Scoliosis

S C O L I O S I S


Structural deformities = Structural scoliosis

Structural defomities are characterized by permanent structural changes in the bone.

There is a fixed curve of the bones of the spine.

With structural scoliosis, the vertebrae are rotated with the anterior body toward the convex side. The rotation causes the posterior ribs and posterior chest wall to be prominent on the convex side and less prominent or sunken in on the concave side.


Functional deformities = Nonstructural scoliosis

Functional deformities do not involve permanent bony changes and typically result from mechanical dysfunction due to poor posture, leg length discrepancy, nerve root irritation, muscular imbalance, soft tissue shortening or a combination of these.

Functional scoliosis is treated by correcting the underlying problem. The spine itself needs no treatment.


Congenital scoliosis

Scoliosis due to bony abnormalities of the spine present at birth. These anomalies are classified as failure of vertebral formation and/or failure of segmentation. This form of scoliosis is relatively rare. Scoliosis could also be part of a syndrome, such as Klippel Feil syndrome.


Neuromuscular scoliosis 

Scoliosis in children with any disorder of the neurological system, such as spina bifida, cerebral palsy, spinal cord injuries and muscular dystrophies.

As children grow, their trunk gets weaker. The curves become worse during rapid growth.
Spina Bifida - Paralysis caused by congenital defect of the spinal column.

Fibrous dysplasia is another cause of scoliosis in children. It may affect the spine with the highest prevalence in the lumbar region. Connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, can be associated with scoliosis.


Degenerative scoliosis

Degenerative scoliosis, also described as "de novo" scoliosis is developing after skeletal maturity without previous history of scoliosis. Degenerative scoliosis affects a significant number of adults and women are mostly affected. The pathogenesis of degenerative scoliosis lies in degenerative changes of the spinal structures, such as the intervertebral disc, the facet joints and the vertebrae itself. Unlike adolescent idiopathic scoliosis, lumbar de novo scoliosis is usually associated with degenerative spondylolisthesis and stenosis. The most commonly implicated causes include osteoporosis and degenerative disc disease. Symptoms of degenerative scoliosis are most frequently progressive back pain, radiculopathy and neurogenic claudication. The main therapeutic goal is to provide pain relief and to improve patient's function. 


Secondary scoliosis

Secondary scoliosis is a vertebral pathology such as an osteiod osteoma. It is a painful scoliosis with a strong limitation of the forward bending of the trunk.


Adolescent scoliosis

Lateral spinal curvature that appears before the onset of puberty and before skeletal maturity. Three-dimensional spinal curvature, that include changes in the sagittal plane, lateral flexion and rotation of the spine.


Adult scoliosis 

Scoliosis which is present after skeletal maturity. Adult Onset scoliosis - from age 18 and beyond.


Juvenile scoliosis

Scoliosis diagnosed between 3 years and 9 years of age.


Infantile scoliosis

A curvature of the spine that develops before three years of age.


Idiopathic scoliosis

A curvature of the spine that develops before three years of age.


Antalgic scoliosis

A spinal postural change that simulate a scoliosis in order to avoid a pain. The main features are the absence of the hump and the presence of pain.


Hysterical scoliosis 

A non-structural deformity of the spine that develops as a manifestation of a psychological disorder.

                                      

Scoliosis classification

The magnitude of the curvature of the spine is measured using Cobb angle measurements. The Cobb angle describes only one plane of the 3-D deformity. It is measured by identifying the most tilted vertebra at the top of the curve and the most tilted vertebra at the bottom of the curve. A line is drawn from the upper edge of the vertebra at the top and the second line from the lower edge of the vertebra at the bottom of the curve. Where, the lines cross is the Cobb angle. There is a standard error of 5 degrees therefore changes below 5 degrees are not significant. The Cobb angle is universal standard to diagnose scoliosis and to assess whether a curvature has stabilized or is getting worse.


Scoliosis is generally classified as Mild, Moderate or Severe. Any measurement under 10 degrees is not considered to be scoliosis.

Mild scoliosis - if the Cobb angle is 10 degrees to 24 degrees                           

Moderate scoliosis - if the Cobb angle is 25 degrees to 50 degrees 

Severe scoliosis - if the Cobb angle is over 50 degrees 

                                               

The most important factor discriminating juvenile scoliosis from adolescent idiopthatic scoliosis is the risk of deformity progression. Curve progression is related to several factors:

  • the patient's gender
  • age
  • Risser sign
  • curve magnitude
  • rate of growth

Misalignments of body posture


The disturbances of human posture can be classified as structural or non-structural. 

The structural misalignments indicate the presence of morphological abnormalities within the bones and soft tissues (fascia, muscles, ligaments, tendons).

The structural misalignments include:

  • idiopathic scoliosis 
  • Scheuermann juvenile kyphosis
  • spondylolisthesis

They require specific diagnostic and therapeutic approach.


The most common types of non-structural misalignment of body posture in the sagittal plane in both children and adults are:


1. lordotic posture

2. kyphotic posture

3. flat back posture

4. sway back posture


They influence the skeletal and the muscular system leading to the functional disturbance.


The kyphotic posture is characterized by: 

  • increased thoracic kyphosis
  • head protraction
  • protraction of shoulders and shoulder blades

The lordotic posture is characterized by: 

  • increased lumbar lordosis
  • increased anterior tilt of the pelvis, which leads to increased flexion of hip joints 


The flat back posture represents a faulty posture that differs from the good one by the following: flattened lumbar lordosis and flattened lower part of thoracic kyphosis.

 

Thoracic scoliosis

Any spinal curvature in which the apex of the curvature is between the T2 and T11 vertebrae.


Thoracolumbar scoliosis

Any spinal curvature that has its  apex at the t12 and L1 vertebrae.


Lumbar scoliosis

A spinal curvature whose apex is between the L1 and L4 vertebrae. 


Lumbosacral scoliosis

A lateral curvature with its apex at the L5 vertebra or below.

Risser Sign

It is used to evaluate skeletal and spinal maturity. 

The Risser classification uses ossification of the iliac epiphysis to grade remaining skeletal growth. Ossification starts laterally and runs medially.

It's correlated with vertebral growth stages. It's based on a scale from 0 = completely immature to 5 = end of growth.

Risser type 1: 25% iliac apophysis ossification. Seen in prepuberty or early puberty.

Risser type 2: 50% iliac apophysis ossification. Seen immediately before or during growth spurt.

Risser type 3: 75% iliac apophysis ossification. Indicates slowing of growth.

Risser type 4: 100% ossification, with no fusion to iliac crest.

Risser type 5: Iliac apophysis fuses to iliac crest. Indicates cessation of growth.

The King classification system:

The King classification system describes curve types in idiopathic scoliosis and the system helps determine surgical treatment.

Type I - primary lumbar and secondary thoracic curves

Type II - primary thoracic and secondary lumbar curves

Type III - thoracic curves only

Type IV- large thoracic curves extending into the lumbar spine

Type V - double thoracic curves


Consultations are by appointment only.


Joanna Slup scoliosis expert


Britannia House, 1-11 Glenthorne Road, Hammersmith, London UK

W6 0LH


Phone: +44 77 1999 7920


Email:

enquiries@scoliosis-treatment.co.uk

To book an appointment:


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