Scoliosis

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Original Editors - Gregory Maes

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Search Strategy

I searched for articles about scoliosis on pubmed and web of knowledge. Searched for basic information and treatments for scoliosis on the internet using google. And I found a lot of information in a chapter about scoliosis in a syllabus of Professor Vaes.

keywords: scoliosis, physical therapy, idiopathic scoliosis, scoliosis treatment, scoliosis diagnosis

Definition/Description

Scoliosis is a sideward’s curving of the spine, resulting in one or even two curves, making the spine look like a S. In some cases the spine even shows a rotation component This rotation starts when the scoliosis becomes more pronounced. This is called a torsion-scoliosis, causing a gibbus. Scoliosis can be present from birth. It is then called congenitive scoliosis. Other sorts of scoliosis can be developed during growth, any causes for this are still not found. We then speak of idiopathic scoliosis. There are several types of idiopathic scoliosis. They are classified by location of the (single or double) curve in the spine.

Clinically Relevant Anatomy

The spine is a number of vertebra that are connected with muscles and ligaments. Between each vertebra we can find a disc. Each disc content a nucleus pulposis surrounded by an annulus fibrosis.
We have 7 cervical vertebra, 12 thoracic vertebra and 5 lumbar vertebra.
For more detailed information I’d like to add next link, which has all the information needed to understand the working of the spine: http://www.spineuniverse.com/anatomy

Epidemiology /Etiology

Epidemiology studies reveal that there are several types of scoliosis, we can conclude that the most frequent scoliosis are from the thoracal type. From a population of ten year olds the prevalention for scoliosis balances between 2% and 4%. From this 2-4% the major part stays stable during the lifetime of the subjects. In 7% of the cases the scoliosis gets worse and in 3% the scoliosis even disappears. It is known that of those 7% the majority is girls (5 to 1).

Characteristics/Clinical Presentation

Scoliosis presents itself as a curved spine that in most cases results in forming an S.
Causes of idiopathic scolioses are:
- Interruption of ligament connections between ribs and vertebra (Langenskjöld 1961-1968) (1)
- Muscular disbalance of muscles from the trunk (Stilwell 1962; Roaf 1968) (1)
- Hindrance of collagen metabolism (Ponseti 1954; Zorab 1971) (1)
- Hindrance of growth of the backside of one or more vertebra. This results in a local lordosis that results in a scoliolordosis. (Sommerville 1952) (1)

Differential Diagnosis

Symptoms for scoliosis can be (2):
- Sideways curvature of the spine
- Sideways body posture
- One shoulder raised higher than the other
- Clothes not hanging properly
- Local muscular aches
- Local ligament pain

Diagnostic Procedures

The most common diagnostic procedures are (2):
- X-rays of the spine
- Measuring the leg length.
- A bone scan, MRI, or computed tomography (CT) scan may be necessary in difficult diagnostic problems.

Outcome Measures

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Examination

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Medical Management

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Physical Therapy Management

Conservative therapy for scoliosis:
The main aspect of therapy for scoliosis is bracing. A brace can cause corrections of scoliosis, but we have to be realistic. When the growthstrenght is not in balance and the difference in growth between several parts of the back is too big, the brace will not be able to undo or correct the scoliosis. In this cases corrective surgery is the best solution.
Apart from the bracing, conservative therapy will include a quite large package of exercise therapy. Some exercises can be done without bracing like e.g. the Klapp creeping exercises. The goal of these exercises is to restore the lost mobility of the spine. I have to refer to the Milwaukee brace exercises where we find a whole package of excercises. Some are meant to maintain muscle tone, other are active correctional exercises, and another group of exercises are abdominal trunk strengthening exercises. I’d like to refer you to next link which has video’s and explanations of various exercises done with or without the Milwaukee brace.
http://www.physiotherapy-treatment.com/scoliosis-exercises.html
The purpose of these exercises is to try to obtain a better muscular control and tension so the spine will ultimately be corrected in a proper position. This we can manage by training the stabilizers of the spine by doing these Klapp- and Milwaukee brace exercises. Beginning from easy staring positions as are lying on the belly and sitting, to more complicated situations, like doing daily activities with attention on how the use the stabilizers properly.

Key Research

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Resources

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

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