09/12/2022
Scoliosis

Adult scoliosis: diagnosis – 2022

scoliosis

Adult scoliosis: diagnosis

The existence and location of pain: it is generally the pain that motivates the consultation. Scoliosis

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What are the symptoms of scoliosis?

Scoliosis can be asymptomatic for a long time.

Spinal pain (lumbago, back pain) is very often the first warning sign (40% of patients). They predominate in the lumbar sector, but can also affect the back and go up to the level of the neck. They are sometimes very severe but often begin with moderate, chronic, sometimes neglected pain.

The pain usually increases with the severity of the deformity, from the front but especially from the side (appearance of forward imbalance in very advanced forms).

Sciatica or cruralgia is sometimes present, especially in advanced forms.

Sciatica is a burning or electrical neurological pain that starts in the back and travels down the back or side of the entire leg to the foot.

Cruralgia corresponds to the same type of pain but is located in the front (inguinal hollow and anterior aspect of the thigh). This pain is caused by the compression of one or more nerve roots in the lumbar spine. The deformation and slippage of the vertebrae following wear of the discs cause aggravation of a stenosis. This results in compression and/or shearing of the nerve roots. A rotatory dislocation is a typical slippage of scoliosis, in three dimensions.

The elements that can compress a nerve in adult scoliosis are:

  • lumbar stenosis
  • osteoarthritic parrot beaks
  • ligament thickening
  • a herniated disc
  • a posterior joint cyst
  • a vertebra slip: spondylolisthesis, rotary dislocation
  • a stretching of the nerve in scoliosis

Neurogenic claudication: fatigue when walking. It occurs after a distance or a duration which will be noted by the doctor (we speak of a walking distance of 5, 10 minutes or 500 meters, etc.).

The patient often describes a feeling of “walking on eggshells” or “walking on cotton wool”. The legs weaken with the efforts and can no longer carry the body.

The patient is forced to sit or lean forward to recover in order to be able to resume his journey (Caddy sign: the patient leans on his cart to relieve himself when shopping)

In the most severe form, the person can no longer leave their home.

Claudication is caused by the narrowing of the medullary canal where the roots of the ponytail run, which innervate the legs and the perineum, we speak of lumbar stenosis. Bladder-sphincter disorders may appear: increasingly frequent urinary leakage, insensitivity of the perineum (decreased sensation of touch in the buttocks, genitals, even faecal incontinence).

A sagittal imbalance: The decrease in physiological lumbar lordosis causes the trunk to fall forward. The patient finds himself hunched over.

The body adapts unconsciously to keep the gaze horizontal (“look straight ahead so as not to fall”): the pelvis becomes vertical, the head straightens (source of neck pain).

In advanced cases, the patient walks with their knees bent in an attempt to maintain an upright posture. In extreme cases the person arches completely: we speak of decompensated sagittal imbalance (in profile).

Respiratory failure. This complication affects idiopathic scoliosis that develops in adulthood, often from menopause (because purely degenerative scoliosis does not affect the thorax). Respiratory failure appears when the thoracic curvature exceeds 100° (Cobb angle), which remains exceptional in adults.

Adult scoliosis: diagnosis

During the consultation, the doctor will look for:

  • The existence and location of pain: it is generally the pain that motivates the consultation (lumbago, sciatica?)
  • The recent or chronic nature of the pain
  • The treatments followed and their effectiveness (drugs, infiltration, physiotherapy)
  • A feeling of weakness (or slippage) of the legs: neurogenic claudication
  • The walking distance (distance or duration that you manage to walk without a break)
  • The presence of vesico-sphincter disorders: appearance of urinary leakage, incontinence

These disorders are a sign of seriousness, they testify to damage to the nerves of the cauda equina. Surgical management is necessary very quickly to avoid sequelae incontinence.

Recent worsening of these symptoms:

  • the existence of scoliosis since childhood, the wearing of a corset
  • the existence of old x-rays

This non-exhaustive list allows you to take stock and estimate the stage of development of your pathology.

 

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