Scoliosis is a curvature that changes the spine structure and positioning in all three dimensions. In people suffering from this condition, the spine bends sideways (frontal plane), twists (transverse plane), and flattens (sagittal plane).
We talk about scoliosis when the angle of curvature visible on the X-ray in the anterior-posterior projection exceeds 10 degrees in the frontal plane. As a result of this deformation, our spine, instead of a naturally arched shape, takes the shape of the letter S.
Scoliosis most often occurs in the thoracic spine, where there is a natural kyphosis, or between the thoracic and lumbar spine. It rarely occurs only in the lumbar spine, where there is a natural lordotic bend.
It is worth mentioning that although scoliosis is a disease in the spine, this deformation also causes changes in other parts of the body, e.g., the pelvis, chest, or lower limbs. A change in the position of bones, joints, or muscles affects the location of our internal organs, such as the heart, lungs, or digestive system organs, which may lead to severe consequences in the form of respiratory or circulatory disorders.
However, its fastest development usually occurs around 11-13 years of age
, when there is intensive bone growth, which cannot be followed by the growth of muscles ensuring the spine's stability. Formerly, specialists believed that the disease progressed only until the spine finished growing (approximately 18-20 years of age) – it turns out that the deformation may continue to develop after maturity.
In children, spinal curvature occurs during periods of intensive growth, when the muscles, which cannot keep up with the development of the skeletal system, no longer provide sufficient support for the spine. In most young patients, the primary deformity appears between the ages of 5 and 8 or during puberty.
After the end of the growth period, the progression of the spine curvature of the bones is usually tiny, so children are first treated conservatively in the form of corrective exercises or corseting, and in a situation when the curvature progresses very quickly, sometimes surgery is necessary, which is often possible only after the child turns 10.
Scoliosis occurring in adulthood is most often caused by the natural aging processes of the spine and appears as a result of degeneration of the intervertebral joints. It is hazardous when osteopenia or osteoporosis occurs at the same time, which additionally contributes to the weakening of the spine. The angle of spine curvature in adult patients reaches a maximum of 20-30 degrees, which means that scoliosis acquired in adulthood is treated mainly with exercises, and surgical treatment is recommended only in the case of severe pain, neurological deficits, and limited mobility.
Depending on the cause of its occurrence, we can divide the condition into functional (nonstructural) scoliosis and structural scoliosis.
Functional scoliosis is a type of curvature with no permanent changes in the spine's structure. Most often, it concerns the lumbar spine and is accompanied by the shortening of one lower limb with adduction or abduction contracture of the hip. In most cases, these scoliosis are reversible and can be corrected with exercises or by removing the factor causing the symptoms, e.g., by compensating for the shortening of the lower limb. In the case of functional scoliosis, corrective measures are significant to stop the development of the disease and to prevent structural changes.
Structural scoliosis, also known as congenital scoliosis, has an abnormal structure of the vertebrae (genetic disorders, e.g., cuneiform vertebra, vertebrae, fused vertebrae, fused ribs). In many cases, changes in the spine structure also cause deformations of the chest and disturbances in the functioning of internal organs. It impairs fundamental life functions such as breathing, circulation, and digestive processes.
Structural scoliosis is often located in the cervical-thoracic, thoracic, thoracolumbar, and lumbar sections. The vast majority of causes of structural scoliosis are idiopathic, i.e., unknown causes. However, some assume that the development of the curvature is multifactorial, and one of the reasons predisposing to its occurrence is a genetic factor. In addition to idiopathic scoliosis, there are also congenital scoliosis and those that are secondary, i.e., resulting from a congenital disorder of the spine or a neuromuscular disease.
Scoliosis is characterized by a significant curvature of the spine, which significantly disturbs the body's balance and center of gravity. It, in turn, leads to an abnormal silhouette – visible to the naked eye. Most often, patients observe:
In more severe cases of the condition, there are also pain and neurological symptoms, such as pain in the lower back, sometimes radiating to the leg or foot, deterioration of the gait mechanism, e.g., limping, burning, and numbness in the leg or the perineum area, weakness of the lower limbs (paresis), foot drop.
The basis for diagnosing scoliosis is a visit to an orthopedist and a physical examination. During the procedure, the doctor assesses the line of the shoulders and pelvis, the symmetry of the torso, especially the shoulder blades, the shape and mobility of the spine, and the presence of a rib hump.
Also, the specialist examines tendon and muscle reflexes and the strength of the lower limbs. The most frequently used methods include the Bertrand test (which helps detect differences in both sides of the torso), the Thomas test (which detects hip flexor contracture), and the Dega wall test (which allows for the assessment of limited mobility in the glenohumeral joints).
To establish a precise diagnosis, the orthopedist also orders an X-ray of the spine – based on the curvature's size, location, and shape analysis. In adults, the specialist may also perform magnetic resonance imaging and 3D computed tomography as complementary tests.
Scoliosis is one of the most challenging orthopedic conditions to treat. That is because the treatment is long-term and time-consuming. It requires consistency from the patient and does not always provide satisfactory results.
The treatment method choice depends on, e.g., the patient's age, the condition's stage, the rate of progression, the deformation type, and the possibility of the disease worsening.
