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createdon: 03 Feb 2023
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Author: Khoa Tran
Published Feb 03, 2023
Updated Jun 05, 2023

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Scoliosis

Etymology and Pronunciation

Scoliosis (skoh-lee-OH-sis)
skolios - Greek for "crooked" or "bent"

History of Scoliosis

The word "scoliosis" comes from the Greek word "skolios" which means "crooked". The condition was first described by the ancient Greek physician Hippocrates, who observed that some people had spines that were curved to the side. He believed that scoliosis was caused by an imbalance in the body's four humors, which was a common medical theory at the time.

In the 16th century, the Italian anatomist and physician Giovanni Battista Morgagni conducted extensive research on scoliosis and contributed greatly to our understanding of the condition. He observed that scoliosis could be caused by a variety of factors, including congenital abnormalities, trauma, and infections.

In the 19th century, the German orthopedist Philipp Bozzini developed the first instrument for examining the inside of the human body, which allowed physicians to see the spine and diagnose scoliosis more accurately. He is credited with developing the first instrument for examining the inside of the human body, which he called the "lichtleiter" or "light conductor". Bozzini's instrument consisted of a long, narrow tube with a mirror at one end and a light source at the other. The mirror reflected the light onto the area being examined, allowing the physician to see inside the body without making an incision. To use the instrument to measure scoliosis, the physician would insert the tube into the patient's mouth and down the throat. The light source at the end of the tube would illuminate the patient's spine, and the physician could use the mirror to examine the curvature of the spine. Today we use a scoliometer: a plastic ruler that is utilized to take readings at different points along the spine to measure the angle of trunk rotation. It comes equipped with a small metal ball that reads the degrees of rotation on a dial.

In 1865, the French physician Ambroise Paré developed a brace to correct spinal curvature, which was the first effective treatment for scoliosis. The brace was made of leather and was designed to be worn around the torso, with metal rods that could be adjusted to apply pressure to the spine. The brace was intended to correct spinal curvature by applying force to the spine in the opposite direction of the curve. However, because the brace was made of leather, it was not very effective at controlling the curvature of the spine, and it was uncomfortable for patients to wear.

In the 1930s, the American orthopedist Paul Randall Harrington developed a brace that could be worn by scoliosis patients to correct spinal curvature. It was made of metal and was designed to fit snugly around the torso. The brace was designed to apply pressure to the spine at specific points, using metal rods and pads that were customized for each patient. Unlike Paré's brace, Harrington's brace was very effective at controlling the curvature of the spine and could be worn for long periods of time without causing discomfort. Harrington's brace revolutionized the treatment of scoliosis and remained the standard of care for many years. However, it was eventually replaced by newer, more advanced braces that were more comfortable and easier to wear.

In the 1950s, the French physician Robert Cotrel and the American orthopedist John Moe independently developed a surgical procedure called spinal fusion, which is still used today to treat severe cases of scoliosis.

Modern Understanding of Scoliosis

Scoliosis is a condition in which the spine develops a side-to-side curve, causing it to look more like an "S" or a "C" shape instead of a straight line. The spinal curvature can be to the side (lateral), to the front (anterior), or a combination of both. This spinal deformity can affect people of any age, from infants to adults, and can have various causes.

One type of scoliosis is idiopathic scoliosis, which means the cause is unknown and is the most common type of scoliosis. Adolescent idiopathic scoliosis specifically affects children during puberty. Congenital scoliosis is a type that is present at birth due to a spinal abnormality that occurs during development in the womb. Neuromuscular scoliosis is caused by conditions that affect the muscles and nerves, such as cerebral palsy or muscular dystrophy. Degenerative scoliosis is caused by the aging process and the gradual wear and tear of the spine. Kyphoscoliosis involves both a spinal curve and a hunching of the upper back.

Symptoms of scoliosis can include uneven shoulder heights, one hip appearing higher than the other, and a noticeable curve in the spine when viewed from the back. The condition can also cause back pain, difficulty breathing, posture issues, spinal rotation, and an increased risk of future back problems, although these symptoms are not always present.

The severity of the curvature is measured by the Cobb angle, which is determined by x-rays. Early detection of scoliosis is important and can be done through scoliosis screening. 

