What is spinal scoliosis

Topic page about scoliosis

Scoliosis is a three-dimensional curvature of the spine.

Scoliosis is one three-dimensional curvature of the spine. With this curvature one goes Side bending of at least 10 degrees. At the same time, the vertebral bodies are deformed and twisted (torsion). In contrast to a pure poor posture, the curvature cannot be straightened alone, i.e. with one's own strength.

Because the spine grows not straight, but twisted, it comes to one depending on the location of the curvature and shape Rib hump and / or lumbar bulge

How do I explain it to my child?

In scoliosis, the spine grows crooked and twisted. In the majority of scolioses, it is not known why they arise. The only thing that is certain is that it is related to growth and has nothing to do with improper nutrition or improper stress.

Because of the twisted growth of the spine, the vertebral bodies shift so that the shoulders can be of different heights and you only have one waist. It can happen that a hump is formed. The causes are unclear, but neither the patient nor the parents can do anything about it and it is nobody's fault.

Causes and origins

Why a spine that was straight for years suddenly grows twisted is still the subject of various studies and has not been conclusively clarified. But there seem to be hereditary factors.

In 80% of the cases, you don't know where the scoliosis comes from. This form is called idiopathic scoliosis. The causes this kind of scoliosis are not eating improperly or carrying heavy school bags. Exercise or work doesn't make them worse either.

Most often it occurs in girls (4 to 5 times more often than boys) who hit puberty very early and have a growth spurt. If the growth is complete and the scoliosis has not gotten too bad by then, it does not worsen afterwards, or only slowly. It seems also a genetic predisposition to give. In any case, it depends Scoliosis occurs along with growth.

With the rest A cause is found in 20% of cases. These include, for example Changes in the bones as well as a Muscle or nerve disease. However, these types of scoliosis occur in early childhood and not just in puberty. As part of the medical diagnosis, it is determined what form it is.

There are three types

Depending on where the curvature is and how big it is, it can "only" be an optical problem. However, it can put considerable strain on the intervertebral discs and vertebral joints of the rest of the spine. In severe cases, it can even affect the lungs and heart.

Idiopathic scoliosis

Idiopathic scoliosis is a growth disorder of the spine that usually first occurs during the growth spurt in puberty.

 

Right convex thoracic scoliosis in a 15 year old girl:

Congenital scoliosis

Congenital scoliosis is the result of congenital bone malformations, such as cervical vertebrae, bone braces between the vertebrae or other things. It is usually noticeable in early childhood.

 

Excess half vertebrae in a 4 year old boy:

Neuromuscular Scoliosis

Neuromuscular scoliosis occurs as a result of a disease of the muscles or the nervous system, such as paraplegia, spasticity or pathological muscle weakness.

 

Left convex long arched lumbar curvature with pelvic inclination and trunk overhang to the right in an 11 year old wheelchair user:

Symptoms of Scoliosis

These characteristics will tell you whether your child could have scoliosis.

What are the symptoms of scoliosis?

In idiopathic scoliosis in children and adolescents, the disease is often caused by the developing Rib hump or lumbar bulge or due to shoulder, chest or pelvic asymmetries discovered. Pain is not typical, but can sometimes arise in the course of the disease and can be caused either by muscle tension or on protruding bones. Targeted physiotherapy usually helps here.

The symptoms can vary in adults. They usually do not occur in the area of ​​the main curvature, but mainly in the lumbar spine below. Since the joints and intervertebral discs are often stressed at an angle here, premature wear and tear and osteoarthritis can occur, which in turn cause pain. This is also one of the reasons why the spine is straightened. This is how you protect the still healthy parts.

Typical features that can occur

  • Different heights of the shoulders
  • Significant protrusion of a shoulder blade or the ribs in front
  • Unevenly shaped waist
  • When stooping, ribs of unequal height (rib hump) or the lumbar bulge are clearly visible

Depending on where the curvature is and how big it is, it can "only" be an optical problem, or it can be Load the intervertebral discs and vertebral joints of the rest of the spine. In severe cases, it can Effects on the lungs and heart to have.

diagnosis

There are several ways to recognize scoliosis. As a rule, it is the affected children and adolescents themselves who notice that their posture differs from their peers. The parents also recognize the change.

