Scoliosis

Scoliosis

Scoliosis (from Greek: skolíōsis meaning "crooked")[1] is a medical condition in which a person's spine is curved from side to side, shaped like an "s", and may also be rotated. To adults it can be very painful. It is an abnormal lateral curvature of the spine. On an x-ray, viewed from the rear, the spine of an individual with a typical scoliosis may look more like an "S" or a "C" than a straight line. It is typically classified as congenital (caused by vertebral anomalies present at birth), idiopathic (sub-classified as infantile, juvenile, adolescent, or adult according to when onset occurred) or as neuromuscular, having developed as a secondary symptom of another condition, such as spina bifida, cerebral palsy, spinal muscular atrophy or due to physical trauma.

Terminology

The condition can be categorized based on convexity, or curvature of the spinal column, with relation to the central axis:

Dextroscoliosis is a scoliosis with the convexity on the right side.[2][3][4]
Levoscoliosis is a scoliosis with the convexity on the left side.[2][3][4]
Rotoscoliosis (may be used in conjunction with dextroscoliosis and levoscoliosis, e.g. levorotoscoliosis) refers to scoliosis on which the rotation of the vertebrae is particularly pronounced, or is used simply to draw attention to the fact that scoliosis is a complex 3 dimensional problem.[5].

Cause

In the case of the most common form of scoliosis, adolescent idiopathic scoliosis, there is no clear causal agent [6]. Various causes have been implicated, but none have consensus among scientists as the cause of scoliosis. The role of genetic factors in the development of this condition is widely accepted[7]. Scoliosis is more often diagnosed in females and is often seen in patients with cerebral palsy or spina bifida,which is a birth defect that involves the incomplete development of the spinal cord and its coverings[8][citation needed], although this form of scoliosis is different from that seen in children without these conditions. In some cases, scoliosis exists at birth due to a congenital vertebral anomaly. Occasionally, development of scoliosis during adolescence is due to an underlying anomaly such as a tethered spinal cord, but most often the cause is unknown or idiopathic, having been inherited through genetics [9].[citation needed] Some therapists like the referenced Hanna Somatic therapist believe that trauma to an adult can cause, not just asymmetry but an actual curve to the spine visible on x-ray, although no documentation is offered in her article. Scoliosis often presents itself, or worsens, during the adolescence growth spurt. During adolescence, due to rapid growth of the body, hip and leg proportions in the leg and thigh may become misaligned, causing temporary acute scoliosis.

In April 2007, researchers at Texas Scottish Rite Hospital for Children[10] identified the first gene associated with idiopathic scoliosis, CHD7. The medical breakthrough was the result of a 10-year study and is outlined in the May 2007 issue of the American Journal of Human Genetics.[11]

Prevalence

Scoliotic curves of 10° or less affect 3-5 out of every 1,000 people.[12] The prevalence of curves less than 20° is about equal in males and females. 2% of women and 0.5% of men are affected by Scoliosis.

Scoliosis Symptoms

Patients aged from 18 or older are less likely to worsen their case due to their mature spines and body system. Pain is often common in adulthood, especially if the scoliosis is left untreated.[citation needed] Though doctors do not always recommend surgery as the solution to scoliosis, it is still the most efficient way to completely strengthen the spine. Scoliosis surgery is often performed for cosmetic reasons rather than pain alone as the surgery cannot guarantee pain loss but it can stabilize a curvature and prevent worsening therefore improving one's quality of life. Pain can occur because the muscles try to conform to the way the spine is curving often resulting in muscle spasms. Some of the severe cases of scoliosis can lead to diminishing lung capacity, putting pressure on the heart, and restricting physical activities. The symptoms of scoliosis can include:

Uneven musculature on one side of the spine
A rib "hump" (Pectus carinatum) and/or a prominent shoulder blade, caused by rotation of the ribcage in thoracic scoliosis
Uneven hip, rib cage, and shoulder levels
Asymmetric size or location of breast in females
Unequal distance between arms and body
Slow nerve action (in some cases)
Different heights of the shoulders

