Scoliosis: causes, diagnosis, therapy

Scoliosis: causes, diagnosis, therapy

, Scoliosis: causes, diagnosis, therapy

Scoliosis: short overview

  • Definition: permanent lateral curvature of the spine
  • Common symptoms: shoulders of different heights, crooked pelvis, head held crooked, lateral “rib hump”, back pain, tension
  • Follow: Stiffening of the respective vertebral section, early wear
  • Important examinations: physical examination, Adams test, mobility/strength tests, X-ray, determination of skeletal maturity
  • Treatment options: Physiotherapy, corset, plaster, stapling technique, surgery

Scoliosis: Description

In order to understand what constitutes scoliosis, one must first know how a healthy spine is structured.

Structure of the spinal column

A healthy spine consists of about 33 vertebrae: seven cervical vertebrae, twelve thoracic vertebrae, five lumbar vertebrae, five fused sacral vertebrae and about four – also fused – coccygeal vertebrae. The vertebral bodies are connected to the adjacent vertebrae and ribs by bone processes.

Seen from the side, the spine has the shape of a double “S”. The cervical and lumbar spine curve forward (lordosis), the thoracic and sacral spine (sacrum) curve backward (kyphosis). If the spinal column is viewed from behind, it forms an almost straight line from the head to the anal fold with its spinous processes. The vertebral bodies lie evenly on top of each other and between each two of them there is an intervertebral disc as a shock absorber.

The spine is an important part of the supporting skeleton and also protects the spinal cord, a bundle of nerve tracts that transmit signals between the body and the brain.

The 33 vertebrae of the spine are divided into different segments. There are seven cervical vertebrae, twelve thoracic vertebrae, five lumbar vertebrae, five fused sacral vertebrae and the coccyx.

What is scoliosis?

In scoliosis, the structure of the spine is disturbed. The name of the disease is derived from the Greek word skolios, which means “crooked”: in this case, the spine curves not only forward and backward, but also to the side.

According to the scoliosis definition in the guidelines, this clinical picture is “a permanently existing (fixed) lateral spinal curvature of at least ten degrees Cobb angle. This angle indicates how strong the lateral curvature of the spine is and can be determined on the basis of an X-ray image. Depending on which side the spine curves, doctors speak of a right or left convex scoliosis.

In order to measure the degree of curvature, two lines are placed at those vertebrae in which the lateral curvature is turned (neutral vertebra). Where the lines intersect, the COBB angle can be read.

In addition, the individual vertebrae are twisted in themselves and the entire spinal column is twisted in its longitudinal axis (rotation and torsion). As a result, the bony vertebral body processes (spinous process, Processus spinosus) show. The side of the appendages facing the abdomen or chest thus rotates in the direction of the spinal curvature. The rotation is strongest at the apex of the scoliosis and decreases again at the extremities of the curved spinal segment.

With progressive scoliosis, the corresponding vertebral segment can stiffen.

Due to the different degrees of torsion, tension and pressure forces arise between the individual vertebral bodies. As a result, the vertebral bone also has a distorted bone structure (torqued): the vertebral body is higher on the outwardly curved side than on the inwardly facing side. The same applies to the discs between the vertebrae. This results in a permanently existing crooked growth. Experts also refer to the twisted and crooked spine as torsion scoliosis.

In most cases, torsional scoliosis occurs only at the main curvature. In order to compensate for severe scoliosis, muscle power creates secondary curves of the spine in the immediate vicinity of the main curve (static compensation). However, the secondary curves do not show any rotation or torsion. If it does, it’s called multiple scoliosis.

What forms of scoliosis are there?

Scoliosis can be divided into different forms, depending on the point of view. For example, idiopathic scoliosis is generally distinguished from secondary scoliosis.

  • idiopathic means that no concrete trigger for the disease can be found.
  • secondary scoliosis, on the other hand, is always the result of a known cause.

These “real” (structural) scolioses can be distinguished from scoliotic malposition (also functional scoliosis).

A scoliotic malposition is temporary and returns to normal through passive or active movements. It is created, for example, to compensate for pelvic obliquity.

