The causes of scoliosis
Once the diagnosis of scoliosis is established, it is important to look for the reason because several causes of scoliosis are possible. So-called “idiopathic” scoliosis is a diagnosis of exclusion established after a patient has been evaluated for congenital, syndromic or underlying neurological causes.
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What is Scoliosis?
Scoliosis corresponds to a deformation of the spine involving a deformation of the vertebrae and discs. This deformation is related to the rotation of vertebrae. The rotation causes a deformation in the 3 planes of space. Scoliosis is a three-dimensional pathology.
This is assessed first clinically: measured by the humpback (in flexion of the trunk, the difference between the posterior costal arches is measured). This gibbosity corresponds to a deformation of the back in the form of a “hump”.
The X-ray of the spine provides us with additional information on scoliosis, in particular with the Cobb angle. By definition, a coronal curvature of 10° or more (Cobb angle) must be present to diagnose scoliosis. When scoliosis is diagnosed, regular clinical and radiological monitoring is essential.
The causes of scoliosis
Once the diagnosis of scoliosis is established, it is important to look for the reason because several causes of scoliosis are possible. So-called “idiopathic” scoliosis is a diagnosis of exclusion established after a patient has been evaluated for congenital, syndromic or underlying neurological causes. Idiopathic scoliosis is most common in children or young adults.
Scoliosis is not a pathology found exclusively in children or adolescents. There are also scoliosis in adults. In adults, first, it may be the progression of idiopathic scoliosis or another existing cause during adolescence. Secondly, it can be a degenerative scoliosis, related to the degeneration of the intervertebral discs, osteoarthritis of the articular facets, and pinching with inclination of the disc spaces (“de novo” scoliosis). We can see appearing and progressing in this type of scoliosis a sliding of the vertebrae. We then speak of spondylolisthesis if the sliding is forward and of retrolisthesis when it is backward. In addition, there may be added rotational dislocation with sideways sliding and associated abnormal rotation. We can also mention neurodegenerative scoliosis which is found in certain pathologies in adults.
Scoliosis can lead to the appearance of clinical symptoms such as:
- Back or lumbar pain
- Pain in the lower limbs: Cruralgia, sciatica, neurogenic claudication, tingling.
- Aesthetic problem (psychological impact)
- Exceptionally, neurological disorders with motor and/or sensory deficit (compression of the spinal cord or nerve roots)
- Sagittal imbalance (loss of lumbar lordosis and increased kyphosis) with pain compensation mechanisms.
- Heart or respiratory problem in case of severe form of scoliosis
What are the additional examinations to be carried out in the context of scoliosis?
Radiological analyzes now widely available provide decisive information for positive and differential diagnosis: x-rays, standing with weight, provide static information and various radiological parameters. These important parameters are recognized as factors for evaluating the initial functional state and the impact of treatment.
For this type of analysis, the EOS type examination is a reference. It corresponds to an X-ray of the spine, from the front and in profile, whole body and makes it possible to specify the overall balance of the patients in the sagittal plane and the frontal plane. One of the important parameters for the evaluation of scoliosis is the Cobb angle. This angle plays a central role. This parameter makes it possible to determine the severity of the scoliosis and also makes it possible to ensure its follow-up. These data make it possible to have a precise follow-up of the patients in order to adjust the care according to the evolution. Associated with the functional parameters, they provide information on the structural state of the patient, allowing a more global assessment of the vertebral disease.
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