What is scoliosis?

This article answers the question What is scoliosis by providing scientific content and resources. Scoliosis is a condition that affects the spine and causes it to curve to the side. The spinal bones, or vertebrae, are not supposed to line up perfectly straight. But when they do, it’s called scoliosis.

While scoliosis can be mild and cause few problems, severe scoliosis can be disabling. The good news is that most cases of scoliosis can be managed conservatively, without surgery.

What is Scoliosis?

Scoliosis is described as a complicated three-dimensional rotational distortion of the spine and trunk that happens in healthy persons and can emerge in response to a variety of reasons at any time throughout a child’s development or adulthood.

The etymology of the word comes from the ancient Greek word “scolios“, meaning crooked.

Scoliosis is a condition which brings about changes in all three planes of movement. It creates a lateral curvature in the frontal plane, an axial bend in the horizontal plane, and a shift in the typical curvatures of the occipital plane (kyphosis and lordosis), frequently resulting in “flatback.”

Scoliosis can be organic (structural), in which lateral tilting of the spine, rotation and deformation of the vertebrae coexist, or functional, which is caused by external causes such as anisoskeletal or muscle spasm.

What Causes Scoliosis?

Most cases of scoliosis have no known cause. This type of scoliosis is called idiopathic scoliosis. Idiopathic scoliosis can run in families, so there may be a genetic predisposition for the condition.

There are other types of scoliosis that occur as a result of another condition or syndrome, such as:

What are the Symptoms of Scoliosis?

The most common symptom of scoliosis is a curved spine. The curve can be mild, or it can be severe. In some cases, the ribs may stick out more on one side of the body than the other.

Other symptoms of scoliosis can include:

How to diagnose scoliosis

The diagnosis of scoliosis is made by considering the clinical and radiological examination. According to the SRS (Scoliosis Research Society), the diagnosis of scoliosis is confirmed when there is a lateral tilt of the spine with a Cobb angle greater than 10 degrees on the X-ray, with concomitant rotation of the spine.

However, in order to have a valid diagnosis, and to distinguish between organic and functional scoliosis, there must be a positive Adam’s test.

The criteria for a positive Adam’s test are lateral inclination of the spine, hypos in the curved part of the curve and interruption of the normal curve of flexion in thoracic scoliosis during the flexion test.

Clinical examination

Depending on the type and size of the scoliosis, some minor or more pronounced changes in the clinical picture of the adolescent are observed, such as :

Radiological examination

To make a diagnosis of scoliosis, there should be lateral inclination of more than 10° (Cobb angle), axial rotation of the vertebrae, and deformity of the vertebral bodies.

In summary, the diagnostic criteria (BSPTS Radiological Criteria) for scoliosis are as follows:

+++ Adam’s test

• Alexander Adam’s test: ‘Adam’s test’ (Adam’s test)
• Tilt of the curve
• Interruption of the normal curve of the kyphosis in thoracic scoliosis
• Any lateral inclination of the spine (even less than 10 degrees) with simultaneous deformation of the vertebrae
• Axial rotation of the vertebrae
• Epidemiology

Scoliosis is a condition that occurs in about 2-3 % of the world’s population, with a much higher incidence, for unknown reasons, in girls. The progression of scoliosis is also greater in girls. The incidence ratio with boys is approximately:

• 1.3:1 for scoliosis 10-20 degrees
• 5.4:1 for scoliosis 20-30 degrees
• 7:1 for scoliosis over 30 degrees

Research suggests that scoliosis incidence rates also depend on latitude.

In 20% of cases, scoliosis occurs after another pathological condition, so it is of known cause.

Examples of known etiology are:

Finally, there are some sports that have a high incidence of scoliosis, without necessarily causing it or affecting its normal progression, but it is considered appropriate to evaluate them during clinical assessment and treatment monitoring.

These sports are swimming, rhythmic and instrumental gymnastics, ballet and tennis, i.e. sports that require flexibility, have several torso bends and often bring the spine into extreme positions.

In general, patients with scoliosis are encouraged to exercise for the general benefits of sport, but under no circumstances should any sport be recommended as a form of treatment for scoliosis.

Scoliosis Treatment

The treatment of Scoliosis is determined by several factors, the most important being the size of the angle of the scoliosis and the child’s stage of development.

Other parameters that should always be taken into account are the type of scoliosis, radiographic rotation and deformation of the vertebrae, trunk rotation, body asymmetry, family history, onset of first period in girls, reduced thoracic kyphosis, etc.

Therefore, the decision on the appropriate treatment of scoliosis should be taken by a specialist and specially trained scientists, in order to avoid less (undertreatment) or more (overtreatment) treatment than is actually needed.

The general guideline from the international scientific communities Scoliosis Research Society (SRS) and Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) is that scoliosis below 25 degrees is only treated with Physiotherapeutic Scoliosis Specific Exercises (PSSE).

The most widely used and scientifically documented method is the Schroth method. It is very often stated by doctors that in scoliosis below 20 degrees only periodic X-ray monitoring is recommended and that there are no exercises that help prevent scoliosis from growing.

This is completely wrong, as there are dozens of studies of high methodological quality and reliability that prove that PSSE can significantly reduce the likelihood of scoliosis worsening and avoid the need for a brace in a very high percentage of cases.

Furthermore, PSSE are also officially recognized by all the international scientific communities involved in the treatment of scoliosis.

Also, the concept of follow-up is quite confusing to most Orthopedic Surgeons, as follow-up is not what the X-ray will show in 3 or 6 months, but what happens during this time and whether the scoliosis is stabilized or not.

So, unfortunately, many cases, even though they had a very early diagnosis and could have successfully treated their scoliosis with the Scoliosis Specific Exercises without the need for a brace, end up wearing a brace for years because the scoliosis grew as long as they simply monitored it or did general, inappropriate or no exercise.

It is therefore of great importance in a scoliosis with the potential to worsen that Specific Supplementary Exercise (PSSE) is implemented early enough to prevent worsening.

Also, it is particularly important that treatment monitoring is carried out by a Specialist Physiotherapist. We ensure all of this at Schroth Scoliosis & Spine Clinic.

Scoliosis Brace

Regarding braces, the SRS and SOSORT guidelines are that it is indicated when the scoliosis is more than 25 degrees and the child has sufficient growth reserve.

However, each case must be considered individually, because as mentioned above, other factors must be taken into account.

At Schroth Scoliosis & Spine Clinic you will have a valid assessment and diagnosis of the condition and appropriate treatment will be recommended.

In the event that a brace is required, detailed instructions will be given on how to plan this, by a qualified physiotherapist.

The surgical indication for scoliosis is over 40-45 degrees. However, this in no way means that those over 45 degrees should have surgery.

Firstly, a good brace along with Schroth exercises seems to offer very good corrections even in very large scoliosis, secondly results with surgical treatment are by no means guaranteed and thirdly there are very many adults who with the application of Scoliosis Specific Scoliosis Exercises (PSSE) manage to stabilize or even improve even very large scoliosis.

So surgery is not a one-way street above 45 degrees and the final decision should be the patient’s, after receiving an objective assessment of their treatment options and the pros and cons of each.

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