yogabook / pathologie / scoliosis

scoliosis

Definition of

There are two forms of scoliosis: functional, reversible scoliosis without rotation of the vertebrae and generally without progression, as occurs in cases of pelvic obliquity and leg length discrepancies, for example, and fixed scoliosis, a fixed lateral curvature of the spine of at least 10° according to Cobb, usually associated with rotation of some vertebral bodies. The vertebral bodies are slightly rotated: the spinous processes are rotated medially, i.e. to the concave side, due to the longitudinal ligaments that hold them together dorsally and the autochthonous back muscles, so the vertebral bodies are rotated ventrally to the lateral side.
The resulting deformity is thus characterized dorsally by a rib hump on the convex side and a rib valley on the concave side. The Cobb measurement measures between the top plate of the cranial and the bottom plate of the caudal vertebra with the greatest deviation in each case, i.e. usually the vertebrae at both inflection points, between which the maximum of the bending lies.

Occurrence: 2-4% of the population have a pronounced scoliosis, women 6 times more frequently; first symptoms and diagnosis usually in the 10th-12th year of life. 68% of over 60-year-olds have scoliosis. Severe scoliosis is 7 times more common in women/girls. 97% of cases are familial; if one identical twin is affected, the other is also affected in 70% of cases. The progression of the curvature is directly proportional to the growth of the spine and increases with its speed. The earlier a scoliosis occurs and the more longitudinal growth can be expected, the greater the scoliosis can be expected. With early onset, aggressive brace treatment is indicated. Only 5% of juvenile scoliosis is non-progressive. During the pubertal growth spurt, 5° – 10° / a according to Cobb are sometimes reached, more rarely up to 40°. Scolioses are labeled according to the area with the greatest degree of curvature (major curve), compensatory curves to maintain the overall statics are called minor curves. Thoracic curves usually extend from Th4, Th5 or Th6 as the uppermost vertebra to L1 as the lowermost, thoracolumbar curves down to L2, L3 or L4. They occur as:

1. S-shaped scoliosis: the most common form, curvature to one side with compensatory counter-curvature to the cranial or caudal side
2. Total scoliosis or C-scoliosis: curvature to one side without countercurvature; approximately less common
3. Triple scoliosis or double S scoliosis: curvature to one side with compensatory counter-curvature to the cranial (cervical spine) and caudal (lumbar spine) sides

The compensatory curvatures in the caudal and cranial directions, i.e. in the lumbar and cervical spine, are usually rotation-free. Scoliosis is often accompanied by unphysiological kyphosis or lordosis. In more pronounced forms, the intervertebral spaces are narrowed on the concave side and the vertebrae develop as wedge vertebrae, also narrower on the concave side. On the concave side, the
roots and vertebral arches are smaller on the concave side and therefore the spinal canal is narrower. Most scolioses are discovered in an asymptomatic stage at the age of 10 – 12 years. In adolescent females, menarche can be used to estimate development, as it is known that growth continues for about 2 years afterwards. Scoliotic children are generally asymptomatic, but if symptoms occur, they must be clarified, as they may be comorbidities or causally related to the scoliosis.
The forms according to aetiology:

