The scoliosis is defined as a dimensional deviation of vertebral column with rotation on its axis.
To understand this process well, it is necessary to know that the spine has normal curvatures, which guarantee stability to the body, and are called lordosis and kyphosis . But there are some types of curvatures that are considered incorrect deviations and can cause pain. Among them, scoliosis.
Regarding the shape, the curve can have a “C” shape, being called a simple curve, as there is only an accentuation of the deviation.
In the double curve, the spine has an “S” shaped scoliosis. In this case, there is a primary and a secondary curve that occurs through postural compensation mechanisms.
The types of scoliosis are quite diverse. It needs to be classified according to its origin or triggering agent, because regardless of the location or degree of deviation, the condition can be divided into structural and functional:
In non-structural or functional scoliosis, the spine has a correct structure and does not present excessive curvatures, but there are factors that cause the misalignment of the vertebral segment.
In general, there is a disturbance or dysfunction in other regions of the body and, in order to adjust or compensate for this alteration, the spine ends up being deflected.
It is important to differentiate and characterize functional scoliosis, as it is a manifestation secondary to a dysfunction in another part of the organism, the curvature tends to be softened or resolved by treating the causative problem.
Some bodily dysfunctions that can cause scoliosis are:
- Difference in the growth of the leg bone;
- Muscle spasms;
- Difference in the tone of the paravertebral muscles;
- Nerve root compression;
- Spine injuries;
- Malpositioning of the trunk.
About 80% of cases of structural scoliosis are idiopathic , that is, the diagnosis fails to identify what caused the spinal deviation. Structural scoliosis is generally a serious and progressive condition, which tends to increasingly compromise the patient’s quality of life if left untreated.
While the functional type usually manifests only a lateral curvature of the column, the structural type presents, in addition to the deviation to the sides, a rotation (torsion) of the column on its own axis.
The most current definitions of the condition point out that it is not enough to define structural scoliosis as a vertebral gap, as this does not account for the complexity of the diagnosis.
It is, therefore, necessary to consider it as a deformity in the 3 planes of the body – frontal, sagittal and transversal -, generally progressive and with severe impairment of posture.
In addition, structural scoliosis has protrusions or prominences, due to vertebral rotation, which are called gibosities or gibas.
Within the structural type, it is possible to subclass the deviation in:
The idiopathic nomination indicates that it is not possible to determine the origin or the cause of the spinal deviation, and some researchers and specialists attribute multiple causes associated with the condition.
It is estimated that up to 80% of patients have idiopathic structural scoliosis, and the condition can appear in healthy children and adolescents, who are developing well and have no history of pathologies or malformations.
The idiopathic columnar deviation can be divided according to the age group that the patient presents the signs:
- Infant – from birth to 2 years of age: it is a rare condition and the most estimated factors are the birth position and the position that the baby, after delivery, maintains when sleeping. In this phase, mild scoliosis affects more boys and tends to resolve itself with simple measures, such as stretching;
- Juvenile – from 3 to 9 years old;
- Adolescent – from 10 to 18 years of age: minor curvatures (mild scoliosis) occur in similar proportions between girls and boys, but the most pronounced deviations affect 4 female patients for every 1 male;
- Adult – after 18 years of age: occurs after the complete formation of bones. Some studies classify the type as Adult Idiopathic Scoliosis (EIA).
However, currently some researchers and specialists use another subclassification for idiopathic scoliosis, dividing it into:
- Early – up to 5 years of age: the condition has a greater impact on the formation of the heart and lungs, which can cause problems in adulthood;
- Late – after 5 years: despite compromising quality of life, the condition that occurs after 5 years tends not to have a severe impact on the patient’s cardiac and respiratory health, as the organs are already almost or completely formed.
There are patients who are more susceptible to spine bending, especially during puberty, due to body growth (called a stretch).
During this period of adolescence, the body tends to show rapid growth, which can accentuate the undue curvature of the vertebral structure, but, even so, there are not always symptoms (such as pain or noticeable deviation).
Several diseases or disorders that affect the central nervous system, nerves and muscles can be the cause of scoliosis, in this case called neuromuscular scoliosis.
Generally, neuromuscular scoliosis has a long “C” shaped curve.
Congenital scoliosis is caused by malformation of the vertebral structure during pregnancy or in newborns. Changes in the constitution of the cartilage of the vertebrae or in the fusion of the ribs may occur. On average, it represents up to 10% of diagnoses.
Some professionals also consider that congenital neuromuscular disorders (that is, when the child is born with the disorder) can be classified in this scoliosis subtype.
They occur due to injuries, fractures, accidents or surgeries improperly performed or recovered.
A study published in the medical journal Revista Portuguesa de Ortopedia e Traumatologia, in 2013, points out that adult scoliosis affects up to 64% of the elderly and causes moderate or severe restrictions on the lives of patients.
Scoliosis diagnosed in adulthood is characterized by marked deviations in the vertebral segment after the total formation (maturation) of the bones. It can also be subdivided into Adult Idiopathic Scoliosis (EIA) and Degenerative Adult Scoliosis (EAD).
While the idiopathic type occurs due to an undiagnosed or untreated scoliosis progression during childhood, without any identifiable causes, the degenerative type is caused by some disease or condition that compromises bone integrity.
In this second type, some factors such as osteoporosis , fractures in spinal compression or degeneration of spinal structures (such as intervertebral discs) may be the cause of scoliosis.
However, the study points out that it is only possible to distinguish the two types of adult scoliosis if there are medical examinations or opinions carried out during childhood or adolescence that attest to the presence or absence of the curvature. That is, it is difficult to make this distinction and the conditions are classified only as degenerative scoliosis.
When the patient suffers an injury or has diseases that cause para or quadriplegia (total loss of movement), due to changes in the spinal cord, a curvature in the vertebral segment may develop, called paralytic scoliosis.
The scoliosis triggered by the impairment of the axial musculature (which supports the body) may be due to infantile paralysis or polio, for example.
Degenerative lumbar scoliosis
Age, traumas or diseases that compromise the body’s structures, whether bones or discs, can favor the degeneration of the spine and cause marked and irregular wear in the lower back.
Where can scoliosis occur?
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Deviations in curvature can be:
- Cervicothoracic : affects the upper (cervical) parts, going from vertebrae C-1 to C-7, and the middle (thoracic), going from T-1 to T-12;
- Thoracic : affects the middle part of the spine (thoracic), between vertebrae T-1 and T-12;
- Thoracolumbar : affects the regions of the thoracic spine (middle), between T-1 and T-12, and the lumbar spine (lower part), between L-1 and L-5;
- Lumbar : affects the lumbar region, between L-1 and L-5;
- Lumbosacral : affects the regions between the lower back, L-1 and L-5, and the sacrum (final part), S-1 to S-5.
What are the degrees of curvature?
The degree of curvature can be classified into 5 levels:
- 0 to 10 degrees : there is no need for physical therapy;
- 10 to 20 degrees : there is a need for physical therapy treatment;
- 20 to 30 degrees : physiotherapy treatment and use of orthopedic vest;
- 30 to 40 degrees : wearing an orthopedic vest or Milwakee;
- 40 to 50 degrees : only surgical treatment.