Scoliosis is a medical condition in which a person's spine has a sideways curve. Curves are usually "S" - or "C" - shapes. In some, the rate curve is stable, while in others, it increases over time. Mild scoliosis usually does not cause problems, while severe cases may interfere with breathing. Usually, there is no pain.
The cause of most cases is unknown, but it is believed to involve a combination of genetic and environmental factors. Risk factors include other affected members of the family. Can also occur due to other conditions such as muscle spasms, cerebral palsy, Marfan syndrome, and tumors such as neurofibromatosis. Diagnosis confirmed with X-rays. Scoliosis is usually classified as a structure in which the arch is repaired, or functionally where the underlying spine is normal.
Treatment depends on curve level, location, and cause. Minor curves can be watched periodically. Treatment may include bracing or surgery. The brace should be attached to the person and used every day until it stops growing. Evidence that chiropractic manipulation, dietary supplements, or exercise may prevent the condition from less deterioration. However, exercise is still recommended because of other health benefits.
Scoliosis occurs in about 3% of people. It most often occurs between the ages of 10 and 20. Girls are usually more severely affected than boys. The term is derived from Ancient Greek: ????????? , translit.Ã, scoliosis meaning "crooked".
Video Scoliosis
Signs and symptoms
Symptoms associated with scoliosis may include:
- Pain in the back, shoulders, and neck and butt closest to the lower back
- Respiratory and/or cardiac problems in severe cases
- Constipation due to curvature causes "tightening" of the stomach, intestines, etc.
- Limited mobility due to pain or limited functionality in adults
- Painful pain
Signs of scoliosis may include:
- Uneven muscle on one side of the spine
- Rib protruding or prominent scapula, caused by rib rotation in thoracic scoliosis
- The unbalanced hips, arms, or legs
- Slow nerve action
- Heart and lung problems in severe cases
- The calcium deposits in the cartilage endplate and sometimes on the disk itself
Course
People who have reached bone maturity tend to have no worsening cases. Several cases of severe scoliosis can lead to reduced lung capacity, pressure on the heart, and limited physical activity.
Recent longitudinal studies reveal that the most common form of this condition, idiopathic late-onset scoliosis, causes little physical disturbance other than back pain and cosmetic problems, even when untreated, with mortality rates similar to the general population. The old belief that untreated idiopathic scoliosis will develop into severe cardiopulmonary defects has been disputed by subsequent studies.
Maps Scoliosis
Cause
Many causes of scoliosis include spinal defects, neuromuscular problems, and environmental-induced disease or conditions.
It is estimated that 65% of cases of scoliosis are idiopathic, about 15% are congenital, and about 10% secondary to neuromuscular disease.
Idiopathic scoliosis is the majority of cases, but the cause is largely unknown. Recent studies show the potential heritability of the disorder. About 38% of the variants in the risk of scoliosis are caused by genetic factors, and 62% are caused by the environment. Genetics may be complex, however, given the inconsistent inheritance and imbalance among monozygotic twins. Specific genes that contribute to the development of scoliosis have not been identified with certainty. At least one gene, CHD7 , has been associated with an idiopathic form of scoliosis. Several studies of candidate genes have found an association between idiopathic scoliosis and genes that mediate bone formation, bone metabolism, and connective tissue structures. Several genome-wide studies have identified a number of loci that are significantly associated with idiopathic scoliosis. In 2006, idiopathic scoliosis was associated with three microsatellite polymorphisms in the MATN1 gene (encoding for matrilin 1, cartilage matrix protein). Fifty-three markers of single nucleotide polymorphisms in DNA that were significantly associated with juvenile idiopathic scoliosis were identified by genomic-wide association studies.
Adolescent idiopathic scoliosis has no obvious causative agent, and is generally believed to be multifactorial. The prevalence of scoliosis is 1% to 2% among adolescents, but the likelihood of development among adolescents with Cobb angles of less than 20 Â ° is about 10% to 20%.
Congenital scoliosis may be associated with spinal malformations during weeks three to six in utero due to failure of formation, segmentation failure, or combination of stimuli. The result of incomplete and abnormal segmentation of abnormally shaped vertebrae, sometimes fused with a normal vertebra or unilaterally united vertebrae, leads to an abnormal lateral spinal curvature.