Often it is noticeable when putting on back lotion during summer vacation. Since there is no scoliosis screening in schools, it is important to see your pediatrician or family doctor if you suspect it. The starting point for a reliable diagnosis is always an examination by a doctor.

The curvature of the spine can best be seen when the patient leans forward. With this forward bend test (Adams Bending Test) you can measure the rib hump and lumbar bulge with a special spirit level, also called a scoliometer. If a limit value of approx. 6 ° is exceeded during this measurement or if the hump increases significantly in a short time, you should take an X-ray.

The angle of curvature and the rotation of the vertebral bodies can be measured with the help of a full-length image of the spine, an X-ray image of the entire spine. The entire spine should always be shown on one image and not several small images, as otherwise the curvature cannot be measured exactly and the statics cannot be assessed.

Special, very expensive X-ray tubes, which of course not every doctor has, are required for these full-length images of the spine. As a result, you may be referred to a specialized spine center. The angles are given in "degrees according to Cobb", since Dr. Cobb developed this measurement method. So-called bending recordings are made before an operation. You have to turn left and then right as far as you can. Then you can measure which curvature is already stiff (rigid) and which is still so flexible that it can compensate itself independently. This is especially important when planning an operation.

In addition to the amount of curvature, your bone age is also important. In order to be able to estimate how long you will continue to grow, the iliac crest is often x-rayed as well. Based on the growth plate there, you can see how long your growth spurt will last. The doctor speaks of the Risser sign here because a Dr. Risser introduced this classification. Other clues for determining growth are the use of voice breaks in boys and menstrual bleeding in girls. Since scoliosis can worsen, especially during growth, it is important to be able to estimate how long you will continue to grow. Regular check-ups are important in the growth phase in order to observe the development and to be able to take appropriate countermeasures.

Determination of bone age based on the Risser sign

In some cases, an MRI (magnetic resonance tomography) is also performed in order to be able to determine any malformations of the vertebral bodies or the spinal cord. This is mainly done in the case of unusual curvatures or before surgery, as malformations of the spinal cord can cause problems. With normal scoliosis, an MRI is usually not necessary.

In the case of congenital scoliosis, computed tomography with 3D reconstruction is often performed so that one can see exactly which bones are malformed or fused. The probability of progression and the surgical method depend on this.

Classifications

In addition to the different types of scoliosis, a classification according to age is also carried out:

Infantile scoliosis

Infantile scoliosis occurs under the age of 3 years.

If scoliosis occurs between the ages of 3 and 9 years, it is called Juventile scoliosis.

Between the ages of 10 and 18, one speaks of adolescent scoliosis.

There are other classifications with regard to the height of the main curvature:

The apex of the curvature is in the thoracic spine (BWS)

The apex of the curvature is at the transition from the thoracic spine (BWS) to the lumbar spine (LWS)

The apex of the curve is in the lumbar spine (lumbar spine)

There is a thoracic and a lumbar curvature

Warning: the double arched thoracic and lumbar scoliosis is often incorrectly referred to as thoracolumbar scoliosis

As well as the direction of the main curvature:

Right convex scoliosis

The curvature of the spine points to the right

Left convex scoliosis

The curvature of the spine points to the left

Right-convex thoracic scoliosis and left-convex lumbar scoliosis are typical, i.e. one has a rib hump on the right and a lumbar bulge on the left when one leans forward.

Treatment and rehabilitation

How scoliosis is treated depends on the age, angle, and type of scoliosis. Learn more about the different treatment options.

Treatment of scoliosis

After an operation

Rest is necessary after surgical treatment for scoliosis. Find out more about how rehab works and what to look out for here.

Rehabilitation after surgery

Patient stories about scoliosis

Amy and Vicky both have scoliosis. They got to know each other through scoliosis and share their story. Here is the video of her scoliosis patient story.

 

Amy, 16 years old - has had scoliosis for 4 years and was operated on in 2018:

"Sure, once scoliosis, always scoliosis. But after the operation it fades into the background again - it becomes a minor matter."

 

To the patient stories

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