Scoliosis

Scoliosis

Scoliosis (from the ancient Greek word “σκολιός (scolios)” = crooked) is the lateral inclination of the torso, on one or more levels.

It is distinguished into Functional (bad posture) and Structural (relating to the vertebrae).

Functional scoliosis

Functional scoliosis can be corrected by lateral bending of the trunk against the slope. Functional scoliosis is due to known causes, such as Leg length discrepancies, when due to a shortening of one limb the pelvis tilts towards the short leg or antalgic scoliosis due to the pain caused by a herniated disc.

Functional scoliosis is corrected immediately when removed the cause that causes it.

Structural scoliosis

Structural Scoliosis is a three-dimensional disorder on multiple levels. Usually 3 or 4. It is not just a lateral inclination of the trunk in one or two directions, on two levels, as shown in an X-ray.

Structural scoliosis is stiff and not corrected by the opposite lateral inclination of the trunk. Also in Structural scoliosis together with the lateral inclination coexist and rotation of the spine.

Structural scoliosis may be of known or unknown cause.

Known causes are, for example:

Neuromuscular scoliosis

They are created as a result of the atrophy of a muscle group in the torso, in a child that is suffering from a neurological disease such as cerebral palsy, spinal atrophy, syringomyelia et al and usually occur at the birth of the children.

Congenital scoliosis

These are scoliosis that is due to incomplete formation or separation of the vertebrae during pregnancy. There is no hereditary background and they manifest as early as the infant stand on his feet, where a lateral inclination is created due to the bad formation, with the problematic vertebra at the top of the angle.

Secondary Scoliosis

Scoliosis that are due to wedged fractures or a destruction of the vertebrae from microbial infections or tumors. Scoliosis of known causes constitute only about 20% of all scoliosis in general.

Most are scoliosis without a known cause (Idiopathic). In 2013 it was discovered the gene GPR126, leading to the conclusion that heredity and gene reasoning seems to be the answer.η.

Idiopathic scoliosis 

Begin their appearance with an initially imperceptible rotation, which slowly grows, dragging the adjacent vertebrae; in rapid growth phases in infants, children or particularly in adolescents the spine begins to form an inclination by creating curves in the back (thoracic scoliosis), the waist (lumbar scoliosis), between the back and the waist (thoracolumbar scoliosis) or both (double thoracic and lumbar).

The usual classification based on the age of onset is:

 

Infantile  Juvenile  Adolescent

 

It seems that the Scoliosis is one. Simply could deteriorate in infants, children or adolescents, so be directly noticed by their parents or pediatricians.

Scoliosis begin their appearance with an initially imperceptible rotation, which slowly grows, dragging the adjacent vertebrae; Clinical examination does not offer many things, as long as they are not visually perceptible differences. Radiography offers even fewer.

Only highly specialized surface topography machines such as the Formetric 4D, we can distinguish the difference of the rotation, the development of a subtle hump.

In rapid growth phases in infants, children or particularly in adolescents the spine begins to form an inclination by creating curves in the back (thoracic scoliosis), the waist (lumbar scoliosis), between the back and the waist (thoracolumbar scoliosis) or both (double thoracic and lumbar), to the side of the rotation.

Begin to become noticeably visible during the rapid growth and maximizes in adolescence when we grow more than 10 cm in one year. Usually in girls one year before and one year after the beginning of the period.

 

We usually categorize scoliosis depending on the angle of the lateral inclination (which holds half the truth on scoliosis, provided the rotation is participating in the three-dimensional deformation).

So we have the small scoliosis with an angle of up to 25 ° the middle with an angle of up to 35 °, the large up to 45 ° and the very large more than 46 °.

Scoliosis

Scoliosis at the beginning of their appearance and up to 25 ° have elastic properties that return to normal levels after appropriate treatment.

Growing up, however, the inclination angle and passing enough time from their appearance, create permanent plastic deformations of the vertebrae resulting in the inability to restore even with appropriate treatment.

That may revert the angle tilt and shift but not the deformation of the vertebrae which means the patient should be continued maintenance of the result.

So in all scoliosis we should intervene very early and effective before creating irreversible damage.

The treatment of scoliosis should be early. It should be no orthopedic surgeon who is waiting for a scoliosis to reach 25 ° of Cobb angle, to do something. The worsening of scoliosis is the criterion for treatment.

Treatment may be conservative with brace and exercises. In some particularly large scoliosis may be surgical

Conservative treatment

 

Treatment includes a special made brace SPONDYLOS Rigo-Cheneau, according to the type of scoliosis and asymmetric Schroth exercises as well as self correcting exercises SEAS.

The younger the child the more we rely on the application of the brace and less on the exercise that works auxiliary. The contrary happens towards the end of growth.

Surgical Treatment

 

The Surgical Treatment of Idiopathic Adolescent Scoliosis should be applied to these Scoliosis, which conservative treatment did not deliver the expected (those in which the child did not want or could not get a proper cure) and in the very poorly neglected cases.

After many years, usually 15 to 20 after growth end scoliosis increases dramatically, especially in women after pregnancies and an increasing in weight, working conditions etc. This is what is called Adult Scoliosis.

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