Diseases

Scoliosis - symptoms, causes and treatment options

Scoliosis - symptoms, causes and treatment options


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Spinal curvature

If the spine deviates from its normal shape and there is a lateral deflection and a rotation of the vertebral body, one speaks of a degree of curvature from a scoliosis. This deformity predominantly occurs in growing age and can sometimes regress without treatment. In cases with larger dimensions and with a progressive course, physiotherapy, corset treatment and, less often, operations are necessary to prevent or limit serious consequences, pain and restricted movement.

A brief overview

Scoliosis is a well-known term for crooked posture and bent spine. But what exactly is behind this clinical picture and what treatment is recommended to those affected? Read the most important facts in the brief overview below and find out more in the following article.

  • definition: Scoliosis describes a lateral curvature of the spine by at least ten degrees (according to the Cobb) in combination with a rotation of the vertebral body, which results in a three-dimensional deformity of the spine. These phenomena mainly occur during the growth phases.
  • Symptoms: The typical external identifying marks for this type of misalignment can lead to psychological stress, especially in adolescents. If there is a greater extent, pain and restricted movement or even functional restrictions of certain organs can occur.
  • causes: The causes are still largely unexplained and, according to all assumptions, the disease is multifactorial. Most scoliosis are classified as idiopathic, that is, without a clear cause. However, some underlying diseases can cause spinal curvature and an inherited component is also assumed.
  • diagnosis: Early diagnosis is the most important aspect for a good prognosis. Appropriate physical inspections, special medical histories and, if suspected, also imaging procedures should be used, in particular for early detection examinations in children and adolescents, in order to be able to precisely determine scoliosis or other possible diseases.
  • treatment: It is not uncommon for special treatment to be necessary, especially in adolescence, because the curvature can resolve spontaneously during growth. The extent and age, but also the symptoms (especially in adults) are decisive criteria for the choice of therapy. In addition to physiotherapy and wearing a corset, surgery is less often advisable.
  • Naturopathic treatment: Naturopathy can be used to relieve symptoms of pain and muscle tension. Affected people report good results with heat or electrical treatments or after acupuncture.

Definition

The spine naturally has a double “S” shape, with the cervical and lumbar spine arching slightly forward (lordosis) and the thoracic and sacral spine (sacrum) slightly arching backwards (kyphosis). Different permanent deviations from this healthy structure are summarized under spinal deformities. In addition to the normal shape (with a slight curvature to the front and back), there is also a lateral deflection (by at least ten degrees according to the Cobb-Angle method) together with twists of the vertebral bodies, one speaks of a three-dimensional curvature of the spine or, in specialist circles, also of scoliosis. The medical term is derived from the Greek “skolios” for “crooked” or “crooked”.

There is usually a primary curvature (primary curvature), whereupon additional compensatory curvatures are formed (secondary curvature) in order to continue to enable an upright posture. In principle, a distinction is made in different forms of scoliosis in which spine segment the curvature has manifested and whether there is a right-sided or left-sided bend. Lateral curvature without rotational deviation does not count as scoliosis.

In addition to the classification according to the location and the curvature pattern (classification according to Lenke or King), scoliosis are mostly classified according to the cause and according to age.

It is believed that about three to five percent of the population suffer from scoliosis, with the mild forms occurring significantly more frequently. Overall, more girls / women than boys / men are affected, although this ratio is more noticeable in later stages or in older age. With increasing age, the number of scoliosis diagnoses also increases overall.

Symptoms

Different forms can cause clearly visible signs and complaints, or can cause hardly recognizable or noticeable problems for those affected. The corresponding clinical picture is therefore very different individually.

Typical visible signs

If you look at the trunk of an affected person from behind, the following classic asymmetries are noticeable in the case of severe scoliosis:

  • Shoulder girdle and pelvis crest are crooked,
  • Waist triangle (triangle between side contour and straight hanging arm) clearly different on the right and left side,
  • Head is not centered over the pelvis (inclined head posture),
  • Shoulder blades are crooked, a shoulder blade protrudes.

Also in the so-called Adams test, in which those affected make a forward bending of the trunk and let their arms hang loosely, an inclined posture can become more apparent. As a rule, an oblique hump (rib hump) and a one-sided protrusion of lumbar muscles (lumbar bulge) are typical identifying features for a pronounced vertebral body rotation.

Possible complaints and restrictions

At the beginning of scoliosis and with slight manifestations, those affected are often symptom-free (whereby infant scoliosis has its own, often temporary, symptom picture) and it is rather optical factors that can lead to psychosocial problems, especially in adolescents.

The location and severity of the bend largely determine the symptoms. If there is a curvature over a long period of time, signs of wear and tear on the spine are much more likely to occur due to the special and one-sided load and there are consequential problems such as muscle tension and pain. This is increasingly the case from the age of thirty.

Lung capacity may also decrease and shortness of breath, a feeling of pressure on the chest or rapid heartbeat may occur.

Common ailments that occur to different degrees with scoliosis and can also lead to restricted movement include:

  • Back pain,
  • Low back pain,
  • Flank pain,
  • Pelvic pain,
  • Sacrum pain,
  • Neck tension,
  • Muscle tension in the back (especially BWS, LWS),
  • Breakthrough feeling,
  • Stiff back.

If the curvature and rotation of the spine is pronounced, surrounding structures in the chest and abdomen can also be narrowed, and certain organs such as the heart, lungs, stomach and intestine or kidneys can be restricted in function.

Lung function appears to be directly dependent on the degree of curvature and functional impairments occur relatively early when the lung volume decreases. A noticeable shortness of breath, like cardiovascular complaints and other impairments, usually only becomes apparent in advanced stages.