Generated from other conditions
Secondary scoliosis due to neuropathic conditions and myopathy can lead to loss of muscle support for the spine so that the spine is pulled in an abnormal direction. Some conditions that can cause secondary scoliosis include muscular dystrophy, spinal muscular atrophy, poliomyelitis, cerebral palsy, spinal cord trauma, and myotonia. Scoliosis often appears on its own, or worsens, during the acceleration of adolescent growth and is more often diagnosed in women than men.
Scoliosis associated with known syndrome is often subclassified as "syndromic scoliosis". Scoliosis may be associated with amniotic band syndrome, Arnold-Chiari's malformations, Charcot-Marie-Tooth disease, cerebral palsy, congenital diaphragm hernia, connective tissue disorders, muscular dystrophy, familial disautonomia, CHARGE syndrome, Ehlers-Danlos syndrome (hyperflexibility, floppy) infants' syndrome, and other variants of the condition, fragile X syndrome, Friedreich's ataxia, hemihipertrophy, Loeys-Dietz syndrome, Marfan syndrome, nail-patellar syndrome, neurofibromatosis, osteogenesis imperfecta, Prader-Willi syndrome, proteus syndrome, spina bifida, spinal muscular atrophy and syringomyelia.
Another form of secondary scoliosis is degenerative scoliosis that develops later in life due to degenerative changes (may or may not be associated with aging). It is a type of deformity that begins and develops due to the asymmetric collapse of the vertebral column.
Diagnosis
People who initially present with scoliosis undergo a physical examination to determine whether the deformity has an underlying cause and to exclude the possibility of underlying conditions more serious than simple scoliosis.
One's walking style is assessed, with tests for other signs of abnormality (eg spina bifida as evidenced by dimples, hairy patches, lipomas, or hemangiomas). Comprehensive neurologic examination is also performed, skin for caffeine spots, indicating neurofibromatosis, leg for cavovarus deformity, abdominal reflexes and muscle tone for spasticity.
When a person can work together, he is required to bend forward as far as possible. This is known as Adams advanced curve test and is often performed on school students. If prominent is noted, then scoliosis is a possibility and an X-ray may be performed to confirm the diagnosis.
Alternatively, scoliometer may be used to diagnose the condition.
When scoliosis is suspected, bearing weight, full-spine AP/coronal (front-rear view) and lateral/sagittal (side view) X-rays are usually taken to assess the scoliosis and kyphosis curves and lordosis, as these can also be affected in individuals with scoliosis. Full-length standing spine X-rays are a standard method for evaluating the severity and development of scoliosis, and whether it is congenital or idiopathic. In growing individuals, serial radiographs are obtained at intervals of 3 to 12 months to follow the development of the curve, and, in some cases, MRI investigations are required to see the spinal cord.
The standard method for assessing curvature quantitatively is to measure the angle of Cobb, which is the angle between two lines, drawn perpendicular to the upper end of the uppermost vertebra involved and the lower endplate of the lowest vertebra involved. For people with two curves, the Cobb angle is followed for both curves. In some people, lateral-bending X-rays are obtained to assess the flexibility of curves or primary curves and compensation.
Congenital and idiopathic scoliosis that develops before the age of 10 is termed early onset scoliosis. The scoliosis that develops after 10 is termed a juvenile idiopathic scoliosis. Filtering an asymptomatic teenager for scoliosis is an unclear benefit.
Definition
Scoliosis is defined as a three-dimensional deviation on a person's spinal axis. In a diagnostic sense, it is defined as a curvature of the spine over 10 ° to the right or left as the examiner confronts the person, ie in the coronal plane.
Scoliosis has been described as a biomechanical deformity, its development dependent on asymmetric strength or otherwise known as Hueter-Volkmann's Law.
