Scoliosis: how to stop this problem?

A scoliosis is an abnormal three-dimensional curvature of the spine that is most marked in the frontal plane. When this curve exceeds 10 degrees in the radiographic measurement, it is called scoliosis.

People with this problem may have curvatures of the spine on the sides – and also rotation of the vertebrae – which often results in asymmetries in the shoulders or waist.

Scoliosis: the ABCs

On an x-ray, scoliosis is visible when the spine appears to be in the shape of an “S” or “C”, rather than the normal straight line.

There are several types of scoliosis: congenital, neuromuscular, idiopathic (cause unknown) and they are classified according to the size and location of the curve. Idiopathic scoliosis is the most common and usually occurs in adolescence.

This problem can affect people of any age, from babies to adults, but it usually begins between the ages of 10 and 15. It is actually the most common spinal deformity in the school age group.

With proper treatment, scoliosis can be improved, although it is not always necessary and in most cases has no health impact.

Symptoms

Symptoms of scoliosis can vary greatly, depending on the severity of the curvatures of the spine.

Mild scoliosis usually has no symptoms. However, in some cases, it may manifest in the following ways:

  • One shoulder higher than the other (misaligned shoulders);
  • One side of the hip higher than the other (uneven waist);
  • Both scapulae may be protruding;
  • Head not centered above pelvis;
  • Asymmetry between rib cage heights on both sides;
  • Changes in the appearance or texture of the skin over the spine (dimpling, patches of hair, or color abnormalities);
  • Whole body tilts to one side;
  • Back pain, which may vary from mild to severe.

When scoliosis is severe, it can lead to:

  • Permanent back pain;
  • Inability to maintain upright posture while standing;
  • Leg pain, numbness and/or weakness, or pressure on nerves in the lumbar spine;
  • Loss of height, in adults;
  • Bowel or bladder dysfunction in particularly severe cases;
  • Difficulty breathing (occurs when the rib cage puts pressure on the lungs);
  • Damage to internal organs.

Types and causes of scoliosis

Scoliosis can be divided into different types:

  • Idiopathic

    This is the most common type, with no specific cause, accounting for approximately 80% of pediatric scoliosis cases. Usually noted in the adolescent period;
  • Degenerative

    It is also very common and mainly affects people over the age of 60. The cause is related to asymmetric disc degeneration of the spine over time. It tends to affect mainly the lumbar region. It can cause back pain (especially sciatica), difficulty standing and difficulty walking.
  • Congenital

    Occurs when the spine does not develop properly in utero. It includes malformations such as hemivertebra (a vertebra that has not formed), segmentation defect (when parts of the spine are fused together) and rib fusion.
  • Neuromuscular

    It is caused by disorders of the brain, spinal cord and muscular system. It occurs in cases such as cerebral palsy, spinal muscular atrophy, Angelman syndrome and Arnold-Chiari malformation (or spinal cord injury).
  • Thoracogen

    This occurs when there is asymmetric development of the spine due to radiation therapy of childhood tumors or surgery to treat a congenital heart defect.
  • Syndromic

    This is scoliosis that develops as part of an underlying syndrome or disorder. For example: problems of the muscular system (muscular dystrophy, polio, arthrogryposis or spina bifida) and connective tissue diseases.

Treatment

As with many other health problems, the earlier scoliosis is treated, the better the person’s quality of life.

However, treatment is not necessary in most cases and only a small number will require either the use of vests (orthotics) or spinal surgery.

In all cases, the decision for treatment should always be made by a specialized orthopedic physician, after specific examinations have been performed. These usually include an X-ray and, in a much smaller number of cases, an MRI.

The type of treatment depends on the age, the severity of the spinal curvature and the likelihood that it will worsen over time, and must be individualized, also taking into account the etiology of the scoliosis.

  • Infants and young children

    They may not require treatment because the curvature of the spine usually improves with time. When necessary, the following options exist: use of a brace (usually indicated for curvatures greater than 25 to 30 degrees in growing children), application of a plaster brace (placed under general anesthesia), or use of a cranial halo (a metal crown attached to the head with multiple pins and applied under general anesthesia).
  • Older children

    They may need to wear a brace until they finish growing, to prevent the scoliosis from getting worse. In some cases, surgery is needed to control the growth of the spine. This is until further surgery is possible to straighten the spine when they stop growing.
  • Adults

    They may need treatment for pain, such as painkillers and spinal injections. Very occasionally, surgery may be required.

Patients with neuromuscular scoliosis who have cerebral palsy or muscular dystrophy, for example, usually have a different treatment. In these cases, the goal of surgery is usually to allow the child to sit properly in a wheelchair.

In general, there is also the possibility of physical therapy, which may include therapeutic exercises, biomechanical education (posture correction, etc.), aquatic therapy, among other methods.

Finally, exercise is helpful for overall health and should not be avoided unless advised otherwise by a physician.

As a general rule, muscle-strengthening and stretching exercises of the so-called “core” (muscle groups in the abdominal and lumbar area) are recommended, as well as low-impact activities, including swimming, cycling, and the elliptical machine.

The ability to run and do other high-impact exercises depends primarily on the presence (or absence) of pain.

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