09/09/2017
Scoliosis: Things to know and Management available
Right before I talk about scoliosis, shall we talk about a little bit on the spine?
The spine is made up of a series bone. These bones are called “vertebrae”. These vertebrae are connected to each other by discs and connective tissue. These vertebrae make up different sections of the spine from top to bottom. These sections include the cervical (vertebra in the neck), thoracic (vertebra in the chest), lumbar (vertebra of the low back) and sacral (located just above the tail bone).
Scoliosis is a three-dimensional deformity of the spine and trunk which includes lateral deviation, rotation, and a disturbance of the sagittal profile.
Treatment for Scoliosis is indicated because scoliosis may lead to negative consequences with regard to the quality of life and other health issues for some patients.
Types/Aetiology
Scoliosis is divided into three categories: congenital (indicates the patient was born with the curvature of the spine and is caused by failures in the formation/segmentation of the vertebrae and ribs), neuromuscular (caused by a wide variety of disorders affecting the neuromuscular system and nervous system e.g cerebral palsy, Duchenne muscular dystrophy and spina bifida) and Idiopathic (which means scoliosis arising from an unknown cause). Each of these categories is very different and requires different treatment interventions.
Idiopathic scoliosis is divided into three age categories based upon the initial presentation of the curve. Infantile idiopathic scoliosis presents between the ages of birth and two years old, juvenile idiopathic scoliosis presents between the ages of three and 10 years old, and adolescent idiopathic scoliosis presents between the ages of 11 and 17 years of age. Another difference between the three types of scoliosis is that infantile and juvenile scoliosis have a higher association with other spinal abnormalities such as tumors, syringomyelia (a large tube or cyst in the spinal cord), and descending of the cerebellum into the spinal canal. These disorders require additional and different treatment from adolescent idiopathic scoliosis.
There is a difference between females and males with AIS. In curves between 11-20 degrees there are more females with AIS than males. As the curves get bigger (greater than 20 degrees) so do the numbers of females with AIS compared to males. Also female curves increase or progress more often than in males.
This article will focus on Adolescent Idiopathic Scoliosis (AIS) being what majority of patients with scoliosis suffer from and rarely Early Onset Scoliosis (EOS). Late onset idiopathic scoliosis, also called adolescent idiopathic scoliosis (AIS) is diagnosed in 80% – 90 % of the total population with scoliosis.
Untreated symptomatic or syndromic scoliosis, as well as EOS, can sometimes cause severe health problems and higher mortality. However, AIS, the most common form of scoliosis, is relatively benign, and does not generally lead to severe health problems or early death.
scoliosis4
Adolescent Idiopathic Scoliosis (AIS) is a three-dimensional (lateral curvature, rotation of the spine and different plane curvatures) deformity of more than or equal to 10 degrees Cobb in the upright or standing position of the growing spine. Although benign in the majority of patients, the natural course of the disease may result in significant disturbance of body morphology, reduced thoracic volume, impaired respiration, increased rates of back pain, and serious esthetic concerns.
Sign and Symptoms
The symptoms and signs of AIS are
– shoulder asymmetry (one shoulder higher than the other)
– Scapula asymmetry
– Waist line/or hips asymmetry or tilt,
– Trunk shift (comparing the chest or torso to the pelvis),
– Limb length inequality
– and disturbances in physiologic kyphosis and lordosis
scoliosis sign
AIS is a painless deformity and the patients have no weakness or movement problems.
Symptoms or signs that alert the physician that another diagnosis should be considered include: other structural abnormalities of the spine found on X-ray, excessive kyphosis (forward curvature of the spine), juvenile-onset scoliosis, infantile onset scoliosis, rapid curve progression, associated syndromes or lower extremity deformities, back pain and neurologic signs or symptoms.
Diagnosis
Most of the time, Adolescent idiopathic scoliosis is usually first identified by a family member, school screening or pediatric or family physician/physiotherapist.
Because AIS is usually painless, a fullness or prominence of the back is noted especially with bending forward while standing and sitting. This prominence or rib hump can be measured using a scoliometer. The scoliometer measures the angle of trunk rotation at the apex or peak of the prominence.
Once the patient is referred to a scoliosis specialist and after a thorough history and physical examination, radiographs or X-rays are taken.
scoliosis6
Scoliosis Progression
Progression of scoliosis depends on the
– curve magnitude
– and the skeletal maturity of the patient at the time it is identified.
The smaller the curve and the more fully grown the patient is, the less likely the scoliosis is to increase.
Treatment
The treatment of scoliosis consists of:
– Physical rehabilitation and brace treatment (15 – 40° Cobb)
– Spinal fusion surgery (> 40 – 50° Cobb)
There is high level evidence for the physical rehabilitation and brace treatment of scoliosis, but there are varying levels of success in the different approaches. However, spinal fusion surgery is not supported by the current evidence
Physical Rehabilitation Exercise will include
– Spinal stabilization
– Balance activities
– Core strengthening
– Postural correction & lateral shifts
– Flexibility
– Respiratory activities
scoliosis b4afer
ORTHOTICS/BRACING
Wilmington Jacket (custom molded, full contact)
Charleston Brace (night time only; maximum sidebend)
Boston Brace (prefabricated with custom inserts)
SpineCor® (dynamic with elastic bands)
EXERCISE PROTOCOLS IN THE LITERATURE
SEAS –Scientific Exercises Approach to Scoliosis
Specific exercise to promote: Spinal stability Spinal stability Balance reactions Retain physiologic sagittal spinal curves
SCHROTH METHOD
Intensive inpatient rehab exercise program 6-8 hours/day for 4-6 weeks Goals: Decrease curve progression Reduce pain Increase vital capacity Improve posture and appearance
Integrated Scoliosis Rehabilitation/ISR Scoliologic™
Goals: Facilitate correction of asymmetric posture Maintain correction during ADLs
DoboMed
Active three-dimensional self-correction
Goal: Active stabilization of the corrected position performed as postural habit in closed kinematic chains
Side shift exercise and hitch exercise
– Lateral trunk shifts toward the concavity of the primary curve (sitting or standing) ( g g)
– Heel lift to “hitch” pelvis on convex side of primary curve
– Combined with part time brace wear
SURGICAL OPTIONS for ADOLESCENT IDIOPATHIC SCOLIOSIS
Posterior Spinal Fusion (PSF) – Rigid Spinal Fixation – Growth Rod (Expandable) Instrumentation Anterior Spinal Release and Fusion (ASF) Anterior/Posterior Spinal Fusion (ASF/PSF)
Contact Us today at Ace PhysioCare Clinics and consulting if you are suffering from scoliosis or any associated back pain.
09076906344 or 08176665420
