A lateral curvature of the spine which exceeds by 10 degrees from the normal is termed as scoliosis.
It is basically of two types:
- Postural or Non-structural scoliosis
- Structural scoliosis.
Postural or Non-structural Scoliosis
This is Grade I scoliosis. This occurs without any bony changes or muscular weakness.
- Impairment of the reflex mechanism.
- Wrong Postural habits, e.g: Standing with stress on one leg or Psychological factors.
The postural scoliosis may get organized into a structural one, due to secondary soft tissue contractures in muscles and ligaments on the concave side of the curve.
This is Grade II and III. In this type there is defect in the bone which results in contractures of the soft tissue on the concave side of the curve and reciprocal stretching on the concave side.
- Postural or Idiopathic scoliosis
- Paralytic scoliosis
- Congenital scoliosis
Postural or Idiopathic Scoliosis
This is again divided into:
Infantile scoliosis: The onset of this is at the age of three years. Usually there is a spontaneous resolution of the curve. If the curve progress then need an early surgical intervention.
Juvenile scoliosis: The age of onset is between three and ten years. Rapid progression of the curve occurs due to the growing age. If bracing fails to control the deterioration, surgery becomes necessary.
Adolescent scoliosis: The age of onset is between ten and twenty years if this is detected earlier acceptable correction is achieved by bracing.
Adult scoliosis: The age of onset is over twenty years. Scoliosis may develop as a result of disc degeneration. When the deterioration is
rapidly progressive, surgery may be indicated.
This occurs in conditions like Poliomyelitis, Cerebral palsy or Spina bifida. This is complicated by the greater degree of the muscle imbalance and growing age complications. Scoliosis will rapidly deteriorate in these children.
Surgery becomes necessary where there is rapid progression of the curve.
This scoliosis occurs by birth. It is of milder and severe forms. The milder form is treated with a brace, the severe form need a surgery.
The Course and Prognosis
The course depends on the age of onset, time of detection, site of the primary curve and the treatment given. If the onset is at an early age, the curve tends to increase with age till the end of the skeletal growth. The prognosis will be poor if affects. Thoracic curve because it interferes with the breathing efficiency. The Thoraco-lumbar or
lumbar curves will compensate well.
Prevention plays a very important role.
- Early detection plays an important role in the prevention of scoliosis.
- Screening programme of all the children between the age group of 10-14 years is necessary because they are more vulnerable.
- Parents can also play an important role in the early detection of a scoliotic curve. So education of the parents on observational techniques may be helpful.
Curve less than 40 degrees: Conservative treatment is sufficient in growing children. This is given in the form. Active correction: This is postural correction. This is again divided for the Grades –I, II and III.
Grade I—Management of Postural Scoliosis
The correction of the deformity is obtained by progressive reduction of the bad posture.
A. General body relaxation
B. Posture maintenance
C. Free mobility exercises to the whole spine, Spinal extensor exercises and abdominal exercises.
D. Deep breathing exercises.
E. Balance exercise
F. Stretching of the soft tissues.
G. After the correction the patient should be advised to continue with exercises avoiding especially the positions and the activities prone to produce the existing deformity.
H. The patient must report regularly for screening
The curves are associated with the compensatory curves. So need a brace called Milwaukee or Boston brace to prevent deterioration of the curve and to maintain correction with active exercise. This brace immobilizes the spine and maintains a stretching effect.
- Mobility exercises are important, as the spine remains immobilized in brace
- Deep breathing exercises are also important, as the expansion of the ribs is limited due to the brace.
- Lumbar lordosis is associated with these curves so correction of the anterior pelvic tilt is important.
- Correction of the major curve is also achieved by putting a pad over a rib hump on the convex side of the curve in the brace.
- Repeated stretching exercises for the hip flexors and hamstrings are important as these have a tendency to shorten due to the pelvic tilt.
- Hanging in head suspension apparatus or on the stall bars can provide effective stretch to the whole spine.
- The whole programme and the brace need to be continued for long-time. As the child grows brace needs repeated adjustment and continued till the child attains skeletal maturity. It can be taken gradually thereafter.
Grade III—Severe Structural Curves
These curves are greater than 40 degree and need a surgical intervention.
Hanging is the best method E.g.: suspension apparatus. Two physiotherapists give axial traction. One will be grasping the pelvis and gives traction towards the legs while the other grasps the chin and gives traction towards the occiput.
Maintenance of Correction
The most important aspect is to educate the patient to maintain the correction by active efforts or with the help of spinal brace. The patient needs education for continuous awareness an exact methodology.