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55-412: The Adams Forward Bend Test is used in many situations to diagnose scoliosis ; however, it is not a primary source for a diagnosis. This test is often used at schools and doctors' offices to check for scoliosis. The patient bends forward, as if they are diving. If the patient has scoliosis, their back often has a prominent line where the spine is, and one side is higher than the other. A patient's back

110-471: A Cobb angle of more than 10° to the right or left as the examiner faces the person, i.e. in the coronal plane . Scoliosis has been described as a biomechanical deformity, the progression of which depends on asymmetric forces otherwise known as the Hueter–Volkmann Law . Scoliosis curves do not straighten out on their own. Many children have slight curves that do not need treatment. In these cases,

165-407: A neuromuscular disease . About 38% of variance in scoliosis risk is due to genetic factors, and 62% is due to the environment. The genetics are likely complex, however, given the inconsistent inheritance and discordance among monozygotic twins. The specific genes that contribute to development of scoliosis have not been conclusively identified. At least one gene, CHD7 , has been associated with

220-490: A life-threatening condition with negative effects on pulmonary function. Scoliosis that develops after 10 is referred to as adolescent idiopathic scoliosis . Screening adolescents without symptoms for scoliosis is of unclear benefit. Scoliosis is defined as a three-dimensional deviation in the axis of a person's spine . Most instances, including the Scoliosis Research Society, define scoliosis as

275-567: A person can cooperate, he or she is asked to bend forward as far as possible. This is known as the Adams forward bend test and is often performed on school students. If a prominence is noted, then scoliosis is a possibility and an X-ray may be done to confirm the diagnosis. As an alternative, a scoliometer may be used to diagnose the condition. When scoliosis is suspected, weight-bearing, full-spine AP/ coronal (front-back view) and lateral / sagittal (side view) X-rays are usually taken to assess

330-467: A ratio of 4:1. The term is from Ancient Greek σκολίωσις ( skolíōsis )  'a bending'. Symptoms associated with scoliosis can include: The signs of scoliosis can include: People who have reached skeletal maturity are less likely to have a worsening case. Some severe cases of scoliosis can lead to diminishing lung capacity, pressure exerted on the heart, and restricted physical activities. Longitudinal studies have revealed that

385-498: A result of working at their desks, and many were diagnosed with scoliosis. It was also considered to be caused by tuberculosis or poliomyelitis , diseases that were successfully managed using vaccines and antibiotics. The American orthopaedic surgeon Alfred Shands Jr. discovered that two percent of patients had non-disease related scoliosis, later termed idiopathic scoliosis , or the "cancer of orthopaedic surgery". These patients were treated with questionable remedies. A theory at

440-965: A scoliotic spine is usually impossible, but for the most part, significant corrections are achieved. The two main types of surgery are: One or both of these surgical procedures may be needed. The surgery may be done in one or two stages and, on average, takes four to eight hours. A new tethering procedure ( anterior vertebral body tethering ) may be appropriate for some patients. Spine surgery can be painful and may also be associated with post-surgical pain. Different approaches for pain management are used in surgery including epidural administration and systemic analgesia (also known as general analgesia). Epidural analgesia medication are often used surgically including combinations of local anesthetics and pain medications injected via an epidural injection. Evidence comparing different approaches for analgesia, side effects or benefits, and which approach results in greater pain relief and for how long after this type of surgery

495-411: Is agnogenic ( agno- , "unknown" + -gen , "cause" + -ic ). The word cryptogenic ( crypto- , "hidden" + -gen , "cause" + -ic ) has a sense that is synonymous with idiopathic and a sense that is contradistinguished from it. Some disease classifications prefer the use of the synonymous term cryptogenic disease as in cryptogenic stroke , and cryptogenic epilepsy . The use of cryptogenic

550-406: Is a condition in which a person's spine has an irregular curve in the coronal plane . The curve is usually S- or C-shaped over three dimensions. In some, the degree of curve is stable, while in others, it increases over time. Mild scoliosis does not typically cause problems, but more severe cases can affect breathing and movement. Pain is usually present in adults, and can worsen with age. As

605-432: Is a type of deformity that starts and progresses because of the collapse of the vertebral column in an asymmetrical manner. As bones start to become weaker and the ligaments and discs located in the spine become worn as a result of age-related changes, the spine begins to curve. People who initially present with scoliosis undergo a physical examination to determine whether the deformity has an underlying cause and to exclude

