Scoliosis is commonly described as an abnormal lateral curvature of the spine. In the case of patients with scoliosis, the spine forms a lateral curve that can have a C or S shape. But the reality is that it is more complicated than that.
Scoliosis is not as much a curve as a helix. A three-dimensional twisting of the spine. As the spine twists, it can cause changes in the position of the ribs, the shoulders and the hips, which can cause health problems, like back pain and cardiopulmonary dysfunction, in addition psychological impact of the physical appearance.
Who does scoliosis affect?
Despite investigations and studies about scoliosis, there is not clear data about its pathophysiology. It looks like scoliosis starts in children and adolescents, being it´s sudden appearance being less common in adults.
The majority of the studies confirm that it is more common in women, especially throughout adolescence. Even though, in very small children (less than 3) scoliosis is found in equal numbers in both genders, or perhaps a bit more common, in males.
Scoliosis affects people of all races and nationalities, even though there are more studies about Caucasians. The cause in the majority of the cases is unknown (idiopathic).
Scoliosis can cause health problems, but there is not always a correlation between the severity of the scoliosis and the symptoms it provokes. A person with mild scoliosis could be in a lot of pain or have postural changes that can be very noticeable, and a person with severe scoliosis may not have any pain or any visible changes in their figure. Every person with scoliosis is different and deserves to be evaluated as an individual.
The Causes of Scoliosis
The majority of scoliosis cases (80%) are denominated idiopathic, which means that the cause cannot be identified. Scoliosis can be classified as childhood, juvenile, adolescence or adult. Even though, these terms describe the moment in which the scoliosis was diagnosed for the first time, and not necessarily when it began.
Although it is common to see several cases in the same family, it has been shown that it is not a genetic problem. There is no gene that causes scolioisis. With identitical twins one twin can develop scoliosis while the other does not. It may be causes by many factors that coincide, and those factors may differ from person to person.
Although in most cases the cause is unknown, in 20% of the cases the scoliosis appears to be secondary to other conditions:
Congenital Scoliosis: This type develops because a bone in the spine did not grow, or it did not grow correctly. This congenital inability to grow may result in lack of vertebral segmentation, resulting in what is known as a hemivertebra.
Neuromuscular scoliosis: This develops as part of a pathology, such as cerebral palsy or certain syndromes (Marfan´s, VATER, etc.)
It is also possible for a scoliosis to develop as the result of a trauma such as an accident or as the result of a surgical procedure.
Although many risk factors exist to help identify if a scoliosis is going to progress, but the truth is that it is very difficult to determine the likelihood of progression. Studies indicate that the likelihood of progression is greater when more time remains until the patient will reach skeletal maturity. That is to say, when the diagnosis occurs at a younger age the prognosis is worse.
It is also more likely that the condition progresses or worsens during periods of rapid hormonal growth like adolescence, and also may worsen during pregnancy or menopause. Although it does occur in all cases, it is important to monitor carefully during these periods.
What are the symptoms that would make you suspect scoliosis?
In theory, it could be a just a feeling. Someone close to the person may have the feeling that a shirt or jacket does not fit right. It is also possible to observe an asymmetry in the spine when we see the person on the beach, with their back uncovered.
In the most severe cases of scoliosis, other symptoms may appear like problems when walking. This is due to that the abnormal curvature of the spine that provokes changes in the alignment of the hip, which creates changes in the person´s stride.
Another sign is when we see a more rigid spine, since the scoliotic curve produces loss of typical flexibility of the spine.
As a consequence of the rotation of the spine, rotations of the thoracic cage may occur that can lead to respiratory problems. There may even appear cardiac pathologies because of the same reason. If the heart is not well-placed because of a rotated thorax, it will not function correctly.
We should not forget the pain, inflammation, and muscular overload may occur. In addition, psychological problems may occur because of the lack of acceptance of the back deformities.
Scoliosis can appear in any part of our spine. The level where it is found leads us to classified it as lumbar or thoracic. Symptoms could also vary, depending where the curve is located.
Scoliosis is diagnosed when an posterior-anterior (PA) radiograph of the spine reveals a Cobb angle greater than 10 degrees. Cobb angle is the most common and simple method to measure scoliosis, even though this measurement has its defects.
The Cobb angle is a bidimensional (2-D) measure of a tridimensional (3-D) condition. Cobbs angle only measures the inclination of two bones in the spine, the first and the last vertebra of the curve, which is why it may be not exact; different doctors measuring the same x-ray sometimes can come up with different measurements.
CLEAR defends the uses of multiple radiological measurements to evaluate the severity of each case and does not base evaluation on only the Cobb angle measurement.
CLEAR uses a complete radiological study with 8 different projections to quantify the position of the spine in 3 dimensions, not only in one. The 76 measurements taken with these x-rays are used later, along with the functional results and the results of the physical exam, to prepare an individualized treatment plan and a program of specific exercises for each patient.
The majority of the treatment methods for scoliosis are based on the Cobb angle. Depending on the angle, they may recommend the use of a brace or surgery. In the case of small curves, the orthopedists may recommend no treatment, that is to say, watch and wait.
The development of a conservative treatment method like the CLEAR protocol comes from the necessity to find an alternative to the current procedures that carry a great impact and risk, both physical and psychological, and very high rate of complications.
Patients with scoliosis decide to receive treatment for many reasons. The most common reason is because they don’t like the change in their physical appearance. Some people seek help because they have pain, or limitations in their daily activities. Other patients, without posture or health problems, decide to receive treatment to reduce or prevent the problems that they could develop in the future.
The official position of our center is that each individual should decide for themselves if they desire to receive treatment, and that they have the right to choose the treatment they prefer.