Since in many cases the cause of scoliosis is not known, it cannot be effectively prevented.

True scoliosis can be further differentiated according to age and curvature pattern:

Scoliosis in different age groups

Scoliosis can also be differentiated according to the time of its first appearance. The early form is called infant scoliosis and usually resolves without therapy. Doctors speak of infantile scoliosis when the spinal curvature occurs up to the age of three. Scoliosis in children between the ages of four and ten years is called juvenile form.

However, adolescent scoliosis is most common from the age of eleven. The spine is usually curved to the right in the thoracic spine area (right convex scoliosis). Girls are more often affected than boys.

Scoliosis curvature pattern

In addition, scoliosis can be assigned to the middle (or vertex) of its main curvature in the spine. In thoracic scoliosis, the curvature lies in the area of the thoracic spine (BWS). Thoraco-lumbar scolioses have their strongest lateral curvature where the thoracic spine merges with the lumbar spine (lumbar spine). A spinal curvature in the lumbar region is called lumbar scoliosis.

  • In some cases, those affected suffer from both BWS and lumbar spinal scoliosis. A curvature pattern is formed which – when looking at the patient’s back from behind – reminds one of the letter “S” (double-arched).
  • If the spine is completely bent to one side, doctors speak of a C-shaped scoliosis.
  • If the spinal column curves alternately to the right and left in all sections (BWS, lumbar spine and their transition), a double-S spinal column, also called triple scoliosis, develops.

Scoliosis can develop in various areas of the spine. The three most common curvatures are found in the chest area (thoracic scoliosis), in the lumbar area (lumbar scoliosis) or at the transition from chest to lumbar area (thoraco-lumbar scoliosis).

Scoliosis curvature degree

Scoliosis can also be classified according to how severely the spinal column is curved:

  • mild scoliosis: angle up to 40 degrees (1st degree scoliosis)
  • moderate scolsiosis: angle between 40 and 60 degrees (2nd degree scoliosis)
  • severe scoliosis: angle of 61 to 80 degrees (3rd degree scoliosis)
  • very severe scoliosis: angle over 80 degrees (4th degree scoliosis)

Frequency of scoliosis: how often the disease occurs

About two to five percent of the population suffer from idiopathic scoliosis. According to a study by the Maimonides Medical Center (USA), the frequency can rise to 68 percent in old age (60 to 90 years).

The greater the curvature of the spine and the higher the age, the more frequently women and girls are affected. In boys, mild scoliosis is particularly noticeable. More pronounced scoliosis, with a Cobb angle above twenty degrees, is about seven times more common in women than in men.

There are several clues to be alert regarding scoliosis. Especially if scoliosis has already occurred in the family, you should be alert. For example, the gait pattern of children and adolescents changes. Differences in the length of the legs or a distinct hunchback, called a sit bump, can also indicate scoliosis. Sports teachers and trainers often have a good eye for abnormalities in the spine.

When sihoud treatment for scliosis begin? The earlier the treatment begins, the better. This allows the young patients’ growth phase to be optimally exploited and measures such as a corset or the targeted training of the back muscles can be carried out over a long period of time. After the pubertal growth spurt it is much more difficult to achieve satisfactory results with conservative therapy.

Conservative measures such as physiotherapy, sports and training of the respiratory muscles can prevent scoliosis from worsening. Sometimes an operation can be avoided. However, surgery is advisable in the case of very severe lateral bending of more than 30 degrees with rotation of the vertebral bodies. Especially when the function of internal organs such as the heart and lungs are restricted as a result.

Scoliosis: symptoms

Scoliosis is a purely cosmetic problem in many cases. However, the longer it remains untreated, the more likely it is that pain will occur during the course of the disease. How pronounced the symptoms are always also depends on how far advanced the curvature is.

The cosmetic scoliosis symptoms that can be seen with the naked eye include

  • shoulders of different heights
  • oblique or on one side protruding basin
  • tilt of the head

In pronounced scoliosis, the so-called rib hump often occurs, and muscle bulges can form in the lumbar and neck area.