Management
The traditional medical management of scoliosis is complex and is determined by the severity of curvature and bone maturity, which together helps predict the likelihood of development. Conventional choices for children and adolescents are:
- Observation
- Affirm
- Surgery
For adults, treatment usually focuses on relieving pain:
- Painkillers
- Affirm
- Surgery
Treatment for idiopathic scoliosis also depends on the severity of curvature, the potential of the spine for further growth, and the risk that curvature will develop. Mild scoliosis (less than 30 Â ° deviation) can be monitored and treated with exercise. Severe scoliosis (30-45 Â °) in a growing child may require boosters. Severe, rapidly developing curves can be treated surgically by placement of the spinal stem. Bracing can prevent a progressive curvature, but the evidence for this is not very strong. In all cases, early intervention offers the best results. More and more scientific research has proven the effectiveness of specialized physical therapy therapy programs, which may include strengthening.
A number of special exercises or physiotherapy may be useful. The evidence to support its use is somehow weak.
Bracing
Bracing is usually done when the person has the remaining bone growth and, in general, is implemented to hold the curve and prevent it from progressing to the point where surgery is recommended. In some cases with teenagers, bracing has significantly reduced the curve, going from 40 ° (from the curve, mentioned in length above) out of the clamp to 18 ° in it. Braces are sometimes prescribed for adults to relieve pain associated with scoliosis. Bracing involves mounting the patient with a tool that covers the torso; in some cases, it extends to the neck. The most commonly used brace is the TLSO, like a Boston brace, a tool like a suitable corset from the armpits to the hips and tailor made from fiberglass or plastic. It is sometimes worn 22-23 hours a day, depending on the prescription, and applying pressure on the curvature of the spine. The effectiveness of brace depends not only on buffer design and orthotist skills, but also patient compliance and total usage per day. The typical use of braces is for idiopathic curves that are not severe enough for surgery, but they can also be used to prevent the development of more severe curves in children, to buy the child's time to grow before surgery, which will prevent further growth in the affected part of the spine.
Indications for corroboration: a growing person present with a Cobb angle of less than 20 ° should be monitored. The growing people who present with Cobb angles from 20 to 29 ° should be pressured according to developmental risk taking into account age, Cobb angle elevation over a six-month period, Risser's sign, and clinical presentation. The people who are still growing who present with Cobb angles greater than 30 Â ° should be styled. However, this is a guideline and not everyone will get into this table. For example, a person still growing with a Cobb angle of 17 Â ° and significant thoracic or flat rotation may be considered for night stands. At the opposite end of the growth spectrum, a Cobb angle of 29 Â ° and a three or four Risser sign may not need to be installed because of reduced development potential. Scoliosis Research Society recommendations for strengthening include a growing curve greater than 25 °, an emerging curve between 30 and 45 °, a Risser mark of 0, 1, or 2 (X-ray measurement of pelvic growth area), and less than six months from the beginning of menstruation in girls.
Scoliosis braces are usually comfortable, especially when well designed and well fitted, also after a rest period of 7-10 days. Well-fitted and functioning brace scoliosis provides comfort when supporting deformity and steering the body to a more corrective and normal physiological position.
Evidence supports that corroboration prevents worsening of disease, but whether it alters the quality of life, appearance, or back pain is unclear.
Surgery
Surgery is usually recommended by orthopedists for curves with high probability of development (ie, greater than 45 to 50 Â ° of magnitude), curves that are cosmetically unacceptable as adults, curves in patients with spina bifida and cerebral palsy that disrupt sitting and treatments, and curves that affect physiological functions such as breathing.
Surgery is indicated by the Society on Orthopedic Treatment and Scoliosis Rehabilitation (SOSORT) at 45 to 50 Â ° and by the Scoliosis Research Society (SRS) at Cobb 45 Â ° angle. SOSORT uses a 45 to 50 Â ° threshold as a result of well documented, plus or minus 5 Â ° measurement errors that can occur when measuring Cobb angles.
A special surgeon performing spinal surgery performs surgery for scoliosis. To completely straighten the scoliotic spine is usually not possible, but for the most part, significant correction is achieved.
The two main types of operations are:
- Anterior Fusion: This surgical approach through an incision on the side of the chest wall.
- Posterior fusion: This surgical approach through an incision in the back and involves the use of metal instrumentation to repair the arch.
