The term Scoliosis comes from the Greek scolios which means curved or crooked. Spinal deformities in general have been observed and described since ancient times. Hippocrates and Galen had already provided data about scoliosis.
Although at present, the correct definition of scoliosis brings together more dynamic aspects. Today, scoliosis is considered a 3-dimensional spinal deformity, where the coronal plane exceeds 10 degrees and there is a lateral displacement of the vertebral body that crosses the midline and is regularly accompanied by rotation.
More than a disease by itself, many specialists consider it a sign or a more complex structural alteration.
Scoliosis can theoretically affect any segment of the spine, but it is mainly located in the thoraco-lumbar area.
Scoliosis has a high incidence, it is the most frequent deformity of the spine. In the general population it is considered that there is a 2% incidence. 4% of all 10-16 year olds have scoliosis. It is more common in girls.
10% of scoliosis can progress or accentuate over time, being more accentuated in the growth stage and in adolescence.
The reasons for consultation may be for functional or cosmetic problems.
It is important to make a good diagnosis, since not all curvatures of the spine are scoliosis. In fact, an angle of 5 degrees in the coronal plane is considered normal. More than 5% of the general population has slight deviations. Also if there is no spinal rotation on x-rays or imaging studies it cannot be considered scoliosis.
In all cases, the specialist in Traumatology or Orthopedics should be consulted, who will do the physical evaluation and the corresponding examinations to corroborate the 3 structural changes of the spine essential for the diagnosis and in turn investigate the probable causes of the problem.
In many cases, scoliosis does not cause any symptoms. Mainly in children and adolescents where the deformity can be very accentuated and is consulted for aesthetic reasons rather than for pain.
Neuropathic pain or root compression pain, due to pinching of a nerve root in the spine.
Asymmetry of the shoulders or the ribs are visibly appreciated at different heights. Also, contractures, muscle spasms or weakness in lower limbs may occur.
Fatigue may occur due to trunk imbalance. As with severe thoracic scoliosis, restrictive respiratory symptoms occur.
In the most severe cases, there are alterations to control the bladder sphincter and anal sphincter.
In most cases, an exact cause cannot be found.
The causes can be:
· Wedge vertebrae
· Vertebral bars.
· Congenital rib fusions
· Neuromuscular: they are all scoliosis secondary to muscular dystrophies, cerebral palsy, syringomyelitis and poliomyelitis.
· Traumatic: they occur after fractures or major trauma due to a traffic accident or sports practices. It can also be after radiotherapy, spinal surgeries or burns.
· Infectious: cases of infected perianal abscess and pilonidal cysts have been associated.
· Syndromic, for well-known syndromes:
· Rheumatoid arthritis.
· Marfan syndrome.
· Ehlers Danlos syndrome.
· Spindyloepiphyseal dysplasia.
· Tumors: such as medullary tumors, Osteoid Osteoma and Histiocytosis X.
· Compensatory: occurs when there is a difference in the length of both lower limbs greater than 2 cm.
· Idiopathic: there are no known causes, they are the most frequent.
Currently, most cases have been associated with a hereditary factor, so exploring the family history of spinal deformities is always very important.
There are three categories of idiopathic scoliosis:
· Infant: between 0 and 3 years old.
· Juvenile: between 4 and 9 years old.
· Adolescent: After 10 years of age.
It is considered that infantile and juvenile scoliosis are of early presentation and adolescent scoliosis, is of late presentation.
Late presentation or adolescent scoliosis represents 85% of all cases.
Several risk factors have been determined for the progression of the disease.
· Age: it has been shown that if the diagnosis is made at a younger age, the risk of its progression increases.
· Males progress more than females
· Once females have their first menstrual period (menarche), the progression of scoliosis slows.
· As the bones grow, the risk of progression is high. After the end of musculoskeletal development, the risk drops, but not completely.
· If you have scoliosis with large or severe curves from the beginning, the progression is faster.
· If there are double bends in the spine, the risk also increases.
Complications of scoliosis
The complications of scoliosis occur when the deformity is very severe and begins to produce alterations in the spine due to compression or in nearby structures that are functionally affected by the deformity.
The most frequent complications of scoliosis progression are:
· Chronic low back pain.
· Radiculopathies due to root compression are the most frequent complication (85%).
· Lower limb weakness in 8% of cases.
· Claudication in 9%.
· Myelopathy alterations of the spinal cord in 1%.
· Sphincter dysfunction 3%.
· Heart and lung damage.
· Psychological, derived from severe deformity and change in physical appearance.
In severe cases that undergo surgery, statistics indicate that between 20 and 40% of cases present some type of post-operative complication.
Surgical complications occur regardless of the etiology or cause of scoliosis. The most frequent are:
· Local infections and osteomyelitis.
· Neurological with root compressions.
· Loss of normal spinal function.
· Increased pain due to dorsal deformity.
· Death in less than 1% of cases.
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