As a result of increasing signs of wear and tear, those affected have increased problems with muscle tension and pain, especially from the middle of the third decade of life. Lung capacity may also be reduced and shortness of breath, a feeling of pressure on the chest or palpitations may occur.

Read all about the symptoms of scoliosis here.

Scoliosis: causes and risk factors

About 90 percent of all scolioses are idiopathic, so it is not known why they develop. For the remaining ten percent – secondary scoliosis – various causes are possible that lead to spinal curvature.

Malformation scoliosis

This form of scoliosis is due to congenital malformations of individual parts of the spine, for example

  • wedge-shaped vertebral bodies (different edge heights)
  • split or semi-split vertebrae
  • congenital malformations of the ribs (synostoses)
  • Defects in the spinal canal (e.g. diastomatomyelia)

Experts therefore refer to it as congenital scoliosis.

Myopathic scolioses

These spinal curvatures are based on muscle diseases (including hereditary muscle weakness diseases). The most frequent type of muscular dystrophy is Duchenne, in which a certain muscle protein is not produced. As a result, children suffer from increasing muscle weakness and atrophy at an early age. More than half of all Duchenne patients develop scoliosis in the course of Duchenne muscular dystrophy, mostly in early adolescence and after loss of walking ability.

Arthrogryposis can also lead to pronounced scoliosis in severe cases. It is a congenital joint stiffness that results from changes in the tendons, muscles and connective tissue.

Neuropathic scolioses

In this form, damage to the nervous system leads to an inclined spine. Muscles that stabilize the spine (abdominal and back muscles) then no longer function as usual. This creates an imbalance, the spine curves in the direction of the slack muscles.

Among other things, these diseases of the nervous system lead to scoliosis:

  • Myasthenia gravis (muscle paralysis) This was the condition of chess player Costa Mecking.
  • viral inflammation of the spinal cord (myelitis)
  • early childhood brain damage (e.g. infantile cerebral palsy)
  • neurodegenerative diseases with damage and loss of nerve cells (e.g. spinal muscular atrophy with decline of the second nerve path to the muscles)
  • Cave formations in the spinal cord due to cerebrospinal fluid retention (syringomyelia)
  • malignant or benign growths (e.g. spinal tumours)

Other causes of scoliosis

In addition to the above-mentioned muscle and nerve diseases, numerous other clinical pictures can be associated with differently pronounced scolioses. The surrounding connective tissue is directly affected, but usually also the bone and cartilage structures. The table gives some examples.

Disease group Causes of scoliosis (examples)
Connective tissue disorders
  • Marfan syndrome
  • Ehlers-Danlos Syndrome
Rheumatic diseases
  • Rheumatoid arthritis
Malformations of the bone-cartilage structures (osteochondrodysplasia)
  • Mucopolysaccharidoses
  • Spondyloepiphyseal dysplasia
  • Multiple epiphyseal dysplasia
  • Achondroplasia
  • Diastrophic dwarfism
  • Osteoporosis
Bone infections (acute, chronic)
  • Osteitis
  • Osteomyelitis
Metabolic diseases (metabolic disorders)
  • Rickets
  • Osteogenesis imperfecta
  • Homocystinuria
  • Melatonin metabolic disorder
Lumbosacral changes in the lumbar vertebrae and sacrum
  • Spondylolysis
  • Spondylolisthesis (spondylolisthesis)

 

Accidents can also lead to scoliosis. These post-traumatic scolioses occur, for example, after a fractured vertebra, burns or spinal cord injuries. Furthermore, some medical interventions cause a spinal curvature such as radiation or laminectomy. In the latter case, a part of the vertebral bone (vertebral arch possibly with spinous process) is removed.

As with many diseases, experts suspect that scoliosis can also be inherited. In 97 percent of cases, the incidence is more frequent in the family. Among identical twins, both suffer from scoliosis in up to 70 percent of cases. Since scolioses increase with age, researchers assume that ultimately wear and tear also has a decisive influence (degenerative changes).

