Idiopathic scoliosis
Description of the disease
This spinal deformity has an unknown cause, but experts believe the cause is multifactorial, involving factors such as genetic predisposition, growth hormone secretion, pineal gland melatonin secretion disruption, impaired connective tissue/muscle function, and platelet changes.
In idiopathic scoliosis, muscles on one side of the spine receive fewer nerve impulses to contract, causing the muscles on the opposite side to twist the spine around its axis. The pelvis lifts and twists as the body attempts to balance the spine, making one leg appear relatively shorter. A rib hump forms in the thoracic region, and the front part of the chest deforms. This deformation results in decreased lung volume and can lead to the development of cardiac pulmonary complications.
Idiopathic scoliosis categorizes age groups as follows: infantile for children up to 3 years old, juvenile for children aged 4-10, and adolescent for those aged 10-20.
Based on localization, idiopathic scoliosis is classified into thoracic, double thoracic, triple, lumbar, and lumbar and thoracic (S-shaped) scoliosis.
Symptoms
Symptoms are clearly visible just by looking – it is the curvature of the spine.
When the child bends over, a muscle prominence becomes visible in the lumbar area. When the child stands, hip rotation and tilt can be observed. In progressive scoliosis, a rib hump appears prominently in the thoracic region.
The curvature of the spine manifests differently according to age, usually noticed in children aged 4-8, initially progressing at a rate of 1-2° per year, with a particularly sharp worsening during puberty (11-12 years for girls, 13-14 years for boys). This progression can reach up to 10° per year. Progression stops at 14 years for girls and 16 years for boys.
Infantile scoliosis typically appears in infants from 6 months of age, most commonly as a left-sided curvature and more often in boys than girls. In 85% of cases, scoliosis does not progress. Juvenile scoliosis is more frequently diagnosed in girls.
Diagnosis
Scoliosis is diagnosed based on clinical signs and X-rays. X-rays measure vertebral rotation, degree of curvature, bone maturation process in the pelvic bones, indicating bone growth potential (when bone growth potential is low, the progression of spinal curvature decreases).
Treatment
No pathogenetic conservative treatment exists for scoliosis. When the curvature reaches 20-25°, doctors apply strengthening exercises for back and abdominal muscles (such as therapeutic exercises and swimming), but this only slightly slows down the progression. When the curvature reaches 35°, there is no need to restrict physical activity. Using a firm mattress, placing boards under the bed, or getting massages do not affect the disease’s progression. Manual therapy accelerates deformation, so professionals prohibit it.When the leg length discrepancy exceeds 15-20 mm, doctors may recommend a shoe lift. Sometimes, braces stabilize the curvature and reduce the rate of progression, helping to avoid surgery.
Doctors indicate surgery for a curvature of 45-50° or for imbalanced curvature. The goal is to balance the spine and align shoulder girdle and pelvic asymmetry. Surgeons implant special CD implants to correct spinal deformities in all planes.
Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology