Scoliosis |Dr. Jayesh Pawar

Scoliosis

Scoliosis is a condition where there is an abnormal lateral (sideways) curvature of the spine. Typically, the spine forms a "C" or "S" shape instead of a straight line. Scoliosis can occur at any age but is most commonly seen in adolescents. It can range from mild to severe and may worsen over time if not properly managed.

Causes

The exact cause of scoliosis is often unknown (idiopathic), but several factors can contribute to its development.

Idiopathic: In most cases, the cause is unknown, though genetics may play a role. Most cases develop during growth spurts in adolescence.
Congenital: Present at birth, resulting from abnormal vertebrae formation during fetal development.
Neuromuscular Conditions: Conditions like cerebral palsy, muscular dystrophy, or spina bifida can lead to scoliosis due to muscle weakness or imbalance.
Degenerative: In older adults, degenerative changes in the spine (such as osteoarthritis) can lead to scoliosis.
Trauma: Spinal fractures or injuries may result in a misalignment leading to scoliosis.
Genetics: Family history of scoliosis may increase the risk of developing the condition.

Symptoms

Scoliosis may not always cause noticeable symptoms, especially in the early stages. However, as the curve progresses, symptoms

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may appear and can vary in severity.

Visible Curvature: A visible side-to-side curve in the back, often noticed by a family member or during a routine check-up.
Uneven Shoulders or Hips: One shoulder or hip may be higher than the other.
Back Pain: Some individuals may experience pain or discomfort, particularly in the lower back.
Limited Range of Motion: Difficulty in bending or twisting the back.
Asymmetrical Rib Cage: The ribs may stick out on one side due to the spinal curvature.
Fatigue: Muscular fatigue due to uneven distribution of weight on the spine.

Diagnosis

Diagnosis of scoliosis involves a thorough physical examination, followed by imaging studies to assess the degree of spinal curvature.

Physical Examination: The doctor may ask the patient to bend forward to observe any unevenness in the back or ribcage, a test called the "Adam's Forward Bend Test."
X-rays: The primary diagnostic tool to assess the angle of the curvature and to determine the severity of scoliosis. The angle of curvature is measured using the Cobb angle method.
MRI/CT Scan: In some cases, an MRI or CT scan is ordered to examine the spinal cord and nerve involvement if there is concern about underlying neurological conditions.
Scoliometer: A tool used to measure the degree of spinal curvature in clinical settings, often used for monitoring.

Treatment

Treatment for scoliosis depends on the severity of the curve, the age of the patient, and whether the condition is progressing.

Treatment options range from observation to surgery.

Conservative Treatment:

Observation: For mild cases (curves less than 20 degrees), regular monitoring through physical exams and X-rays may be sufficient.
Bracing: For moderate scoliosis (curves between 25-40 degrees) in growing children or adolescents, a brace may help prevent further progression of the curvature. Braces are worn until the skeleton stops growing.
Physical Therapy: Exercise programs focusing on strengthening the core muscles and improving posture. Special exercises like the Schroth Method can help with scoliosis management.
Pain Management: Over-the-counter pain relievers like NSAIDs may help relieve discomfort from mild scoliosis.

Surgical Treatment:

Indications: Surgery is considered for severe cases (curves greater than 45-50 degrees), or when the curve is causing significant pain, respiratory difficulties, or neurological issues.
Spinal Fusion: The most common surgery for scoliosis, involving fusing two or more vertebrae together to stop the curve from worsening. This is typically done with metal rods, screws, and bone grafts to stabilize the spine.
Growing Rods: For younger children with scoliosis who are still growing, expandable rods may be used. These rods allow for continued spinal growth while controlling the curvature.
Vertebral Body Tethering: A newer, less invasive surgical technique that uses a flexible cord to correct the curvature without fusing the vertebrae.
Spinal Osteotomy: In some cases, corrective surgery may involve cutting and realigning the vertebrae to restore normal spinal alignment.

Other Treatments:

Alternative Therapies: Acupuncture, chiropractic care, and yoga may provide symptom relief, but they are not considered primary treatment options.
Pain Management: In cases with significant pain, stronger pain medications or epidural injections may be considered.