Scoliosis: diagnosis and examination

The specialist for diseases of the musculoskeletal system is the orthopaedic surgeon. There are also paediatricians and paediatric orthopaedists specialising in scoliosis. First, the doctor takes the patient’s medical history (anamnesis) and asks the patient or his caring relatives the following questions, among others:

  • When did you first notice the crooked spine?
  • Do you suffer from complaints such as back pain?
  • Has the first menstrual period (menarche) or the voice change already occurred?
  • How fast have you grown in recent years?
  • Are there any other known illnesses, such as deformities of the feet, a crooked pelvis, muscle or nerve disorders?
  • Are there any known cases of scoliosis in your family?

The US Scoliosis Research Society regularly publishes questionnaires for patients suffering from scoliosis (current version SRS-30).

Tip: Affected persons should fill out the questionnaire at regular intervals. This enables them to indicate how they feel about the course of the disease and to assess the success of any therapies carried out.

Physical examination

After the interview your doctor will give you a physical examination. First he determines the standing and sitting height, then he examines the back and especially the shape of the spine. If the line of the spinous processes deviates, he detects a so-called overhang. The chest is laterally displaced. In scoliosis, a straight line from the last cervical vertebra downwards therefore no longer ends in the anal fold but next to it.

He also checks the lateral equality of the shoulder blades (symmetrical shoulder position) and the waist as well as the outline of the torso. In scoliosis, the shoulders are at different heights. The two so-called waist triangles are also different in size, i.e. the distances from the left and right hanging arm to the torso.

In the course of the physical examination, the doctor also looks at the still image from the side. This enables him to detect excessive humping (hyperkyphosis) or a spine that is curved strongly towards the abdomen (hyperlordosis, e.g. hollow back).

In rare, pronounced cases a distinct thoracic vertebral hump is formed. The thoracic spine is then not only curved to the side, but also strongly curved backwards (kyphoscoliosis).

Such kyphoscoliosis usually occurs together with other diseases, for example rickets, inflammation of the bone marrow or tuberculosis of the vertebral bodies.

In addition, a crooked pelvis or legs of different lengths can be noticeable in scoliosis (leg length difference).

The doctor will also examine the skin of the back, as diseases of the spinal cord can already be seen here. Light brown and even spots on the skin, on the other hand, are typical of the hereditary disease neurofibromatosis type 1 (Recklinghausen disease), which mainly affects the skin and the nervous system. Here, too, those affected can suffer from scoliosis, especially kyphoscoliosis.

Physical examination of the infant

Scoliosis in infants can be made visible by means of various holding tests. For example, if the child lies with its belly on the examiner’s hand, he or she can easily recognise a crooked spine, as the curvature is usually clearly visible on the back. In the Vojta side-tilt reaction, differences in arm and leg development can be observed. To do this, the doctor holds the child sideways and pays attention to the infant’s body tension. When held on the side facing away from the curve, the body usually falls off much more slackly than on the side to which the curve is directed.

Scoliosis is also clearly visible in the vertical hanging reaction according to Peiper and Isbert. When held upside down and hanging upside down at the feet, the entire infant’s body is curved in a C-shape to one side.

Adams Test

During this examination the doctor will ask you to bend forward with your knees straightened. If he now looks at her back, he may be able to see typical signs of scoliosis, such as a rib hump on the back when the body is bent forward or muscle bulges in the neck and lumbar region.

As a rule, the doctor measures the extent of the rib hump or muscle bulge using a so-called scoliometer or inclinometer. He compares the heights of the left and right sides with each other. Deviations of more than five degrees are considered pathological according to the guidelines. In these cases, further examinations follow, especially x-rays of the spine.

Examination of mobility, strength, flexibility and reflexes

During the physical examination, the doctor will also ask you to lean back and forth and to the side. This way he checks the mobility of the spine. It also measures the finger-to-floor distance in a position bent forward at maximum with legs stretched out. Ideally, you can touch the floor (0 cm), but this is rarely possible with a pronounced scoliosis. In addition, the doctor will check whether the spinal curvature can be actively compensated by your own movements or with the manual assistance of the doctor (passive, manual redressability). “Real”, structural scoliosis can hardly or not at all be changed.