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660-409: Is about 10–20%. Congenital scoliosis can be attributed to a malformation of the spine during weeks three to six in utero due to a failure of formation, a failure of segmentation, or a combination of stimuli. Incomplete and abnormal segmentation results in an abnormally shaped vertebra, at times fused to a normal vertebra or unilaterally fused vertebrae, leading to the abnormal lateral curvature of

715-415: Is also sometimes reserved for cases where it is presumed that the cause is simple and will be found in the future. Some congenital conditions are idiopathic, and sometimes the word congenital is used synonymously with idiopathic ; but careful usage prefers to reserve the word congenital for conditions to which the literal sense of the word applies (that is, those whose pathophysiology has existed since

770-457: Is completely straight if they do not have scoliosis. The test, named after William Adams, was described in 1865. He discovered "the nature of the rotational element of scoliosis" after performing a postmortem on surgeon and geologist Gideon Mantell , who had suffered from spinal problems for years. This medical diagnostic article is a stub . You can help Misplaced Pages by expanding it . Scoliosis Scoliosis ( pl. : scolioses )

825-402: Is complex and is determined by the severity of the curvature and skeletal maturity , which together help predict the likelihood of progression. The conventional options for children and adolescents are: For adults, treatment usually focuses on relieving any pain: Treatment for idiopathic scoliosis also depends upon the severity of the curvature, the spine's potential for further growth, and

880-402: Is confirmed with X-rays . Scoliosis is typically classified as either structural in which the curve is fixed, or functional in which the underlying spine is normal. Left-right asymmetries , of the vertebrae and their musculature, especially in the thoracic region, may cause mechanical instability of the spinal column. Treatment depends on the degree of curve, location, and cause. The age of

935-424: Is custom-made from fiberglass or plastic. It is typically recommended to be worn 22–23 hours a day, and applies pressure on the curves in the spine. The effectiveness of the brace depends on not only brace design and orthotist skill, but also people's compliance and amount of wear per day. An alternative form of brace is a nighttime only brace, that is worn only at night whilst the child sleeps, and which overcorrects

990-480: Is indicated by the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) at 45–50° and by the Scoliosis Research Society (SRS) at a Cobb angle of 45°. SOSORT uses the 45–50° threshold as a result of the well-documented, plus or minus 5° measurement error that can occur while measuring Cobb angles. Surgeons who are specialized in spine surgery perform surgery for scoliosis. To completely straighten

1045-507: Is more often diagnosed in females than males. Scoliosis associated with known syndromes is often subclassified as "syndromic scoliosis". Scoliosis can be associated with amniotic band syndrome , Arnold–Chiari malformation , Charcot–Marie–Tooth disease , cerebral palsy, congenital diaphragmatic hernia , connective tissue disorders , muscular dystrophy, familial dysautonomia , CHARGE syndrome , Ehlers–Danlos syndrome (hyperflexibility, "floppy baby" syndrome, and other variants of

1100-408: Is most susceptible to genetic and environmental influences. Because female adolescents undergo growth spurts before postural musculoskeletal maturity, scoliosis is more prevalent among females. Although fewer cases are present since using Cobb angle analysis for diagnosis, scoliosis remains significant, appearing in otherwise healthy children. Despite the fact that scoliosis is a disfigurement of

1155-885: Is of low to moderate quality. A 50-year follow-up study published in the Journal of the American Medical Association (2003) asserted the lifelong physical health, including cardiopulmonary and neurological functions, and mental health of people with idiopathic scoliosis are comparable to those of the general population. Scoliosis that interferes with normal systemic functions is "exceptional" and "rare", and "untreated [scoliosis] people had similar death rates and were just as functional and likely to lead productive lives 50 years after diagnosis as people with normal spines." In an earlier University of Iowa follow-up study, 91% of people with idiopathic scoliosis displayed normal pulmonary function, and their life expectancy

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1210-469: Is warranted to look at the spinal cord. An average scoliosis patient has been in contact with around 50–300 mGy of radiation due to these radiographs during this time period. The standard method for assessing the curvature quantitatively is measuring the Cobb angle , which is the angle between two lines, drawn perpendicular to the upper endplate of the uppermost vertebra involved and the lower endplate of