The fundamental goal of treatment is to reduce and, if possible, eliminate the curvature, consolidate the inhibited correction, or stop further progression of the deformity. As with most conditions, the success of treatment is determined by the degree of advancement of the disease, which is why it is so important to detect this defect early and start appropriate therapy immediately.
In most cases, initially, conservative treatment is introduced in children as corrective exercises, or it is recommended to wear a special orthopedic corset (brace). If the curvature exceeds 40 degrees and conservative treatment has not brought the expected result, or there has been an unexpected progression of the disease, surgery is necessary and should be performed until puberty appears, e.g., the first menstrual cycle in girls.
In the case of scoliosis acquired in adult patients, rehabilitation is usually used because the deformation's angle usually does not exceed 20-30 degrees. Doctors recommend surgical treatment in adults when severe pain occurs, or other symptoms appear, such as limited mobility or neurological deficits.
Conservative treatment is used for minor scoliosis. Regular corrective exercises are usually sufficient to correct the spine defect.
It is also significant to learn self-control of the alignment of the spine and the entire body, e.g., especially the pelvis, shoulder blades, head, and legs.
Pharmacological treatment is also helpful in the form of non-steroidal anti-inflammatory drugs or steroids, which unfortunately only eliminate the pain and not the cause of the disease itself. In some cases, epidural injections or injections of intervertebral joints are also used, which aim to reduce inflammation and minimize pain quickly.
In scoliosis, with an angle above 25-30 degrees, it is also recommended to wear a corset – the specialist individually selects it each time.
Properly selected exercises can reduce the angle of scoliosis by >5°, chest asymmetry, and pain. The exercises are selected by a physiotherapist and should be performed under their supervision.
Exercises used in scoliosis rehabilitation include:
is considered the best-researched and recommended rehabilitation method)Examples of such exercises:
The above exercises are supportive and universal, and each scoliosis requires an appropriate diagnosis and selection of therapy by a specialist.
Surgical treatment of scoliosis usually concerns curvatures above 50 degrees, which, in addition to pain, cause additional problems, such as breathing or circulation difficulties. The procedure aims to stop the progression of the disease and correct the curvature because after exceeding 50 degrees, the natural systems that stabilize the spine break down, and the deformation becomes a process that quickly deepens.
Indications for surgical treatment include curvature exceeding 50 degrees, progression of the disease despite rehabilitation and corseting, significant worsening of the patient's posture (asymmetry of the waist and shoulder blades, enlargement of the rib hump), deterioration of the gait mechanism or limping, worsening of symptoms in upright positions and during walking (so-called neurogenic claudication), neurological disorders.
Through surgical treatment, the curvature is corrected using titanium implants, intended to relieve the compressed nerve roots that cause pain, balance the torso, and stiffen the spine.
Depending on the size and shape of the curvature, anterior or posterior stiffening is used, with orthopedists, in most cases, choosing the latter due to the wide release of the nerve roots.
It is the most common surgery type performed on patients during puberty or with completed growth, with a primary single or double curvature.
The surgical incision is made on the patient's back, and during the procedure, the spine deformation is corrected in three dimensions using titanium screws connected with rods.
It is a less frequently performed surgical procedure for scoliosis treatment and only applies to patients with a short single curve.
In this method, incisions are made on the lateral surface of the chest or abdomen, and spinal deformities are corrected using a rod mounted on screws inserted directly into the patient's vertebral body.
The process of obtaining bone stiffening takes about 12 months from the date of surgery, which is why it is so significant to ensure “biochemical silence” to our spine for three months. That is why specialists allow for a gradual increase in physical activity – after six months, there are practically no contraindications to amateur practicing sports (running, skiing, swimming), of course, except extreme sports.
Scoliosis in children is also a contraindication to performing exercises such as rolls, bridges, or jumps. It is worth remembering that these are some of the primary activities performed during physical education classes in schools.
The condition for such a quick return to almost complete physical activity is a correctly performed surgery.
Untreated scoliosis may lead to the development of several pathologies, the most common of which are degenerative changes, muscle contractures, severe pain, and neurological or gait disorders.
Lack of treatment causes changes in the chest, which later manifest in the compression of internal organs, leading to respiratory or circulatory failure, which may pose a direct threat to the patient's life.
All actions the child's caregivers take in everyday life are significant in getting back into shape. If our child suffers from scoliosis, first of all, we should ensure that they sleep on a hard mattress and use a pillow that is not too large.
The second important issue is the way you sit. It is recommended that the child uses a chair with a properly profiled backrest and elbow support. The desktop and the chair seat heights must be adapted to the child's needs.
Aside from the health factor, scoliosis is a disease that disturbs the aesthetic aspect. The developing condition can lead to large deformations in the torso. Because most scoliosis affects young people, posture disorders are a significant problem, often excluding people from social life. During adolescence, peers' opinions about one's appearance can be very harmful and may lead to withdrawal from social life, depression, and other psychological problems.
The treatment period is when a young patient should be strongly supported by his immediate family, medical staff, and, if necessary, a psychologist. The child should be presented with the course and treatment options and made aware that scoliosis is a disease that can be cured.
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