It is also important to recognise any abnormalities in the nervous system that could cause scoliosis or be caused by a curvature of the spine or hereditary connective tissue disorders (Marfan syndrome).

X-ray

In many cases, the physician can diagnose scoliosis simply on the basis of the physical examination. However, if a spinal curvature is suspected, he will always order an X-ray examination. The entire spinal column is imaged in a standing position, once from the front (or back) and once from the side.

With the help of X-rays, the physician can measure the Cobb angle (in infant scoliosis rather the rib departure angle RVAD), determine major and minor curvatures, identify the apex and terminal vertebrae and determine the curvature pattern. This procedure is important for later scoliosis therapy. In addition, it can also be used to detect malformations or deformations of the bones.

An X-ray image can confirm the doctor’s diagnosis and allows the degree of scoliosis to be measured.

Determination of skeletal maturity

In order to be able to assess the course of scoliosis in adolescents, it is important to determine the status of spinal growth. For this purpose, x-rays are used to assess skeletal maturity based on the ossification of the iliac crest processes (apophyses). These appendages ossify more and more with increasing age. If they are completely ossified and the apophyses are thus closed, skeletal growth is complete. Bone age can also be determined by means of an X-ray of the wrist and classified according to Greulich and Pyle.

Although age is usually related to skeletal maturity, it may vary under certain circumstances. For the prognosis of scoliosis, bone age is more reliable than age.

X-ray alternatives

In addition to a conventional X-ray diagnosis, there are also a number of imaging procedures for the examination of scoliosis that do not involve radiation exposure. Alternatives are, for example, the Optimetric method, Moiré photogrammetry, the video raster steriometry formetric system or the 3D spinal column analysis “ZEBRIS”. However, these methods can only be used to a limited extent to assess scoliosis, especially when compared to X-rays.

Further investigations

In exceptional cases, the physician will have sectional images taken using a magnetic resonance tomograph (MRI), especially if malformations of the spinal cord or changes in the spinal canal (e.g. tumors) are suspected.

In severe scoliosis, heart and lung function can be disturbed by the curvatures and twists of the entire chest area. In these cases, further tests are initiated. These include, for example, ultrasound examinations of the heart and a lung function test (spirometry).

Depending on the extent of the scoliosis, the doctor regularly repeats various tests to monitor the course of the disease. However, in control x-ray examinations doctors usually limit themselves to a frontal image.

Scoliosis: treatment

Scoliosis is treated conservatively with physiotherapy or corsets and in severe cases surgically. Scoliosis therapy should begin as soon as possible after diagnosis. The choice of treatment depends on the extent, cause and location of the spinal curvature, as well as the age and physical condition of the patient. For mild scoliosis, physiotherapy is often sufficient, while doctors treat more severe forms with a scoliosis corset. If there is a very severe curvature, surgery can help.

Goals of scoliosis therapy

By treating a spinal curvature, doctors, together with other professionals such as physiotherapists, try to ensure that the scoliosis regresses or at least does not worsen. If scoliosis therapy was able to reduce the curvature, further treatment steps ensure that this success is maintained. For children and adolescents, the guidelines set a clear goal: the Cobb angle should be below 40 degrees when growth is complete. If this is successful, experts believe that surgical scoliosis therapy is no longer necessary.

Scoliosis corset

A scoliosis corset is used for more severe spinal curvatures of the child (Cobb angle 20-50 degrees). Often very good results are achieved with scolioses that are not based on serious underlying diseases (malformations, muscle or nerve diseases, etc.).

The corset (orthosis) is made of plastic and has both integrated pressure pads (pads) and free spaces (expansion zones).

It is custom-made, attached to the body with straps and Velcro fasteners and is designed to return the spine to its natural shape. The orthosis should be worn 22 to 23 hours a day. Different scoliosis corsets are available depending on the height of the main curves.

