The spine of the human body consists of 24 vertebrae. There are 7 cervical vertebrae in the Scoliosis is a potentially crippling condition that can cause deformity in children. Early detection and treatment, therefore, is extremely important in reducing or eliminating these effects and their subsequent impact on the person’s life. Neck, 12 thoracic vertebrae in the back, and 5 lumbar vertebrae at the lower end of the spine. These bones are all connected by ligaments and muscles and the bones themselves become progressively greater in size from the top to the bottom of the spine.
In some people, a curvature of the spine develops and this is the condition known as scoliosis. The condition of scoliosis can be described according to the area of the spine and also the direction of the deformity in the spine. Cervical scoliosis is rare and may be left or right sided. Thoracic scoliosis is by far the most common. It can also be left or right sided. Scoliosis is not a problem in the lumbar area as it is too short for the condition to develop.
There are two main forms of scoliosis, mobile and postural. When the curvature is mobile, stretching or leaning exercises will straighten it. This type of scoliosis is called postural scoliosis. If the problem is in the spine itself, it is structural scoliosis which is fixed and permanent and requires more medical intervention as it may have some serious secondary effects. These will be discussed in greater detail in the following paragraphs.
There are a number of causes of postural scoliosis. One cause is having one leg shorter than the other, causing the person to balance by leaning toward the longer leg, thus curving the spine. Unfortunately, the person has to do this to remain upright unless the condition is addressed. The simple act of wearing a raised shoe or shoe insert on the shortened leg eliminates the scoliosis that has been produced.
Some people have excessive contracture of the hip muscles and this causes the pelvis to tilt. The centre of the pelvis is connected to the spine so the pelvic tilt causes the spine to bend sideways. Consequently, the top part of the spine must then twist in the opposite direction, creating a scoliosis.
A slipped disk or prolapsed disk can cause unbalanced spasms in the large muscles at the sides and back of the vertebrae. This is a protective response by the muscles and the resulting scoliosis is not permanent though it may last for quite a while if the original condition is not treated.
An easy way to see if the person has postural scoliosis rather than structural scoliosis is to sit the person down and view from behind. When it is a postural scoliosis, the curvature disappears when the person sits down as the pelvis automatically becomes level. If it is structural scoliosis, sitting will not make any difference to the visible curvature.
Fixed or structural scoliosis affects more girls than boys and it becomes evident during childhood. There are a number of causes including abnormality in the bones at birth, paralysis caused by poliomyelitis or any other condition where some of the spinal the muscles are weaker than others, causing an imbalance through compensation. All of these things have the ability to cause the spine to become curved.
Structural scoliosis can also be caused by cerebral palsy, muscular dystrophy, and a condition called neurofibromatosis where there are numerous benign tumors on the small nerves. There is also a condition called Marfan’s syndrome, a genetic disorder, where the protein collagen is deficient. Another form of scoliosis begins in babies and may recover spontaneously or go on to cause severe deformity.
All of these conditions are associated with an actual abnormality in the bones creating some rotation of the vertebrae. A change in posture does not alter the deformity and any secondary curves that result from the primary deformity will quite often become fixed as well.
In recent times, it has become known that the most common cause of structural scoliosis is idiopathic adolescent scoliosis, meaning that the origin is unknown. However, some experts believe that it results from unbalanced muscular development. This condition is normally evident prior to reaching puberty, usually around the ages of 8-10. If it is not treated, it may progress until the person’s skeleton has reached maturity in the early 20s. However, it must not be assumed that all scoliosis that appears in the young is of this type and all apparent cases of scoliosis should be checked to ensure that other conditions are not the cause.
Idiopathic adolescent scoliosis affects girls more so than boys (a ratio of 5:1) and has a tendency to be genetic. In most cases, the only symptom is the curvature itself and, even in severe cases of scoliosis, there is usually little pain. However, it can lead to arthritis in later life, resulting in backache.
The most serious complication is that a secondary curvature of the upper spine may compress the lung and stop it from expanding. This inability to expand may cause decreased function of the lung and resultant respiratory difficulties. The blood vessels in the affected lung can also become resistant to blood flow, making the heart work harder to maintain circulation. This can lead to a dangerous condition called corpulmonale.
A special brace can be worn to prevent the deterioration of mild curvatures though more severe cases may require a specialized vest or jacket as well as traction exercises to correct the deformity.
Most severe cases, however, need surgical intervention to straighten the curve. After the surgeon straightens the curve, the bones of the spine are joined together with a bone graft or metal rods. Usually, this operation results in a considerable improvement in appearance and prevents the curvature from deteriorating again.
The primary concern with scoliosis is that it will continue to deteriorate to a more serious deformity. This is aesthetically unattractive and may also cause a problem in sitting and walking.
However, with early recognition and treatment the deformity can usually be prevented from becoming severe. Once the spine has ceased to grow in the early 20s, the curvature will not become any worse.
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