1265-510: Is weak. Low quality evidence suggests scoliosis-specific exercises (SSE) may be more effective than electrostimulation. Evidence for the Schroth method is insufficient to support its use. Significant improvement in function, vertebral angles and trunk asymmetries have been recorded following the implementation of Schroth method in terms of conservative management of scoliosis. Some other forms of exercises interventions have been lately used in

1320-617: The MATN1 gene (encoding for matrilin 1, cartilage matrix protein). Fifty-three single nucleotide polymorphism markers in the DNA that are significantly associated with adolescent idiopathic scoliosis were identified through a genome-wide association study. Adolescent idiopathic scoliosis has no clear causal agent, and is generally believed to be multifactorial; leading to "progressive functional limitations" for individuals. Research suggests that Posterior Spinal Fusion (PSF) can be used to correct

1375-400: The neonatal period). The term syndrome without a name (SWAN) is used "when a child or young adult is believed to have a genetic condition and testing has failed to identify its genetic cause". It is believed that "about half (50%) of children with learning disabilities and approximately 60% of children with congenital disabilities (disabilities which are apparent from birth) do not have

1430-470: The body . Secondary scoliosis due to neuropathic and myopathic conditions can lead to a loss of muscular support for the spinal column so that the spinal column is pulled in abnormal directions. Some conditions which may cause secondary scoliosis include muscular dystrophy , spinal muscular atrophy , poliomyelitis , cerebral palsy , spinal cord trauma, and myotonia . Scoliosis often presents itself, or worsens, during an adolescent's growth spurt and

1485-430: The children grow up to lead normal body posture by itself, even though their small curves never go away. If the patient is still growing and has a larger curve, it is important to monitor the curve for change by periodic examination and standing x-rays as needed. The rise in spinal abnormalities require examination by a neurosurgeon to determine if active treatment is needed. The traditional medical management of scoliosis

1540-459: The clinical practice for therapeutic management of scoliosis such as global postural reeducation and the Klapp method. Bracing is normally done when the person has bone growth remaining and is, in general, implemented to hold the curve and prevent it from progressing to the point where surgery is recommended. In some cases with juveniles, bracing has reduced curves significantly, going from a 40° (of

1595-684: The condition progresses, it may alter a person's life, and hence can also be considered a disability . It can be compared to kyphosis and lordosis , other abnormal curvatures of the spine which are in the sagittal plane (front-back) rather than the coronal (left-right). The cause of most cases is unknown, but it is believed to involve a combination of genetic and environmental factors . Scoliosis most often occurs during growth spurts right before puberty. Risk factors include other affected family members. It can also occur due to another condition such as muscle spasms , cerebral palsy , Marfan syndrome , and tumors such as neurofibromatosis . Diagnosis

1650-502: The condition was discovered by the Greek physician Hippocrates , a cure has been sought. Treatments such as bracing and the insertion of rods into the spine were employed during the 1900s. In the mid-20th century, new treatments and improved screening methods have been developed to reduce the progression of scoliosis in patients and alleviate their associated pain. School children were during this period believed to develop poor posture as

1705-546: The condition), fragile X syndrome , Friedreich's ataxia , hemihypertrophy , Loeys–Dietz syndrome , Marfan syndrome , nail–patella syndrome , neurofibromatosis , osteogenesis imperfecta , Prader–Willi syndrome , proteus syndrome , spina bifida , spinal muscular atrophy, syringomyelia , and pectus carinatum . Another form of secondary scoliosis is degenerative scoliosis, also known as de novo scoliosis, which develops later in life secondary to degenerative (may or may not be associated with aging) changes. This

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1760-509: The condition, the cause may not be readily apparent or characterized. In these cases, the origin of the condition is said to be idiopathic . With some other medical conditions, the root cause for a large percentage of all cases has not been established—for example, focal segmental glomerulosclerosis or ankylosing spondylitis ; the majority of these cases are deemed idiopathic. Certain medical conditions, when idiopathic, notably some forms of epilepsy and stroke , are preferentially described by

1815-488: The curve, mentioned in length above) out of the brace to 18°. Braces are sometimes prescribed for adults to relieve pain related to scoliosis. Bracing involves fitting the person with a device that covers the torso; in some cases, it extends to the neck (example being the Milwaukee Brace). The most commonly used brace is a TLSO , such as a Boston brace , a corset -like appliance that fits from armpits to hips and