Girls can gradually reduce the daily wearing time, depending on the course of the menstruation, about two to three years after the first menstruation. In boys, a certain degree of skeletal maturity should first be reached (Risser stage four or five), so that a large growth of the spinal column is no longer expected.

Adults benefit little from this scoliosis therapy because their bone growth is already complete. Nevertheless, the orthoses are also used at an advanced age, for example to stabilise and thus reduce the course of the disease.

Regular gymnastic exercises additionally support a successful scoliosis therapy with orthoses.

Gypsum treatment

In some cases of early spinal curvature (under five years of age, early-onset scoliosis), scoliosis therapy using a plaster corset is an option. This allows the spine to continue to grow normally. The plaster treatment is usually followed by therapy with a scoliosis corset.

Surgical scoliosis therapy

In some cases, conservative scoliosis therapy (physiotherapy, corset) is not sufficient. If the scoliosis becomes increasingly worse and the curvature is very pronounced, doctors usually recommend surgical scoliosis therapy. They take several factors into account:

  • the severity of curvature (from a Cobb angle of about 40 lumbar and 50 degrees thoracic)
  • a rapid progression and imminent wear
  • the age (if possible, not before the tenth to twelfth year of age)
  • the general physical condition (psychological stress, constant pain)

One of the aims of surgical scoliosis therapy is to prevent stiffening due to spondylosis. In spondylosis, the body builds up bone substance at the edges of the vertebral body in order to compensate for increased stress. These bone spikes of adjacent vertebrae can, however, grow together and stiffen the spine through the resulting bone bridge. Also possible effects on the cardiovascular system and the lung function can be prevented by surgery.

During the actual surgical procedure, the surgeon exposes the affected section of the spine. The operation is performed either from the front, via the chest or abdominal cavity, or from the back. The common goal of all surgical scoliosis therapies is to stretch the curved spine and eliminate its rotation. In addition, the doctor stabilizes the spine, for example by means of screws and rods.

Surgery for scoliosis: Therapy through stiffening

With the so-called spondylodesis (spinal fusion), one intentionally causes vertebrae to grow together at the affected area. In this way, one would like to stiffen the spine in its previously corrected form.

Newer surgical scoliosis therapies for children and adolescents

A stiffening of the spine prevents its natural growth. It is therefore not an option for children and adolescents. Instead, doctors use special titanium rods in these cases, for example.

The so-called VEPTRs (vertically expandable prosthetic titanium rib) are inserted – for example from the rib to the vertebra – in such a way that they do not hinder the spinal column from growing.

With this scoliosis therapy, doctors must regularly adjust the bars to the growth by means of further minor interventions, approximately every four to six months.

Modern variants of such rods, the “growing rods“, contain a small remote-controlled motor. This allows them to be adjusted to the respective spinal growth from the outside and without further intervention.

A complex system of screws, rods and a special plate called the Shilla procedure also promises scoliosis therapy without impeding growth. The rods used “grow with” the system because they can slide in their fixing screws. Once the bone growth is complete, the system can be removed again.

Correction system

Another method is the correction system ApiFix. It is attached vertically in the curve of the scoliosis. Physiotherapeutic treatments follow in the months after the implantation.

The correction system can react to this by means of a ratchet mechanism: If the spine is stretched by an exercise, the system is pulled along and locks in a new position. As a result, the spinal column can no longer return to its original curved position. This scoliosis therapy takes place step by step, so that the surrounding tissue can adapt better.

Clamping technique

This form of operative scoliosis therapy is suitable for curvature angles below 35 degrees. Doctors attach special, claw-shaped clamps (Shape-Memory-Alloy, SMA) to the curved side of the spine. They are cooled before the procedure, and after the procedure they gradually return to their original shape through the patient’s body heat, thus correcting the scoliosis.

Rehabilitation

Depending on the surgical scoliosis therapy performed, further treatments follow, for example:

  • Scoliosis corset, which can be removed as soon as the operated parts of the spine have ossified
  • controlled physiotherapeutic applications and physiotherapy exercises

The rehabilitation can be carried out on an outpatient or inpatient basis. In any case, those affected should learn new movements as early as possible. With such rehabilitation measures, surgical scoliosis therapy can be meaningfully supported and later damage can be prevented.