Associated conditions

Scoliosis is sometimes associated with other conditions such as Ehler-Danlos Syndrome (hyperflexibility, 'floppy baby' syndrome, and other variants of the condition), Charcot-Marie-Tooth, kyphosis, cerebral palsy, spinal muscular atrophy, muscular dystrophy, familial dysautonomia, CHARGE syndrome, Friedreich's ataxia, proteus syndrome, Spina bifida, Marfan's syndrome, neurofibromatosis, connective tissue disorders, congenital diaphragmatic hernia, and craniospinal axis disorders (e.g., syringomyelia, mitral valve prolapse, Arnold-Chiari malformation).

Investigation

Patients who initially present with scoliosis are examined to determine whether there is an underlying cause of the deformity. During a physical examination, the following is assessed:

Skin for café au lait spots indicative of neurofibromatosis
The feet for cavovarus deformity
Abdominal reflexes
Muscle tone for spasticity

During the exam, the patient is asked to remove his shirt and bend forward (this is known as the Adam's Bend Test and is often performed on school students). If a hump is noted, then scoliosis is a possibility and the patient should be sent for an x-ray to confirm the Scoliosis diagnosis. Alternatively, a scoliometer may be used to diagnose the condition.[13] The patient's gait is assessed, and there is an exam for signs of other abnormalities (e.g., Spina bifida as evidenced by a dimple, hairy patch, lipoma, or hemangioma). A thorough neurological examination is also performed.

It is usual when scoliosis is suspected to arrange for weight-bearing full-spine AP/coronal (front-back view) and lateral/sagittal (side view) xrays to be taken, to assess both the scoliosis curves and also the kyphosis and lordosis, as these can also be affected in individuals with scoliosis. Full-length standing spine X rays are the standard method for evaluating the severity and progression of the scoliosis, and whether it is congenital or idiopathic in nature. In growing individuals, serial radiographs are obtained at 3-12 month intervals to follow curve progression. In some instances, MRI investigation is warranted.

The standard method for assessing the curvature quantitatively is measurement of the Cobb angle, which is the angle between two lines, drawn perpendicular to the upper endplate of the uppermost vertebrae involved and the lower endplate of the lowest vertebrae involved. For patients who have two curves, Cobb angles are followed for both curves. In some patients, lateral bending xrays are obtained to assess the flexibility of the curves or the primary and compensatory curves.

Genetic testing for AIS, which has become available in 2009, greatly improves the ability of physicians to accurately predict the likelihood of curve progression[14].

Mass-screening for scoliosis using posture photos

It has been suggested that entire populations be examined, for early detection. For example, in the 1940s, American psychologist William Sheldon proposed mandatory physical examinations that included nude photographs of each person being examined. One purpose of these photographs was the detection of rickets, scoliosis, and lordosis. His approach was implemented at a number of ivy league schools in which all freshmen were examined (Ivy League nude posture photos). A similar program was implemented in Boston's prison system.

Prognosis

The prognosis of scoliosis depends on the likelihood of progression. The general rules of progression are that larger curves carry a higher risk of progression than smaller curves, and that thoracic and double primary curves carry a higher risk of progression than single lumbar or thoracolumbar curves. In addition, patients who have not yet reached skeletal maturity have a higher likelihood of progression.

Genetic Testing for Adolescent Idiopathic Scoliosis

Through a genome-wide association study, geneticists have identified single nucleotide polymorphism markers in the DNA that are significantly associated with Adolescent Idiopathic Scoliosis. Genetic testing for AIS now allows many AIS patients to find out, with great accuracy, their own likelihood of progression to a severe curve[16].