One or both of these surgical procedures may be necessary. Surgery can be done in one or two stages and, on average, takes four to eight hours.
Prognosis
A 50-year follow-up study published in the Journal of the American Medical Association (2003) confirms lifelong physical health, including cardiopulmonary and neurologic function, and mental health of idiopathic scoliosis patients comparable to that of the general population. Scoliosis that interferes with normal systemic function is "extraordinary" and "rare" patients, and "untreated and fatal scoliosis patients who have similar and functional mortality rates and are likely to live productive lives 50 years after diagnosis as people with normal thorns". In an earlier University of Iowa study, 91 percent of idiopathic scoliosis patients showed normal lung function, and their life expectancy was 2% longer than the general population.
Generally, the prognosis of scoliosis depends on the possibility of development. The general rule of development is that larger curves carry a higher risk of development than smaller curves, and thoracic and dual primary curves carry a higher risk of development than a single lumbar or thoracolumbar curve. In addition, patients who have not reached bone maturity have a higher likelihood of development (ie, if the patient has not completed a juvenile growth spurt).
Epidemiology
Scoliosis affects 2-3% of the US population, which is equivalent to about 5 to 9 million cases. Scoliosis skoliosis curve of scoliosis 10 Â ° or less affects 1.5% to 3% of individuals. The age of onset is usually between 10 years and 15 years (can occur at a younger age) in children and adolescents, up to 85% of those diagnosed. This is seen because of the rapid growth that occurs during puberty when the development of the spine depends most on genetic and environmental influences. Because young women experience rapid growth before postural musculoskeletal maturation, scoliosis is more common in women. Although fewer cases are present today using Cobb corner analysis for diagnosis, scoliosis remains a prevailing condition, appearing in healthy children. The incidence of idiopathic scoliosis (IS) stops after puberty when bone maturity is achieved, however, further curvature may last during late adulthood due to spinal osteoporosis and weakened muscles.
Society and culture
The cost of scoliosis involves monetary losses and lifestyle restrictions that increase with severity. Respiratory deficits may also arise from chest deformities and cause abnormal breathing. This directly affects exercise and work capacity, decreasing overall quality of life.
In the health care system in the United States, the average hospital cost for cases involving surgical procedures is $ 30,000 to $ 60,000 per patient by 2010. In 2006, bracing costs were published up to $ 5,000 during a period of rapid growth , when braces must be consistently replaced in some follow-up.
History
Because scoliosis was discovered by Hippocrates, doctors and orthopedic surgeons have been trying to find a cure for the condition. In the mid-20th century, modern medicine and treatments reduced the development of scoliosis in patients and reduced the pain they experienced. This is a result of the development of screening and treatment of scoliosis. New ways are developed to treat scoliosis as this condition is increasingly understood among medical professionals and orthopedic surgeons. This treatment is like a buffer and the insertion of the stem into the spine is possible at the turn of the 20th century. During this time, many schools subjected their students to physical examination and posture tests. Students are believed to suffer from negative effects such as bad posture because they bend over the desk for hours in the classroom. Although this examination is not intended to detect curvature of the spine, doctors diagnose many students with scoliosis. Scoliosis is considered a disease based on conditions during the mid-20th century caused by tuberculosis or poliomyelitis. The diseases responsible for causing spinal defects were managed throughout the 1960s due to the distribution of vaccines and antibiotics. Although successful disease management leads to spinal deformity, many patients suffer from scoliosis with no known cause. Unknown causes are ultimately determined to be idiopathic scoliosis. Alfred Shands Jr., an orthopedic surgeon, found that two percent of patients had unrelated scoliosis with the disease. Idiopathic scoliosis, also known as "orthopedic surgical cancer", is determined to be dangerous because there is no current treatment. This condition needs to be detected in the patient immediately so that treatment can be developed in time to stop its development. As a result, schools require students to screen for scoliosis. From the outset, the prescribed symptoms were recognizable among the students tested from the ages of five to eighteen, but subsequent research never confirmed them for this age range. To begin playback, children