Scoliosis: Etiology, symptoms, diagnosis, and treatment.

Etiology:

  • Idiopathic Scoliosis: The primary form, typically presenting during adolescence, is characterized by a lateral curvature of the spine without an identifiable cause. Current research suggests a multifactorial etiology involving genetic predisposition, abnormal growth patterns of the spine, and neurosensory factors.
  • Congenital Scoliosis: Arises from vertebral malformations present at birth, resulting from disruptions in embryonic development. It can involve abnormal vertebral segmentation, formation, or fusion.
  • Neuromuscular Scoliosis: Occurs secondary to neuromuscular disorders like cerebral palsy, spinal muscular atrophy, or muscular dystrophy. Muscle imbalance, weakness, and impaired neuromotor control contribute to spinal deformity.
  • Degenerative Scoliosis: Develops later in life due to age-related changes in the spine, including disc degeneration, facet joint arthritis, and vertebral osteoporosis. Loss of spinal alignment and stability leads to curvature progression.
  • Traumatic Scoliosis: Results from spinal trauma or injury, causing structural abnormalities and subsequent curvature. Fractures, dislocations, or ligamentous injuries can disrupt spinal integrity and alignment.

Symptoms:

  • Asymmetrical Posture: Observable lateral curvature of the spine, often evidenced by a prominent rib hump or shoulder height discrepancy.
  • Back Pain: Common, especially in adolescents with idiopathic scoliosis, attributed to muscular strain, spinal asymmetry, and altered biomechanics.
  • Functional Limitations: Reduced mobility, endurance, and balance due to spinal deformity and associated musculoskeletal imbalances.
  • Respiratory Compromise: Severe curvature may impinge on thoracic cavity volume, impairing lung expansion and ventilation.
  • Neurological Deficits: In cases of congenital or neuromuscular scoliosis, symptoms may include sensory or motor deficits, bowel or bladder dysfunction, and gait abnormalities.

Diagnosis:

  • Physical Examination: Assessment of spinal alignment, shoulder and pelvic symmetry, and trunk rotation using the Adam's forward bend test.
  • Radiographic Evaluation: Anteroposterior and lateral standing radiographs provide detailed visualization of spinal curvature, vertebral morphology, and associated deformities. The Cobb angle method quantifies curvature magnitude.
  • Neurological Assessment: In neuromuscular scoliosis, evaluation for underlying neurological conditions and functional deficits is essential.
  • MRI or CT Imaging: Reserved for assessing congenital anomalies, spinal cord abnormalities, or neural compression in selected cases.

Treatment:

  • Observation: Regular monitoring of curvature progression in mild cases, with periodic clinical and radiographic assessments.
  • Bracing: Custom-designed orthoses prescribed for adolescents with moderate idiopathic scoliosis to halt progression during growth spurts. Brace type, duration, and compliance are critical determinants of efficacy.
  • Physical Therapy: Individualized exercise programs focusing on core stabilization, flexibility, and postural awareness can improve muscular balance and functional capacity.
  • Surgical Intervention: Reserved for severe or progressive curvature refractory to conservative measures, spinal fusion with instrumentation aims to correct deformity, restore spinal alignment, and stabilize the spine.

Prognosis:

Prognosis varies based on scoliosis type, severity, skeletal maturity, and response to treatment.

Early detection and intervention optimize outcomes, minimizing curvature progression and functional impairment.

Long-term follow-up is crucial to monitor spinal growth, assess treatment efficacy, and manage potential complications, including adjacent segment degeneration.