Scoliosis can be screened non-invasively using using a scoliometer: a plastic ruler (with a rounded notch at the bottom) that is put on the spine to measure the angle of its curve. The instrument has a level bubble (a metal ball that falls directly downwards on the curve of the ruler) and a rotatable dial that displays the degree of rotation or twist in the spine. There are mobile apps that allow people do this at home on their phones - but always confirm with a professional before self-diagnosing.

Further diagnostics to confirm scoliosis can be done using an x-ray.

It is recommended to screen for scoliosis during a child's developmental period of 9-16.

In mild cases, scoliosis may not require any treatment, but in more severe cases, treatment may include bracing, physical therapy, or surgery. The goal of treatment is to prevent the curve from getting worse and to alleviate any pain or discomfort that may be present.

Causes of Scoliosis

- Congenital scoliosis - this is when the spine doesn't develop properly in the womb, leading to a curvature at birth.
- Neuromuscular scoliosis - this type of scoliosis is caused by neuromuscular disorders such as cerebral palsy, muscular dystrophy, or spina bifida, which affect the muscles and nerves that control the spine.
- Idiopathic scoliosis - this is the most common type of scoliosis and occurs when there is no known cause for the curvature of the spine. It can develop during childhood or adolescence, and may run in families.

Non-structural scoliosis, also known as functional scoliosis, is caused by factors outside of the spine, such as:

- Poor posture - this can result in muscle imbalances and uneven pressure on the spine.
- Leg length discrepancy - when one leg is shorter than the other, it can cause the pelvis to tilt and the spine to curve.
- Injuries or conditions that affect the spine - such as infections, tumors, or fractures.

Treatments for Scoliosis

There are various treatments available for scoliosis, ranging from non-invasive to surgical options. Brace treatment is a non-invasive option that involves wearing a brace to help slow or stop the progression of the curvature. Physical therapy, chiropractic care, exercise, stretching, and strengthening can also help manage scoliosis symptoms.

Surgical options for scoliosis include spinal fusion, rod instrumentation, pedicle screw fixation, vertebral body tethering, posterior spinal fusion, anterior spinal fusion, hybrid spinal fusion, and spinal decompression. Scoliosis-specific exercises, such as swimming, yoga, Pilates, can also help improve the symptoms. Cold therapy, heat therapy, massage therapy, acupuncture, and pain management can also be used to manage symptoms.

It is important for people with scoliosis to have a well-rounded treatment plan that includes physical therapy, exercise, and pain management, as well as support from family, friends, and scoliosis support groups. It is also important to have regular check-ups with a doctor to monitor the progression of the curvature and adjust the treatment plan as needed.

Lifestyle Changes

- Regular exercise: Engaging in regular physical activity can help improve strength, flexibility, and posture. Low-impact exercises such as swimming, walking, yoga, and Pilates are often recommended for individuals with scoliosis. Strengthening the core muscles and the muscles surrounding the spine can help provide better support for the spine and alleviate discomfort.
- Posture awareness: Maintaining good posture throughout the day can help reduce the strain on the spine. It's important to be conscious of your posture when sitting, standing, and engaging in activities. Sit up straight, avoid slouching, and use ergonomic chairs or cushions that provide support to the lower back.
- Avoiding heavy lifting: Individuals with scoliosis should avoid heavy lifting or carrying loads that can strain the back. If lifting is necessary, it's important to use proper lifting techniques such as bending the knees and using the leg muscles instead of the back.
- Sleep position: Choosing the right sleep position can help alleviate discomfort. Sleeping on the side with a pillow between the knees or using a supportive mattress and pillow can help maintain proper spinal alignment during sleep.
- Nutrition and weight management: A balanced diet rich in essential nutrients can support overall bone health. Adequate intake of calcium, vitamin D, and other minerals is important for maintaining strong bones. Additionally, maintaining a healthy weight can help reduce stress on the spine.
- Stress management: Chronic pain and the emotional impact of scoliosis can lead to increased stress. Engaging in stress management techniques such as meditation, deep breathing exercises, or seeking support from a counselor or support group can help cope with the emotional and psychological challenges associated with scoliosis.

Symptoms

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Uneven shoulders
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Rib hump
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Uneven waist
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Back pain
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Fatigue
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Shortness of breath
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Limited mobility

Confirmation Tests

- Scoliometer
- X-rays

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