Causes

The causes have not yet been clearly clarified and it is believed that several factors play a role in the development of the disease. Therefore, idiopathic scoliosis occurs most frequently, at around eighty to ninety percent. A classification that defines a curvature of the spine with no known cause. Depending on the age at which the disease occurs, a distinction is made between infantile, juvenile, adolescent or adult (from eighteen years of age) idiopathic scoliosis.

Scoliosis is one of the spinal deformities that primarily develop during growth and can worsen without treatment, especially during the growth phases and during puberty. In adults, it is often difficult to find out whether the curvature has actually arisen ("de novo" scoliosis) or whether there is a progression from a curvature that has already started in childhood and adolescence.

The curvature of the spine is less common due to other (ascertainable) causes. These can be, for example, congenital malformations, degenerative processes (in adults), trauma or other underlying diseases, such as the muscles and nerves or the connective tissue and metabolism. A certain hereditary component is also assumed to be the triggering factor.

Diagnosis

Early diagnosis and corresponding early detection examinations in childhood and adolescence are of great importance. Because the sooner a scoliosis occurs, the more serious are the courses, which can be counteracted as best as possible, especially with timely treatment.

Specialist, orthopedic examinations can be used to check and classify the first abnormalities and possible complaints by means of a medical history and physical examination. In addition to the assessment of typical identifying marks, this also includes further analyzes of the spine while standing and sitting. In this way, other (additional) deformities can also be identified (for example, kyphosis or spondylolisthesis) or differences in leg length that are also decisive for the respective form of treatment.

If children or adolescents are affected, times of growth spurts and the first menstrual period (menarche) are asked for with a special medical history and the duration of the growth phases is also determined, if possible.

During the medical examination, attention should also be paid to so-called café-au-lait spots, since these can provide evidence of the presence of neurofibromatosis, a possible cause of the development of scoliosis.

If scoliosis is suspected, an X-ray examination or other imaging methods are used in the vast majority of cases. The images may provide additional information on the underlying causes and enable the severity to be determined precisely via the angles of curvature (Cobb angle) and the skeletal maturity (Risser symbol). All of these factors influence the prognosis and subsequent treatment options. It is believed that with idiopathic adolescent scoliosis, the risk of disease progression increases with the extent of the curvature, but decreases with increasing skeletal maturity.

If there are other peculiarities or if the extent is severe, for example with existing organ dysfunction, further examinations are necessary.

Treatment

The exact diagnosis (for the form and cause), the age and the individual symptoms of the affected person decide on the necessity and the form of the best form of therapy. There is no uniform treatment strategy and it is also possible that no treatment will be scheduled due to the factors mentioned. It is assumed that the vast majority of scoliosis correct themselves spontaneously during growth. In this context, however, close follow-up controls play an important role. If the disease progresses (also unexpectedly), treatment is essential.

The goal of any therapy in growing age should be to reduce the curvature or at least to prevent it in the long term and stably prevent existing scoliosis from progressing. In adulthood, however, adult scoliosis is treated more according to the symptoms.

In most cases and in the case of rather mild forms, conservative therapy methods are considered first. These are regular physiotherapy with special applications and exercises and wearing a corset (orthosis) for more severe oblique postures.

In corset treatment, growth should be directed against the present deformity in the direction of the normal state. This measure is used more often in children and adolescents, since spine growth no longer occurs in adults. In some cases, a corset can also help stabilize the spine in older people.

In particularly serious forms, taking into account all advantages and disadvantages, various surgical interventions are used, which may have to be carried out several times. Post-operative, physiotherapy and possibly a corset are just as important a part of the therapy for rehabilitation.

If certain underlying diseases have been identified as the cause of a scoliosis, treatment concepts also play a role.

Forms of therapy after determining the Cobb angle

The Cobb angle (degree of lateral spinal curvature) already plays a decisive role in the diagnosis, because scoliosis is only mentioned in children from ten degrees. In summary, in the treatment question, it can be stated that, in principle, treatment only has to take place at twenty degrees in order to counteract an expected progression during growth.

While physiotherapy is also advisable at lower angles of curvature, an orthosis is usually only recommended at twenty-five degrees. If the Cobb angle is forty degrees or even more, especially at the time the growth is complete, surgery may be necessary.

Naturopathic treatment

For symptomatic treatment, mainly against the back pain that occurs, there are a number of means and methods available in the field of naturopathy that can supplement or even replace the use of pain relievers. These include heat and electrotherapy (e.g. transcutaneous electrical nerve stimulation) or acupuncture. (tf, cs)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. rer. nat. Corinna Schultheis

Swell:

  • Seifert, Jens Thielemann, Falk, Bernstein, Peter: Adolescent idiopathic scoliosis, guidelines for practical use. in: The Orthopedist, Edition 6/2016
  • Bernstein, Peter and Seifert, Jens: Scoliosis in growth, in: Orthopedics and Trauma Surgery up2date Edition 10/04 (2015), pp. 259-276, thieme.de
  • Trobisch, Per et al .: Idiopathic scoliosis. in: Deutsches Ärzteblatt Int. Edition 107/49 (2010), pp. 875-884, aerzteblatt.de
  • Stücker, Rlaf: The idiopathic scoliosis, in orthopedics and trauma surgery up2date 5/1 (2010), pp. 39-56
  • Website of the German Scoliosis Network (DSN): http://www.deutsches-skoliose-netzwerk.de (accessed: June 18, 2019)
  • German Society for Orthopedics and Orthopedic Surgery (DGOOC): Guideline Special Rehabilitation Concept for Spinal Deformities, as of 03/2012 (revised), published by AWMF online, awmf.org

ICD codes for this disease: M41ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.


Video: Scoliosis - Curvature of the Spine (July 2022).


Comments:

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  6. Mikazuru

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  7. Cullin

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