1870-758: The deformity. Whilst nighttime braces are more convenient for children and families, it is unknown if the effectiveness of the brace is as good as conventional braces. The UK government have funded a large clinical trial (called the BASIS study) to resolve this uncertainty. The BASIS study is ongoing throughout the UK in all of the leading UK children's hospitals that treat scoliosis, with families encouraged to take part. Indications for bracing: people who are still growing who present with Cobb angles less than 20° should be closely monitored. People who are still growing who present with Cobb angles of 20 to 29° should be braced according to

1925-404: The idiopathic form of scoliosis. Several candidate gene studies have found associations between idiopathic scoliosis and genes mediating bone formation, bone metabolism, and connective tissue structure. Several genome-wide studies have identified a number of loci as significantly linked to idiopathic scoliosis. In 2006, idiopathic scoliosis was linked with three microsatellite polymorphisms in

1980-399: The lowest vertebra involved. For people with two curves, Cobb angles are followed for both curves. In some people, lateral-bending X-rays are obtained to assess the flexibility of the curves or the primary and compensatory curves. Congenital and idiopathic scoliosis that develops before the age of 10 is referred to as early-onset scoliosis. Progressive idiopathic early-onset scoliosis can be

2035-402: The more severe deformities caused by adolescent idiopathic scoliosis. Such procedures can result in a return to physical activity in about 6 months, which is very promising, although minimal back pain is still to be expected in the most severe cases. The prevalence of scoliosis is 1–2% among adolescents, but the likelihood of progression among adolescents with a Cobb angle less than 20°

2090-504: The most common form of the condition, late-onset idiopathic scoliosis, causes little physical impairment other than back pain and cosmetic concerns, even when untreated, with mortality rates similar to the general population. Older beliefs that untreated idiopathic scoliosis necessarily progressed into severe (cardiopulmonary) disability by old age have been refuted. An estimated 65% of scoliosis cases are idiopathic (cause unknown), about 15% are congenital , and about 10% are secondary to

2145-546: The onset of menses in girls. Evidence supports that bracing prevents worsening of disease, but whether it changes quality of life, appearance, or back pain is unclear. Surgery is usually recommended by orthopedists for curves with a high likelihood of progression (i.e., greater than 45–50° of magnitude), curves that would be cosmetically unacceptable as an adult, curves in people with spina bifida and cerebral palsy that interfere with sitting and care, and curves that affect physiological functions such as breathing. Surgery

2200-417: The opposite end of the growth spectrum, a 29° Cobb angle and a Risser sign three or four might not need to be braced because the potential for progression is reduced. The Scoliosis Research Society's recommendations for bracing include curves progressing to larger than 25°, curves presenting between 30 and 45°, Risser sign 0, 1, or 2 (an X-ray measurement of a pelvic growth area), and less than six months from

2255-412: The patient is also important, since some treatments are ineffective in adults, who are no longer growing. Minor curves may simply be watched periodically. Treatments may include bracing , specific exercises, posture checking, and surgery. The brace must be fitted to the person and used daily until growing stops. Specific exercises, such as exercises that focus on the core, may be used to try to decrease

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2310-489: The percentage of cases designated as idiopathic decreases. The word essential is sometimes synonymous with idiopathic (as in essential hypertension , essential thrombocythemia , and essential tremor ) and the same is true of primary (as in primary biliary cholangitis , or primary amenorrhea ), with the latter term being used in such cases to contrast with secondary in the sense of "secondary to [i.e., caused by] some other condition." Another, less common synonym

2365-529: The person has not yet completed the adolescent growth spurt). Scoliosis affects 2–3% of the United States population, or about five to nine million cases. A scoliosis (spinal column curve) of 10° or less affects 1.5–3% of individuals. The age of onset is usually between 10 years and 15 years (but can occur younger) in children and adolescents, making up to 85% of those diagnosed. This is due to rapid growth spurts during puberty when spinal development

