Scoliosis and it's effect on posture....

Posture related information

1. Scoliosis By: farhan adil takkar

2. SCOLIOSIS Scoliosis is an abnormal lateral curvature of the spine. The curvature may be toward the right (more common in thoracic curves) or the left (more common in lumbar curves). S coliosis is often associated with kyphosis and lordosis .

3. Scoliosis can occur as a result of Idiopathic unknown cause (80%) Osteopathic bone disorders Myopathic muscle weakness Neuropathic CNS disorder

4. O nset I nfantile (0 to 3 years) J uvenile (ages 3 to 10) A dolescent (age 10 until bone maturity at between 18 and 20 years of age) Majority of cases A dult (after skeletal maturation) * The incidence is increased with associated neuromuscular impairments such as cerebral palsy, spina bifida, neurofibromatosis, and muscular dystrophy.

5. E tiologic Factors 1. STRUCTURAL SCOLIOSIS A fixed curvature of the spine associated with vertebral rotation and asymmetry of the ligamentous supporting structures. It can be caused by deformity of the vertebral bodies and may be congenital (e.g., wedge vertebrae, fused ribs or vertebrae, hemivertebrae ), musculoskeletal (e.g. osteoporosis, spinal tuberculosis, rheumatoid arthritis), neuromuscular (e.g. cerebral palsy, polio, myelomeningocele , muscular dystrophy ), or most commonly, idiopathic. 2. FUNCTIONAL SCOLIOSIS(postural) may be caused by factors such as pain, poor posture, leg length discrepancy, or muscle spasm induced by a herniated disk or spondylolisthesis . These curves disappear when the cause is remedied. Functional scoliosis can become structural if untreated.

6. Pathogenesis Unclear - better understood in relation to the underlying cause. Abnormal embryonic formation and segmentation of the spinal column are possible pathologic pathways in congenital scoliosis. Neuromuscular scoliosis is often the result of an imbalance or asymmetry of muscle activity through the trunk and spine. T he earliest pathologic changes associated with idiopathic scoliosis occur in the soft tissues as the muscles, ligaments, and other tissues become shortened on the concave side of the curve with the muscles on the convexity being in a lengthened position, muscle imbalance is present.

7. Clinical Manifestations mild scoliosis: Curvatures of less than 20 degrees. rarely cause significant problems. Severe untreated scoliosis: curvatures greater than 60 degrees may produce pulmonary insufficiency and reduced lung capacity, back pain, degenerative spinal arthritis, disk disease, vertebral subluxation, or sciatica.

8. Usually one primary curvature exists with a secondary or compensatory curvature that develops to balance the body. Two primary curvatures may exist (usually right thoracic and left lumbar). If the curvatures of the spine are balanced (compensated), the head is centered over the center of the pelvis; if the spinal alignment is uncompensated, the head is displaced to one side.

9. Common characteristics A symmetric shoulder and pelvic position, often identified when clothes do not hang evenly. Curves are designated as right or left depending on the convexity Paraspinal muscles on the convex side of the curve become rounded, appearing prominent or bulging, while the muscles on the concave side flatten. Rotational deformity on the convex side is observed as a rib hump ( gibbus ) sometimes seen in the upright position but always apparent in the forward bend position.

10. DIAGNOSIS Patient bend forward 90 degrees with the hands joined in the midline as if taking a dive into a swimming pool. A scoliometer also can be used to measure the angle of trunk rotation (ATR) An abnormal finding includes asymmetry of the height of the ribs or paravertebral muscles on one side. The examiner also checks for leg length discrepancy and other asymmetries and for the presence of hair patches, nevi, pits, or areas of abnormal skin pigmentation in the midline indicating possible underlying spinal abnormality. Differential diagnosis is important in determining whether the scoliosis is structural or functional. Structural curvatures maintain their position irrespective of whether the spine is in an upright or forward bending position. Functional curvatures straighten when placed in a forward bend position.

11. N eurologic examination Full-length radiographs of the spine X-ray, MRI etc Search for: Cobb method , Risser sign

12. TREATMENT. Prevention of postural or idiopathic structural scoliosis is the key to management of the majority of scoliosis cases. Observation and monitoring every 4 to 6 months for curvatures less than 25 degrees S pinal orthoses for curvatures 25 to 40 or 45 degrees S urgery for curvatures greater than 45 degrees have been recommended. Bracing, Curvatures with an apex between T8 and L2 and compensated thoracolumbar curves respond the most favorably to bracing, 1 3 5 whereas curvatures with an apex at T6 or above have the poorest outcome. Progressive resistive exercises specifically aimed at the trunk rotators and extensors are effective for curves less than 45 degrees.

13. PROGNOSIS. Postural curvatures resolve as the primary problem is treated. Structural curvatures are not eliminated but rather increase during periods of rapid skeletal growth. If the curvature is less than 40 degrees at skeletal maturity, the risk of progression is small. In curvatures greater than 50 degrees, the spine is biomechanically unstable, and the curvature will likely continue to progress at a rate of 1 degree/ yr throughout life. Poor seating can contribute to this progression. In severe kyphoscoliosis , pain and comfortable positioning can complicate care, and pulmonary compromise can lead to death.

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