will have their shoulders height, leg length and spinal curvature measurements taken while partially dressed. This is followed by forward curve test and body comparison with an ideal reproduction postural wall reproduction graph. Unfortunately, this examination is not always accurate and many students are misdiagnosed because bad posture can often be misconstrued as scoliosis. One of the first designed treatments was the Milwaukee buffer, a rigid device of metal rods attached to a plastic corset or leather, designed to straighten the spine. As a result of the constant pressure exerted on the patient's spine, it is very painful and uncomfortable to wear due to imposed physical limits. Wearing a brace is known to cause jaw pain, skin irritation, muscle aches and low self-esteem among patients. The 'Harrington Rod' technique is the second major treatment for emerging scoliosis and becomes the first significant surgical procedure for manipulating the position of the spine. This treatment was originally developed to treat paralytic scoliosis resulting from a polio epidemic of the 1950s. The Milwaukee brace was the only nonoperative and noninvasive alternative to surgery at the time to provide postoperative correction for polio patients. Curves that exceed sixty degrees require the Harrington rod technique, if not recommended Milwaukee brace. However, Canadian physician Elizabeth Wyne observed that fifty percent of patients using Milwaukee clamps still require surgery in the future. Surgery can straighten the spine but not always eradicate the patient from all the pain they suffer from scoliosis. Individuals who are undergoing surgery are left with scars and often have less flavor on their backs for the invasive nature of this treatment. Despite the advent of scoliosis treatment, but what should be determined is a reliable, risk-free medication and which results in little or no consequences for the patient.
Evolutionary considerations
There is a relationship between the morphology of human spine, bipedality, and scoliosis that shows the evolutionary basis for the condition. Scoliosis has not been found in chimpanzees or gorillas. Thus, it has been hypothesized that scoliosis may actually be related to human morphological differences from this ape. Other monkeys have shorter and lower spine than humans. Some of the lumbar vertebrae in Pan are "captured", meaning that the bones are held rapidly between the bones of the pelvic ilium. Compared to humans, Old World monkeys have larger spinae muscles, those muscles that keep the spine stable. These factors make the lumbar spine of most primates less flexible and far less likely to diverge than humans. Although this is explicitly related only to lumbar scolioses, it is likely that a small imbalance in the lumbar spine may trigger a thoracic problem as well.
Scoliosis may be a by-product of a strong selection of bipedalism. For a bipedal position, a very mobile, elongated lower spine is very useful. For example, the human spine takes an S-shaped curve with lumbar lordosis, which allows better balance and support from the erect stem. Selection for bipedality may be strong enough to justify the maintenance of such disturbances. Bipedality is hypothesized to arise for a variety of different reasons, many of which certainly provide a fitness benefit. This can increase visibility, which can be useful in hunting and foraging and protection from predators or other humans; it makes long distance travel more efficient for feeding or hunting; and it facilitates terrestrial feeding of grass, trees, and bushes. Given the many benefits of speci fi c dependent spinal bipedalities, the likelihood of selection for bipedalism plays a major role in the development of the spine as we see today, regardless of the potential of "scoliotic deviations". According to the fossil record, scoliosis may be more common among previous hominids such as Australopithecus and Homo erectus, when bipedality first appeared. Their fossils suggest that there may be selection over time for a slight reduction in lumbar length to what we see today, supporting the spine that can efficiently support bipedalities with lower scoliosis risk.
Research
The genetic test for AIS, which was available in 2009 and still under investigation, attempts to gauge the likelihood of developing a curve.
See also
- Back brace
- Kyphosis
- Lordosis
- Neuromechanical idiopathic scoliosis
- Pott's Disease
- Scheuermann's Disease
- Schooliosis
- Community Research Scoliosis
References
External links
- Scoliosis in Curlie (based on DMOZ) Early Onset Scoliosis is an abnormal spine curve in the spine in children under 5 years, often including children with congenital scoliosis (present at birth, with spinal disorders) and infantile scoliosis (born to 3 years ).
- Questions and Answers on Scoliosis in Children and Adolescents - US National Arthritis Institute and Musculoskeletal and Skin Diseases
Source of the article : Wikipedia
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