| Peter Fysh, DC
Scoliosis is defined as an abnormal curvature of the spine
greater than 10 degrees in the sideways or coronal plane.
Since scoliosis is a physical finding and does not represent
a diagnosis, its cause should be investigated in all cases
and its classification established prior to the commencement
of any treatment program.
Scoliosis Screening
Scoliosis can be readily detected during a thorough physical
examination and many cases of scoliosis are found during routine
spinal screenings. Scoliosis screening is such an effective
process for locating previously unidentified cases of scoliosis
that screenings are becoming a common occurrence in schools.
Many school screenings are now carried out by local chiropractors.
Examination of a patient for scoliosis requires undressing
and careful examination of the entire spine. A scoliosis which
is evident with the patient in the standing position, but
which disappears when the patient sits, is most commonly classified
as a functional scoliosis. A scoliosis which is evident in
the standing position and which persists with the patient
in the forward bending position is most likely a structural
scoliosis. The forward bending test is performed by having
the patient flex forward at the waist to 90 degrees with the
hands clasped together in-front. With the patient in this
forward bent position, alignment of the ribs and vertebral
spinous should be evaluated. If a distortion is detected,
such as a unilateral rib hump, prominent scapular or obvious
deviation of the spine to one side, then x-ray films should
be obtained.
X-Ray Evaluation
Any patient who has the signs of apparent scoliosis should
have their spine x-rayed to determine the extent of the scoliosis.
Scoliosis is evaluated using the following criteria: the angle
of the scoliosis, the side to which the curve deviates, the
upper and lower vertebrae which form part of the curve and
the apex vertebra, i.e., the vertebra which is furthest from
the spinal midline. Evaluation of any spinal curvature detected
on an x-ray film should be made using either the Cobb method
or the Riser-Ferguson method to determine the extent of the
curvature.
Functional Scoliosis
The patient with suspected functional scoliosis should be
evaluated for leg-length inequality or pelvic distortion.
Frequently, these scoliosis can be corrected by spinal and
pelvic adjusting.
Congenital Scoliosis
Congenital scoliosis is associated with failure of appropriate
formation of the spine during embryological development. It
may be due to specific vertebral anomalies, such as hemivertebrae,
or to failure of proper segmentation of the vertebral structures.
Congenital scoliosis frequently presents concurrently with
other developmental anomalies, such as genitourinary anomalies,
cardiac anomalies and spinal cord tethering. The goal of any
management program is to prevent the progression of the scoliosis.
Classically, bracing has been the method of choice to prevent
further progression of the curve. Initially, watching and
evaluating the curve, especially small ones, may be appropriate.
Also curves may be nonprogressive but this can only be determined
by evaluation over a period of 6-12 months.
Idiopathic Scoliosis
The most common form of scoliosis is an idiopathic scoliosis,
which means scoliosis of unknown origin. Idiopathic scoliosis
has no associated back pain, therefore any young patient who
presents with scoliosis, accompanied by associated back pain,
should be evaluated carefully for an alternative cause for
their complaint.
Idiopathic scoliosis is the most common classification of
scoliosis and is a classification which is reserved for scoliosis
which cannot be classified into any other category. Idiopathic
scoliosis may therefore be considered to be a diagnosis of
exclusion. It is more common in females and tends to progress
more rapidly during an adolescent growth spurt.
Scoliotic curvatures which are less than 25 degrees can be
safely treated in the chiropractor's office, without referral
for orthopedic opinion. Once the curvature reaches or exceeds
25 degrees, the patient should be referred for possible bracing.
Some scoliosic curvatures have more of a tendency to progress
than others. Such curvatures are seen in females whose scoliosis
developed before the onset of menses, who have not as yet
reached skeletal maturity and whose curvature measures 20
degrees or greater.
Neuromuscular Scoliosis
Scoliosis associated with neuromuscular disorders, e.g., cerebral
palsy, tend to be progressive and usually require bracing
to minimize deterioration.
Other Scoliosis Classifications
Identifiable scoliosis should be classified according to the
following table, as such classification helps to determine
not only the cause, but also the likely progression and prognosis.
CLASSIFICATION OF SCOLIOSIS
Idiopathic
Infantile (0-3 years)
Juvenile (4 years to puberty)
Adolescent (puberty to epiphyseal closure)
Neuromuscular
Cerebral palsy
Spinal muscular atrophy
Syringomyelia
Friedreich's ataxia
Spinal cord tumor
Spinal cord trauma
Myopathic
Muscular dystrophy
Congenital
Failure of formation (hemivertebrae)
Failure of segmentation (Unilateral bar)
Mesenchymal
Marfan's syndrome
Ehlers-Danlos syndrome
Other Causes
Leg-length inequality
Hysterical
Metabolic
Soft tissue contractures
Ostechondrodystrophies
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