Scoliosis
Campylobacter Infections Pneumonia Carcinoid Tumors Spleen Diseases Bacterial vaginosis Toxoplasmosis Meningococcal Disease Vaginal Diseases Stomach cancer Ingrown Nail Giardiasis Cardiogenic shock Scoliosis Chronic Diarrhea Urinary Tract And Bladder Infections Aortic Stenosis Mitral Valve Prolapse Colorectal cancer Liver cancer Yersinia Enterocolitica Kaposi's Sarcoma Leukemia, Adult Acute Shigellosis Sickle-cell disease Adenoviridae Coming Soon	Scoliosis Scoliosis (from Greek: skolíōsis meaning "crooked")[1] is a medical condition in which a person's spine is curved from side to side, shaped like an "s", and may also be rotated. To adults it can be very painful. It is an abnormal lateral curvature of the spine. On an x-ray, viewed from the rear, the spine of an individual with a typical scoliosis may look more like an "S" or a "C" than a straight line. It is typically classified as congenital (caused by vertebral anomalies present at birth), idiopathic (sub-classified as infantile, juvenile, adolescent, or adult according to when onset occurred) or as neuromuscular, having developed as a secondary symptom of another condition, such as spina bifida, cerebral palsy, spinal muscular atrophy or due to physical trauma. Terminology The condition can be categorized based on convexity, or curvature of the spinal column, with relation to the central axis: Dextroscoliosis is a scoliosis with the convexity on the right side.[2][3][4] Levoscoliosis is a scoliosis with the convexity on the left side.[2][3][4] Rotoscoliosis (may be used in conjunction with dextroscoliosis and levoscoliosis, e.g. levorotoscoliosis) refers to scoliosis on which the rotation of the vertebrae is particularly pronounced, or is used simply to draw attention to the fact that scoliosis is a complex 3 dimensional problem.[5]. Cause In the case of the most common form of scoliosis, adolescent idiopathic scoliosis, there is no clear causal agent [6]. Various causes have been implicated, but none have consensus among scientists as the cause of scoliosis. The role of genetic factors in the development of this condition is widely accepted[7]. Scoliosis is more often diagnosed in females and is often seen in patients with cerebral palsy or spina bifida,which is a birth defect that involves the incomplete development of the spinal cord and its coverings[8][citation needed], although this form of scoliosis is different from that seen in children without these conditions. In some cases, scoliosis exists at birth due to a congenital vertebral anomaly. Occasionally, development of scoliosis during adolescence is due to an underlying anomaly such as a tethered spinal cord, but most often the cause is unknown or idiopathic, having been inherited through genetics [9].[citation needed] Some therapists like the referenced Hanna Somatic therapist believe that trauma to an adult can cause, not just asymmetry but an actual curve to the spine visible on x-ray, although no documentation is offered in her article. Scoliosis often presents itself, or worsens, during the adolescence growth spurt. During adolescence, due to rapid growth of the body, hip and leg proportions in the leg and thigh may become misaligned, causing temporary acute scoliosis. In April 2007, researchers at Texas Scottish Rite Hospital for Children[10] identified the first gene associated with idiopathic scoliosis, CHD7. The medical breakthrough was the result of a 10-year study and is outlined in the May 2007 issue of the American Journal of Human Genetics.[11] Prevalence Scoliotic curves of 10° or less affect 3-5 out of every 1,000 people.[12] The prevalence of curves less than 20° is about equal in males and females. 2% of women and 0.5% of men are affected by Scoliosis. Scoliosis Symptoms Patients aged from 18 or older are less likely to worsen their case due to their mature spines and body system. Pain is often common in adulthood, especially if the scoliosis is left untreated.