1. idiopathic scoliosis: the most common form (80-90%). A distinction can be made between infantile (up to 3 years of age), adolescent (4-10 years of age) and adult scoliosis according to the time of onset.
2. Infantile/malformational scoliosis: congenital, in the case of severe prenatal developmental disorders probably due to asymmetrical development of the back muscles or vertebral malformations, e.g. wedge vertebrae (in frontal view) cause scoliosis. Other causes: Malformations of the ribs, adhesions (synostoses), defects in the spinal canal
3. Adolescent scoliosis due to overuse (child labor, sports); posture, strain, degeneration are discussed as factors
4. Metabolic scoliosis: due to diseases of the bone metabolism such as juvenile osteoporosis, rickets (now de facto extinct in Western Europe), osteogenesis imperfecta(brittle bone disease), homocystinuria, melatonin metabolism disorders
5. Neuropathic scoliosis: caused by diseases of the nervous system, e.g. myasthenia gravis, viral myelitis, early childhood brain damage (e.g. infantile cerebral palsy), neurodegenerative diseases, spinal cord damage, spinal tumors. These scolioses can reach massive proportions.
6. Paralytic scoliosis: mostly with hemiparesis
7. myopathic scoliosis: due to muscle diseases, e.g. Duchenne muscular dystrophy: 50% of those affected develop scoliosis, usually in early adolescence after losing the ability to walk. Also arthrogrypsosis multiplex congenita (AMC, Guérin-Stern syndrome), a congenital joint stiffness of varying severity
8. Cicatricial scoliosis: post-op
9. Post-traumatic scoliosis: due to fractures in the pelvis or spine, spinal cord injuries, burns, amputations, spinal surgery
10. mesenchymal (fascial) scoliosis: due to diseases of the connective tissue such as Marfan syndrome, Ehlers-Danlos syndrome, severe scarring in the mesentery
11. Radiogenic scoliosis: consequence of radiotherapy in childhood
12. Inflammatory scoliosis: osteitis, osteolyelitis, due to severe inflammation in the area of the vertebral bodies
13. osteochondrodysplastic scolioses: mucopolysaccharidoses, spondyloepiphyseal dysplasia, multiple epiphyseal dysplasia, achondroplasia, diastrophic dwarfism, osteoporosis
14. due to lumbosacral changes: Spondylolysis, spondylolisthesis
15. Static scoliosis: due to leg length discrepancies
16. with RA
17. due to other systemic diseases such as neurofibromatosis, skeletal dysplasia

ICD M41

Cause

1. 90% unknown
2. (see forms according to etiology)

Predisposing

1. Rapid growth in length: adolescents with scoliosis are taller on average than those without
2. one-sided loads
3. Hypokyphosis of the thoracic spine

Diagnosis

1. Stages according to scoliosis angle (COBB angle of the vertebrae/vertebral base plates in the X-ray)
2. Active equalization
3. Passive manual redressability
4. Neurological tests to rule out neurological causes
5. X-ray

Symptoms

1. 80% right convex thoracic spine rotational scoliosis (looking over the vertebral processes when bending forward)
2. Rotation of individual vertebral bodies
3. Unilateral shoulder elevation
4. Asymmetrical triangles of the eyelids (pelvis-thorax side-arm triangle)
5. with pronounced scoliosis: thoracic deformity with impaired lung function. usually due to lateral displacement of the upper body’s center of gravity, mostly arthritic changes in the knee or pelvis
6. Back pain, usually on one side
7. in severe cases dynpnea, tachypnea, tachycardia

Complications

1. Spondyloarthritis
2. Intervertebral disc damage
3. possibly due to reduction of the chest and abdominal cavity, restrictions of the heart, lungs and, more rarely, other internal organs
4. In severe cases (over 80° according to Cobb) insufficiency of the right heart (arterial filling), due to restriction of vital capacity cor pulmonale, reduced life expectancy

Therapy

1. Therapy: for scoliosis angles up to 20°: KG, spinal gymnastics
2. Up to 20° consistent KG, neurophysiological exercises and electrostimulation; scoliosis therapy according to Schroth
3. 20° – 50°: in addition to KG: individually made corset, may cause deterioration at the beginning and may have to be remade annually for adolescents
4. From 50°: if the patient is suffering: surgical intervention in the form of fusion. Dorsal procedures and, if indicated, ventral procedures are available. The indications for surgery are mainly due to progression:
   (a) unstoppable or significant deterioration despite brace,
   b) thoracic progression,
   c) progressive deterioration of lung function, as well as other factors: psychological difficulties caused by the brace treatment, pronounced pain symptoms in the thoracic spine or lumbar spine, pronounced disfigurement of the shoulder area.
5. For infant scoliosis: prone positioning, consistent KG