2420-482: The possibility of the underlying condition more serious than simple scoliosis. The person's gait is assessed , with an exam for signs of other abnormalities (e.g., spina bifida as evidenced by a dimple , hairy patch, lipoma , or hemangioma ). A thorough neurological examination is also performed, the skin for café au lait spots , indicative of neurofibromatosis , the feet for cavovarus deformity , abdominal reflexes and muscle tone for spasticity . When

2475-404: The prognosis of scoliosis depends on the likelihood of progression. The general rules of progression are larger curves carry a higher risk of progression than smaller curves, and thoracic and double primary curves carry a higher risk of progression than single lumbar or thoracolumbar curves. In addition, people not having yet reached skeletal maturity have a higher likelihood of progression (i.e., if

2530-459: The risk of progression by considering age, Cobb angle increase over a six-month period, Risser sign, and clinical presentation. People who are still growing who present with Cobb angles greater than 30° should be braced. However, these are guidelines and not every person will fit into this table. For example, a person who is still growing with a 17° Cobb angle and significant thoracic rotation or flatback could be considered for nighttime bracing. On

2585-466: The risk of worsening. They may be done alone or along with other treatments such as bracing. Evidence that chiropractic manipulation , dietary supplements, or exercises can prevent the condition from worsening is weak. However, exercise is still recommended due to its other health benefits. Scoliosis occurs in about 3% of people. It most commonly develops between the ages of ten and twenty. Females typically are more severely affected than males with

2640-478: The risk that the curvature will progress. Mild scoliosis (less than 30° deviation) and moderate scoliosis (30–45°) can typically be treated conservatively with bracing in conjunction with scoliosis-specific exercises. Severe curvatures that rapidly progress may require surgery with spinal rod placement and spinal fusion. In all cases, early intervention offers the best results. A specific type of physical therapy may be useful. Evidence to support its use, however,

2695-445: The scoliosis curves and the kyphosis and lordosis , as these can also be affected in individuals with scoliosis. Full-length standing spine X-rays are the standard method for evaluating the severity and progression of scoliosis, and whether it is congenital or idiopathic in nature. In growing individuals, serial radiographs are obtained at 3- to 12-month intervals to follow curve progression, and, in some instances, MRI investigation

2750-441: The spine, it has been shown to influence the pneumonic function, balance while standing and stride execution in children. The impact of carrying backpacks on these three side effects have been broadly researched. Incidence of idiopathic scoliosis (IS) stops after puberty when skeletal maturity is attained, however further curvature may occur during late adulthood due to vertebral osteoporosis and weakened musculature. Ever since

2805-431: The spine. Vertebrae of the spine, especially in the thoracic region, are, on average, asymmetric. The mid-axis of these vertebral bodies tends to point systematically to the right of the median body plane . A strong asymmetry of the vertebrae and their musculature, may lead to mechanical instability of the column, especially during phases of rapid growth. The asymmetry is thought to be caused by an embryological twist of

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2860-552: The synonymous term of cryptogenic . The term 'idiopathic' derives from Greek ἴδιος idios "one's own" and πάθος pathos "suffering", so idiopathy means approximately "a disease of its own kind". Diseases where the cause is seen as wholly or partly idiopathic include: Advances in medical science improve the understanding of causes of diseases and the classification of diseases; thus, regarding any particular condition or disease, as more root causes are discovered and as events that seemed spontaneous have their origins revealed,

2915-401: The time—now discredited—was that the condition needed to be detected early to halt its progression, and so some schools made screening for scoliosis mandatory. Measurements of shoulder height, leg length and spinal curvature were made, and the ability to bend forwards, along with body posture, was tested, but students were sometimes misdiagnosed because of their poor posture. An early treatment

2970-433: Was found to be 2% more than that of the general population. Later (2006–) studies corroborate these findings, adding that they are "reassuring for the adult patient who has adolescent onset idiopathic scoliosis in approximately the 50–70° range." These modern landmark studies supersede earlier studies (e.g. Mankin-Graham-Schauk 1964) that did implicate moderate idiopathic scoliosis in impaired pulmonary function. Generally,

3025-490: Was the Milwaukee brace , a rigid contraption of metal rods attached to a plastic or leather girdle, designed to straighten the spine. Because of the constant pressure applied to the spine, the brace was uncomfortable. It caused jaw and muscle pain, skin irritation, as well as low self-esteem. Idiopathic For some medical conditions, one or more causes are somewhat understood, but in a certain percentage of people with

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