[citation needed] Though doctors do not always recommend surgery as the solution to scoliosis, it is still the most efficient way to completely strengthen the spine. Scoliosis surgery is often performed for cosmetic reasons rather than pain alone as the surgery cannot guarantee pain loss but it can stabilize a curvature and prevent worsening therefore improving one's quality of life. Pain can occur because the muscles try to conform to the way the spine is curving often resulting in muscle spasms. Some of the severe cases of scoliosis can lead to diminishing lung capacity, putting pressure on the heart, and restricting physical activities. The symptoms of scoliosis can include: Uneven musculature on one side of the spine A rib "hump" (Pectus carinatum) and/or a prominent shoulder blade, caused by rotation of the ribcage in thoracic scoliosis Uneven hip, rib cage, and shoulder levels Asymmetric size or location of breast in females Unequal distance between arms and body Slow nerve action (in some cases) Different heights of the shoulders Associated conditions Scoliosis is sometimes associated with other conditions such as Ehler-Danlos Syndrome (hyperflexibility, 'floppy baby' syndrome, and other variants of the condition), Charcot-Marie-Tooth, kyphosis, cerebral palsy, spinal muscular atrophy, muscular dystrophy, familial dysautonomia, CHARGE syndrome, Friedreich's ataxia, proteus syndrome, Spina bifida, Marfan's syndrome, neurofibromatosis, connective tissue disorders, congenital diaphragmatic hernia, and craniospinal axis disorders (e.g., syringomyelia, mitral valve prolapse, Arnold-Chiari malformation). Investigation Patients who initially present with scoliosis are examined to determine whether there is an underlying cause of the deformity. During a physical examination, the following is assessed: Skin for café au lait spots indicative of neurofibromatosis The feet for cavovarus deformity Abdominal reflexes Muscle tone for spasticity During the exam, the patient is asked to remove his shirt and bend forward (this is known as the Adam's Bend Test and is often performed on school students). If a hump is noted, then scoliosis is a possibility and the patient should be sent for an x-ray to confirm the Scoliosis diagnosis. Alternatively, a scoliometer may be used to diagnose the condition.[13] The patient's gait is assessed, and there is an exam for signs of other abnormalities (e.g., Spina bifida as evidenced by a dimple, hairy patch, lipoma, or hemangioma). A thorough neurological examination is also performed. It is usual when scoliosis is suspected to arrange for weight-bearing full-spine AP/coronal (front-back view) and lateral/sagittal (side view) xrays to be taken, to assess both the scoliosis curves and also the kyphosis and lordosis, as these can also be affected in individuals with scoliosis. Full-length standing spine X rays are the standard method for evaluating the severity and progression of the scoliosis, and whether it is congenital or idiopathic in nature. In growing individuals, serial radiographs are obtained at 3-12 month intervals to follow curve progression. In some instances, MRI investigation is warranted. The standard method for assessing the curvature quantitatively is measurement of the Cobb angle, which is the angle between two lines, drawn perpendicular to the upper endplate of the uppermost vertebrae involved and the lower endplate of the lowest vertebrae involved. For patients who have two curves, Cobb angles are followed for both curves. In some patients, lateral bending xrays are obtained to assess the flexibility of the curves or the primary and compensatory curves. Genetic testing for AIS, which has become available in 2009, greatly improves the ability of physicians to accurately predict the likelihood of curve progression[14]. Mass-screening for scoliosis using posture photos It has been suggested that entire populations be examined, for early detection. For example, in the 1940s, American psychologist William Sheldon proposed mandatory physical examinations that included nude photographs of each person being examined. One purpose of these photographs was the detection of rickets, scoliosis, and lordosis. His approach was implemented at a number of ivy league schools in which all freshmen were examined (Ivy League nude posture photos). A similar program was implemented in Boston's prison system. Prognosis The prognosis of scoliosis depends on the likelihood of progression. The general rules of progression are that larger curves carry a higher risk of progression than smaller curves, and that thoracic and double primary curves carry a higher risk of progression than single lumbar or thoracolumbar curves. In addition, patients who have not yet reached skeletal maturity have a higher likelihood of progression. Genetic Testing for Adolescent Idiopathic Scoliosis Through a genome-wide association study, geneticists have identified single nucleotide polymorphism markers in the DNA that are significantly associated with Adolescent Idiopathic Scoliosis. Genetic testing for AIS now allows many AIS patients to find out, with great accuracy, their own likelihood of progression to a severe curve[16].
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