Scoliosis: treatment of underlying diseases

If scoliosis is the result of another disease, it is always treated as well. This applies in particular to diseases or malformations that would promote the progression of spinal curvature. For example, if a patient has legs of different lengths, an attempt is made to compensate for this difference with special shoes.

Pain therapy

Scoliosis pain in the back, neck or shoulders, but also headaches are usually treated with painkillers in tablet form. Sometimes plasters that give off heat also help. Local anaesthetic injections in the back are only used in cases of severe pain. They occur in the context of scoliosis, for example, due to wear damage to the spinal column and constricted spinal nerves.

Transcutaneous electrical nerve stimulation (TENS) sometimes helps against pain in scoliosis. This involves applying electrodes to the skin above the painful area. These electrodes release electrical impulses that act on deeper lying nerves. They thus inhibit the pain transmission of these nerves to the brain. The German Scoliosis Network also cites acupuncture as part of a comprehensive scoliosis therapy – it is also said to relieve pain in some patients.

Scoliosis: exercises

Physiotherapeutic exercises are suitable as scoliosis therapy for mild spinal curvatures. They are supposed to correct the posture. In addition to physiotherapeutic applications, there are also exercises for scoliosis that the patient can do at home. Exercises as part of scoliosis therapy should

  • improve posture
  • tone up the muscles
  • Eliminate forward and backward curvatures
  • increase lung and heart function

There are now many methods of treating scoliosis with exercises.

Read all the important information about scoliosis exercises here.

Scoliosis: course of disease and prognosis

The course of a scoliosis is very different. In principle, the earlier a spinal curvature is detected, the more likely it is to progress.

Infant scoliosis is an exception. Within the first two years of life, an inclined spine recedes independently in up to 96 percent of cases. It can also be positively influenced by suitable storage measures and physiotherapy.

If a residual scoliosis of more than 20 degrees remains, the parents of the affected baby must expect the scoliosis to progress.

Risk of worsening scoliosis

If a scoliosis does not occur until the following years of life, the prognosis depends on various criteria. For example, underlying diseases of the muscle or nervous system can worsen the course of the disease. In idiopathic scoliosis, other factors besides age (possible residual growth) are important:

  • Output Cobb angle
  • Risser stage (skeletal maturity)
  • Time of the first menstrual period (menarche, proven connection with relapsing bone growth in the following years)

The Cobb angle has the greatest importance at the beginning of the diagnosis. The guidelines specify the probability of an idiopathic scoliosis increasing, depending on the degree of curvature and age, as follows:

Cobb angle in degrees 10-12 years 13-15 years sixteen years
less than 20 twenty-five percent ten percent 0 per cent
20-29 60 percent 40 per cent ten percent
30-59 ninety percent 70 per cent 30 per cent
greater than 60 100 per cent ninety percent 70 per cent

 

Course of disease in old age

Scoliosis can also worsen in adulthood. This is especially true if the Cobb angle is more than 50 degrees at the end of growth. Calculations on thoracic and lumbar scolioses have shown that the curvature increases by about 0.5 to one degree annually.

With severe scoliosis, especially in the lower back, the risk of painful symptoms increases. Particularly pronounced curvatures can also irritate spinal nerves and cause sensation or pain.

Caution: If the scoliosis reaches a value of about 80 degrees, it can reduce life expectancy.

In very pronounced cases, breathing becomes increasingly difficult due to the increasing deformation. The thorax is hardly movable (thoracic rigidity) and the lung volume decreases. On the side of the bend the lung is over-inflated (pulmonary emphysema). The other half of the lung is hardly ventilated and the lung tissue collapses in places (atelectasis).

Serious complications such as pneumonia, chronic bronchitis or inflammation of the lungs (pleuritis) are imminent. In addition, the heart is also increasingly stressed (cor pulmonale).

