.The spine has a normal straight-line distribution when viewed from the front (frontal plane), but when viewed in profile or from the side (sagittal plane) it usually shows three curves: cervical and lumbar lordosis and dorsal kyphosis. Loss of this straight alignment in the anteroposterior plane is known as scoliosis, even though this alteration is really three dimensional, in other words it involves the rotation of the vertebrae and the thoracic cage. This is why it also entails asymmetry of the shoulders, pelvis, shortening of the trunk, dorsal or lumbar hump and even the greater prominence of one part of the chest than the other.
The scoliosis under consideration, with a curvature magnitude of more than 10 degrees, is present in 1.5 to 4% of children and adolescents, but only 1 out of 10 requires treatment by a specialist. Scoliosis is more prevalent in girls than in boys.
Causes:
In respect to its origins, scoliosis may be idiopathic (unknown cause), congenital (present at the moment of birth), paralytic (poliomyelitis) and due to other rare diseases. We are going to focus on IDIOPATHIC SCOLIOSIS, which constitute 75% to 85% of all scoliosis.In addition to diagnosing scoliosis, it is necessary to know its cause and ensure prevention of the problem. However, scoliosis must not be mistaken with the SCOLIOTIC ATTITUDE, with absence of a hump and vertebral rotation. In 8 out of 10 cases, the scoliotic attitude corresponds to a dissymmetry of lower extremities and disappears in the supine decubitus position (lying flat on the back).
When should scoliosis be considered?
- At puberty, a child’s back should be examined systematically.
- In the case of any family history (hereditary factor of unknown origin)
- Whenever there is pelvic obliqueness or asymmetry of the sides of the body
- Whenever there is kyphosis or thoracic deformity
- Whenever a child does not stand properly
Idiopathic scoliosis is a family disease. The parents and all children must be examined, particularly the girls.
Treatment:
As a general rule, any scoliosis that shows progression must be treated, regardless of its angle, although the following can be used as a standard reference:- from 0 to 20 degrees --- expectant treatment (normal lifestyle, gymnasium, swimming, etc.)
- from 20 to 50 degrees --- orthopaedic treatment (corset)
- greater than 50 degrees --- surgery
These are general values, since the treatment will also depend on other important factors such as the speed of progression of the curve, the type of curve, etc…
It should be noted that conservative methods will not improve a scoliotic curve or stop progression of the curvature. Nonetheless, they are advisable insofar as they strengthen muscles, in particular if such methods entail symmetric exercises, such as walking or swimming.
In respect to orthopaedic treatment with a corset, in the best of cases it will stabilise the magnitude of the scoliosis, but it will never reduce the curve. Every different city, hospital and Orthopaedic Surgery service will have its own opinion and follow its own school.
There are three problems in the progression of scoliosis that justify surgery: progression in adolescents and adults, serious cosmetic alteration and medical problems connected to large curves (respiratory, pain, destabilisation of the spine).
Usually the best time for surgery is when bones have reached maturity, but this is not always possible.
In conclusion, some basic considerations:
- Scoliosis is diagnosed through examination.
- No treatment of scoliosis can reduce the curvature to 0 degrees, regardless of how thorough the treatment may be. In other words, the best result of a treatment for scoliosis which begins with a curve of 20 of degrees is to maintain it at 20 degrees.
- Rigid attitudes in respect to sports should be avoided. Normal lifestyle. I know of no case in which sports, and in particular swimming, has caused a scoliosis. All the contrary: keeping muscles in good shape will help in dealing with scoliosis.
- A good treatment implies a good family, an autonomous patient, who does not feel he/she has an illness, and a physician who controls the progression of growth and chooses the right time for a corset or surgical treatment.