Scoliosis: Cause,Diagnosis and Treatment

Specifically with regard to scoliosis, the Adams test (flexion of the trunk forward and downward reveals the curvature and hump) has been shown to be very useful…

Scoliosis project 2022

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Cause

The cause of most pathological deviations of the spine is idiopathic, that is, its origin is obscure, unknown. In cases where it is possible to determine the cause, the abnormal deviations of the spine can have a genetic explanation or, then, be caused by congenital or acquired anomalies throughout life. They may also be associated with bone, muscle or neurological changes in the body. Among them, it is worth highlighting inadequate postural habits, trauma, tumors, obesity, improper physical activity, sedentary life, smoking.

Diagnosis

The diagnosis of spinal deviations is based on a thorough clinical examination, with the patient from the front, back, and profile, as well as findings from X-ray examinations of the spine. In addition to recording the occurrence of deviations in the alignment of the spine, radiography allows measuring the degree of curvature and identifying injuries that affect the discs and joints, as well as visualizing signs of fractures, dislocations or tumors in this region of the body.

There are cases suggestive of deformities in which it is necessary to resort to computed tomography and magnetic resonance imaging to establish a definitive diagnosis and refer treatment.

Specifically with regard to scoliosis, the Adams test (flexion of the trunk forward and downward reveals the curvature and hump) has been shown to be very useful for the early diagnosis of adolescent idiopathic scoliosis (AIS), a disease manifested in childhood and adolescence. Performed in a few minutes, this exam allows the identification of abnormal deviations in the alignment of the spine and asymmetries in the trunk (one side of the back is higher than the other) linked to vertebral rotation and the presence of gibbosity.

Treatment

Some pathological spinal deviations are asymptomatic. When the signs of the disease manifest, in general, the treatment is conservative and takes into account the peculiarities of each case with regard to the patient’s age, the degree and pattern of curvature, the characteristics of the installed deformity, the intensity of pain. . The goal is to stop the progression of the disorder, restore spinal function, and relieve symptoms. If the cause of the disorder can be identified, attention should also be focused on controlling the underlying disease. In cases of obesity, it is essential that the carrier find a way to lose weight.

In general, conservative treatment includes physiotherapy techniques, such as RPG – Globalized Postural Reeducation – stretching exercises and to strengthen the muscles and electrical stimulation. Orthotics, such as insoles and orthopedic braces, can be useful to stop the progression of the curve and, as far as possible, keep bones and joints in the proper position.

Conservative treatment does not exclude the use of anti-inflammatory drugs, analgesics and muscle relaxants for pain relief, such as paracetamol, aspirin, ibuprofen, dipyrone, diclofenac sodium.

Surgery for spinal stabilization is only recommended for adult patients in very special situations. In scoliosis, for example, it only represents an option to correct the deformity, when the deviation is greater than 50º, the pain is intense and there is impairment of lung function.

Recommendations

Spinal care should start in childhood. The child needs to be encouraged, on a daily basis, to develop a correct posture, that is, the one that demands less muscular effort to guarantee protection for all the structures of the backbone. Once these habits are acquired, ideally, they should be observed for a lifetime. For that, it is essential:

• Keep body weight within the ideal standards for height and age. Obesity poses a risk for the appearance of spinal deviations, as excess weight not only alters the body’s balanced position, but also causes wear and tear on the joints and can lead to calcification of the vertebrae;
• Avoid sedentary lifestyle. The regular practice of physical exercises, as long as they are well oriented, represents an important resource to strengthen the muscles of the back, hips and abdomen and support the spine;
• Adopt a healthy and varied diet, rich in calcium, an essential mineral for bone health;
• Take extra care to protect the spine when transporting heavy objects. Carrying them close to the body helps to reduce the force imposed on the spine, muscles and joints;
• Avoid self-medication for pain relief and other symptoms empirically attributed to spinal problems;
• Seeking medical assistance is an indispensable measure in the face of any alteration that may suggest a pathological deviation of the spine;
• Carefully choose the type of shoes and the height of the heels, to avoid those that can compromise gait and strain the structures of the spine. It is already proven that excessively high heels cause changes in the body’s center of gravity, which alters the positioning of the spine. To compensate, the shoulders are thrown back and the head is projected forward, which causes a change in the angulation of the cervical and lumbar curves. It is always good to remember that a change in one region of the spine results in changes in the entire spine, so that the trunk position and balance are preserved.

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