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About Scoliosis

 

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"Scoliosis is a complex three-dimensional phenomena involving vertebral wedging, extension, and rotation that transforms the entire shape of the trunk and its ability to optimally transfer forces during movement.  Scoliosis can be screened clinically by having the individual perform an Adam’s Forward Bend Test, but is confirmed radiologically on X-ray with a Cobb Angle > 10º."

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Scoliosis can be
Structural or Functional

A functional scoliosis is the spine’s attempt to upright the and level the head and eyes to compensate for muscular imbalances. In this type of scoliosis, an Adam’s Forward Bend Test is negative, with no visible rib hump or asymmetry. Over time, though, a functional scoliosis can become structural.

 

Structural scoliosis involves lateral wedging and rotation of both the discs and the vertebrae and impacts the entire 3D shape of the spine, rib cage and torso. In a structural scoliosis, the Adam’s Forward Bend Test is positive, revealing a visible rib hump in one or more areas of the back. In a structural scoliosis, not only are the vertebrae laterally shifted and rotated, but the shoulders, rib cage, and pelvic blocks are, too.

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Scoliosis Incidence & Prevalence

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  • Affects 3-4% of the population

  • Can develop at various stages of life, but most commonly presents during adolescence

  • Affects females and males equally, but females have 8x risk for curve progression to levels that require treatment.

  • Tends to progress during periods of rapid growth for both males and females, and peri-menopause in females

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Types of Scoliosis

  • Idiopathic (no known cause or etiology) 75-80%

  • De Novo (adult onset with no known history, also known as degenerative scoliosis)

  • Neuromuscular (5-7%)

  • Congenital (10%)

  • Other (secondary to other conditions, including Marfan’s syndrome, tumors, etc)

Idiopathic Scoliosis Defined

The current working definition of idiopathic scoliosis is best defined as:

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“A complex 3D torsional deformity of the spine and the trunk (CE Aubin) which appears in apparently healthy children, and can progress in relation to multiple factors during any rapid period of growth or later in life.”

 

-M Rigo, MD; Th Grivas, MD; J O’Brien, Scoliosis (2010)

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Classifications of Idiopathic Scoliosis

Idiopathic Scoliosis is classified according to the age of onset, not necessarily the age of diagnosis.

  • Infantile Idiopathic Scoliosis (IIS)                                      < 3 years old

  • Juvenile (Idiopathic Scoliosis JIS)                                     3-10 years old

  • Adolescent Idiopathic Scoliosis (AIS)                               10-18 years old     

  • Adult Scoliosis​​​​​​

a) Adolescent scoliosis that continues into adulthood​

b) DeNovo - adult onset with no previously known history of scoliosis

Causes

Many factors can contribute to the development of scoliosis, including genetics, biomechanics, low levels of Vitamin D, calcium, magnesium, leptin, the presence of osteoporosis or osteopenia, and more.

In Idiopathic Scoliosis (IS), while there is no known cause yet, many theories exist, but the most current scientifically accepted theory is the Bi-NOTOM (double neuro-osseous timing of maturation) theory proposed in 2009 by RG Burwell et al in Scoliosis.

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Neuromuscular Scoliosis involves asymmetry of the spine secondary to neuromuscular diagnoses such as cerebral palsy (CP), muscular dystrophy (MD), spinal muscular atrophy (SMA), and more. The nature,  presentation, and treatment of neuromuscular scoliosis is quite different from Idiopathic Scoliosis

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Congenital Scoliosis initiates in utero due to abnormal development of the vertebral column during gestation. Although the skeletal asymmetry is present at birth, congenital scoliosis may not progress or present until later stages of childhood growth.

Adult Onset/Degenerative, or De Novo Scoliosis is a scoliosis that develops in adulthood (usually > age 40) and is secondary to osteopenia, osteoporosis, muscle weakness, postural imbalances and chronic asymmetric loading of the disc and spinal facet joints. This type of scoliosis is most common in the lower thoracic and lumbar spine due to the foundational nature and most loaded region of the vertebral column.

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Signs and Symptoms of Scoliosis

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  • Possible trunk imbalance/leaning to the right or left side

  • Possible pelvic shift to the right or left side, opposite the primary curve.

  • One shoulder higher/lower than the other

  • Asymmetric rotation in shoulders

  • Uneven shoulder blades

  • Uneven waistline

  • One hip possibly elevated

  • Visible prominence (rib hump) observed from behind during a forward bend or spinal flexion

  • Spinous processes not in a straight line (non-rectilinear)

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Diagnosis

While postural asymmetries such as scoliosis and hyperkyphosis (Scheuermann’s Kyphosis) are screened for clinically, radiographic imaging such as X-rays or MRI are required to confirm a diagnosis.  EOS X-rays are a great option that many families choose to explore, as EOS provides a beautiful full-spine image at often a fraction of the radiation exposure of traditional X-rays.

Treatment

Many treatment options exist to support individuals and families with scoliosis.

 

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  • Observation

  • Physiotherapeutic Scoliosis Specific Exercise (PSSE)

  • Bracing

  • Surgery

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What is PSSE?

Physiotherapeutic Scoliosis Specific Exercise (PSSE) - PSSE differs from traditional physical therapy on many levels and is truly a specialized field requiring extensive training and certification post graduate school.  While there are a number of PSSE methods globally, the standard features of all PSSE programs are to:

  1. Optimize 3-dimensional postural balance

  2. Promote neutral spine core stability to so that the new, midline and balanced posture becomes the individual’s new habitual postural. 

  3. Educate and train patients on optimal body mechanics with activities of daily living (ADLs)

PSSE is patient specific and is only one part of a multidisciplinary approach in the conservative management of scoliosis and spinal dysfunction.

Sources:

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               Images & Sources were compiled and written by Meredith Weiss; reprinted with permission.

Curious to learn more?

Our video library is full of presentations on all of the above topics from leading world experts in the field of Spine and Scoliosis. We invite you to check it out and let us know how you like it!

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Our SSOL Schroth Course: Fundamentals of Scoliosis and Spinal Conditions is a 24 hour deep dive - 10 modules, 3 hours each, comes with comprehensive summaries

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