Scoliosis
by Robert Tallitsch, PhD | September 25, 2024
Video explaining scoliosis and the vertebral column with a case study example!
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Scoliosis is an abnormal lateral curvature of the vertebral column. This curvature may be in the form of a “C” or an “S”. Although scoliosis is most often diagnosed in adolescents, it may be diagnosed in adults as well. This Brain Builder will discuss the anatomy of the vertebral column as well as the causes, symptoms, and treatment of scoliosis.
The Vertebral Column
The vertebral column consists of bones, termed vertebrae, and the associated connective tissue structures (intervertebral discs and ligaments). There are 24 presacral vertebrae: seven cervical, twelve thoracic, and five lumbar vertebrae. Two composite vertebrae are located in the pelvic region: five fused vertebrae form the sacrum, and three to five fused coccygeal vertebrae form the coccyx.
Vertebrae are designated according to their location within the vertebral column. For instance, the second cervical vertebrae, which is called the axis, is indicated as C2, with the letter "C" for cervical, and the subscript number for its location within that region of the vertebral column. Therefore, the second lumbar vertebra would be designated L2, and the tenth thoracic vertebra would be designated T10. Because cervical and coccygeal both begin with the letter "C", the coccygeal vertebra would be indicated with the letters "Co." So, the second coccygeal vertebra would be Co2.
The joints between adjacent vertebral bodies from C2 to S1 are symphysis joints. Fibrocartilaginous pads, termed intervertebral discs, are found between all adjacent vertebrae from C2 to S1. No intervertebral discs are found between C1 and C2, nor between adjacent adult sacral or coccygeal vertebrae.
Spinal Curves
When viewed in the anterior or posterior axis the vertebral column appears to be a straight line. However, when viewed from the side the vertebral column has four visible spinal curves: cervical, thoracic, lumbar, and sacral. The thoracic and sacral curves are termed primary curves, in that they are in the same direction as the fetal vertebral curves. The cervical and lumbar curves, termed secondary or compensatory curves, develop later in life. All four of these curves serve to bring the body weight in line with the center of gravity of the body.
Scoliosis and hyperkyphosis are the two most common abnormal curves of the vertebral column. Scoliosis is an abnormal lateral curvature of the vertebral column. Hyperkyphosis is an abnormal posterior curvature of the thoracic region of the vertebral column. A third, less common abnormal curve of the vertebral column is hyperlordosis. This is an abnormal anterior curvature of the lumbar region of the vertebral column.
Scoliosis
There are three different forms of scoliosis:
- Congenital scoliosis develops because of misshapen vertebrae during fetal development. As the child develops this type of scoliosis often worsens.
- Neuromuscular scoliosis typically develops in a child or adult with an underlying neuromuscular condition. This is because the maintenance of normal vertebral anatomy requires normal muscular activity and the proper balance of this activity. Muscular paralysis, cerebral palsy, spinal bifida, and muscular dystrophy are neuromuscular conditions that are accompanied by weak and unbalanced muscular activity, which may ultimately result in the development of scoliosis.
- Idiopathic scoliosis is the term given to the development of scoliosis due to one or more unknown causes. This type of scoliosis often develops at the onset of adolescence — typically around the age of ten. Continued growth of the individual often worsens idiopathic scoliosis. If idiopathic scoliosis develops at or before the age of two this type of scoliosis is termed idiopathic infantile scoliosis.
The most common symptoms of scoliosis are:
- The position of the head is not centered with the rest of the body.
- Uneven shoulder height or position, or a difference in scapular height or position.
- Difference in hip height or position.
- Asymmetry in the ribs when viewed in the anterior-posterior axis.
- A difference in the way the arms hang at the side of the body when the individual tries to stand straight.
A definitive diagnosis of scoliosis is typically accomplished by x-ray. However, CT or MRI scans are often required for non-idiopathic scoliosis — particularly congenital scoliosis.
Although scoliosis is typically thought of as being diagnosed primarily in adolescents, the number of adults with scoliosis appears to be higher than previously thought. Two types of scoliosis are typically found in adults: adult idiopathic scoliosis and adult degenerative scoliosis.
Adult idiopathic scoliosis is the result of an undiagnosed case of idiopathic scoliosis that existed during childhood. Often the symptoms were minor during childhood but increased in severity with age.
Adult degenerative scoliosis typically occurs after the age of fifty and is often the result of disease, work-related conditions, surgery, trauma, or degeneration of the vertebra from other causes. The most common symptoms that ultimately result in a diagnosis of adult degenerative scoliosis are problems of the lower limb, back, or neck, and associated nerve pain in the affected region.
Treatment of Scoliosis
In adolescents, the main treatment goal is halting the progression of scoliosis, and thereby preventing deformity in the developing individual. “Wait and watch” is the most common form of treatment in adolescents. Here the individual undergoes regular physical examinations in order to determine whether or not the vertebral column is continuing to curve. This “wait and watch” treatment in a growing child will continue until the curvature is greater than twenty degrees, but less than fifty degrees. If the curvature exceeds twenty degrees and remains less than fifty the individual will typically be prescribed to wear an external torso brace (termed a TLSO) for a certain number of hours per day. The brace will apply corrective pressure to the growing vertebral column with the goal of preventing further worsening of the scoliosis.
If the curvature in an adolescent becomes greater than fifty degrees surgery is often recommended in order to correct the abnormal vertebral curvature. Surgical procedures vary from minimally invasive surgery, where several small incisions are made to allow the surgeon to attach rods and screws to the vertebral column in an attempt to straighten the vertebral column. In very serious cases open surgery may be required to insert larger rods in an attempt to straighten the vertebral column.
Adults have fewer options for the treatment of scoliosis. The use of an external torso brace has been demonstrated to be ineffective in adults. Surgery is often the only option to prevent pain and further disability.
Key Terms
Idiopathic - A disease of unknown causes
Scoliosis - An abnormal lateral curvature of the vertebral column.
Adult degenerative scoliosis - Adult degenerative scoliosis typically occurs after the age of fifty. It is often the result of disease, work-related conditions, surgery or trauma, or degeneration of vertebrae from other causes.
Congenital scoliosis - Congenital scoliosis is the result of misshapen vertebrae during fetal development.
Hyperkyphosis - An abnormal posterior curvature of the thoracic region of the vertebral column.
Hyperlordosis - An abnormal anterior curvature of the lumbar region of the vertebral column.
Neuromuscular scoliosis - A form of scoliosis that develops as the result of an underlying neuromuscular condition.
Adult idiopathic scoliosis - A form of adult scoliosis that is the result of an undiagnosed case of idiopathic scoliosis that existed during childhood.
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