Scoliosis.

Scoliosis occurs when the spine develops an abnormal lateral curvature. While everyone has a natural slight curvature in their spine, scoliosis refers to a more pronounced deviation. In some cases, the curvature forms an "S" shape, while in others, it forms a "C" shape.

The causes of scoliosis vary depending on the type and the individual affected. Women are more likely to develop this condition than men. During growth stages, such as childhood and adolescence, the curvature often worsens.

Most of the time, scoliosis does not present symptoms beyond the visible curvature of the spine. However, the main signs include irregularities and deformities in the skeletal structure, which may sometimes cause symptoms affecting quality of life:

• Difference in shoulder and hip height: Scoliosis can cause one shoulder or one side of the hip to be higher than the other.
• Back pain.
• Feeling of heaviness or tiredness in the back after standing or sitting for long periods.

While symptoms generally do not significantly impact quality of life, complications can arise:

• Chronic pain due to vertebral wear.
• Spinal nerve damage from an untreated curvature.
• Low self-esteem, especially in children required to wear a brace.
• Respiratory issues in severe scoliosis cases.

Preventing scoliosis involves regular pediatric check-ups during childhood.

Scoliosis can be categorized based on various factors:

• By duration:
  • Structural: Permanent curvature caused by conditions such as disease, birth defects, trauma, or infection.
  • Non-structural or functional: Temporary curvature that can be corrected with proper measures.
• By patient age:
  • Infantile scoliosis: Occurs in children under three years old.
  • Juvenile scoliosis: Affects children aged four to ten years.
  • Adolescent scoliosis: Common in adolescents aged 11 to 18 years.
• By cause:
  • Neuromuscular scoliosis: Caused by nervous system disorders affecting muscles, such as muscular dystrophy or cerebral palsy.
  • Congenital scoliosis: Present at birth due to improperly formed vertebrae or ribs.
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Diagnosis

The progression and prognosis of scoliosis depend on factors such as the cause and degree of curvature. For children, a greater curve increases the likelihood of complications in adulthood. For individuals with scoliosis caused by a nervous system condition, a complete diagnosis is necessary to determine the extent of the curvature and whether surgery is needed. Congenital scoliosis often involves many complications and generally requires one or more surgeries.

To identify if a patient has scoliosis, a specialist performs physical tests to evaluate the curvature of the spine. During the examination, the patient bends forward to make the spine more visible, a procedure known as the forward bend test or Adams test. The doctor checks shoulder alignment and pelvic tilt. In addition to physical exams, radiological tests are performed to confirm the deviation, as the spine's condition is often worse than what physical exams reveal.

A scoliometer may also be used during diagnosis. This tool, a curved level containing liquid with a metallic ball, is placed on the patient's back during the Adams test. If there is asymmetry, the ball moves to one side.

Treatments

Treatment depends on factors such as the severity of the curve, its origin, and the patient’s age. For idiopathic scoliosis, no treatment or intervention is typically necessary, but specialists monitor its progression.

For children still growing, a specialist may recommend a brace to stabilize the back and prevent further spinal deviation. However, braces or orthopedic devices are not typically recommended for scoliosis caused by nervous system conditions.

In cases where scoliosis progresses rapidly or the curvature is severe, surgery may be required. Metal rods may be implanted to stabilize the vertebrae and correct the curve. Post-surgery, the patient typically wears a brace for some time to avoid sudden movements until the bones heal.

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