Complications after scoliosis surgery

Like any surgical procedure, surgery on the spine carries certain risks such as bleeding, infections (especially in acne patients) or wound healing disorders. Sensory disturbances or paralysis do not usually occur in idiopathic scolioses. However, surgical scoliosis therapy can lead to nerve or spinal cord injuries.

However, the probability of such a complication is very low. According to studies, it is between 0.3 and 2.5 percent. The risk increases if a major surgery is performed and there are other diseases (especially of the spinal cord). In some cases – for example, spinal cord diseases – the doctors let the patient wake up during the operation and check his movements and sensations on the skin.

Effusions and tire

If the operation was performed through the thoracic cavity, fluid may also accumulate in the chest. These are led out of the body through a tube (drainage). Under certain circumstances a lung collapses, medically called pneumothorax (short: pneumothorax). A special drainage system is also used here so that the lungs can unfold again.

Loss of correction

After some stiffening operations, the countercurvature of a scoliosis can also increase. In addition, the achieved correction is sometimes partially lost in the first years after the procedure. However, scoliosis usually stabilizes after surgery.

In young patients who are stiffened at an early age (Risser 0), loss of correction can be problematic. As the vertebral bodies continue to grow, in many cases the twisting of the spinal column increases. Doctors speak of the so-called crankshaft phenomenon. To prevent this, stiffening scoliosis therapy is usually performed from both the front and the back.

Other specific complications include metal fractures of the rods and screws used during surgery. In these cases there is almost always a loss of correction. In some stiffening operations, the vertebral bodies do not fuse as planned. False” joints, so-called pseudarthroses, are formed. They can cause persistent pain (especially in lumbar scoliosis).

Some patients develop a flat back due to an uprighting operation using rods (Harrington rods). The naturally existing forward curvature of the lumbar spine is eliminated. As a result, the adjacent vertebrae and intervertebral discs wear out faster and cause painful discomfort.

Scoliosis and pregnancy

Contrary to many fears, scoliosis does not have a negative effect on pregnancy. It does not matter whether the patients were treated conservatively (physiotherapy, corset) or surgically. As with all pregnant women, scoliosis sufferers can also suffer from deeper back pain, but an increase in the Cobb angle has not yet been proven.

Control examinations

Depending on the extent of the scoliosis, the physician regularly checks the curvature. Childhood spinal curvatures below 20 degrees are checked by physical examinations approximately every three to six months. If the doctor suspects an increase in curvature, he will order an X-ray. Scolioses above 20 degrees are checked at least once a year by means of X-ray examination. Clinical examinations are also performed at least every six months as part of scoliosis therapy.

Once growth is complete and the Cobb angle is less than 20 degrees, no further control is required. In the case of scoliosis of 20 to 40 degrees that has not been operated on, the doctor will carry out a control examination about two to four years after the end of growth. If the curvature has increased by five degrees, further checks follow. If adults suffer from over 40-degree scoliosis, the guidelines recommend an annual review.

If the affected person has had surgery, no further routine examinations are necessary two years after the operation when the stiffening is stable and the Cobb angle is below 40 degrees.

Living with scoliosis

In most cases, patients can live well with their scoliosis. It is important to work actively against the spinal deformity. Integrate scoliosis exercises into your everyday life. Do (school) sports. If you have concerns about some activities, you should always consult your doctor.

If your scoliosis burdens you in your everyday life, for example at work or in your free time, do not hesitate to ask for help. Contact your employer, your physiotherapist or friends. Some of those affected are also involved in self-help groups. If the scoliosis is weighing on your psyche or that of your child, psychotherapeutic treatment may also be useful. By behaving openly and actively, you can collect valuable tips and prevent the progression of your scoliosis.

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Sandra Eades
Hello I am Sandra Eades, physician, researcher and author from Australia. I am working currently as researcher for a private institution. I have studied in Britain and Australia, where I currently reside. I write about research topics in the organization of the public health government agencies. For the iMS I write about general medical conditions. I also research scholar sources to provide information to writers of other articles. I also check the citations of scholar papers. Finally, I read other articles before they are published. I am also a mother of three children!