Scoliosis - congenital and idiopathic
Scoliosis is derived from the greek word for ‘crooked’ and is defined as a lateral deviation of the normal vertical line of the spine with associated rotation of the vertebrae. It is a 3D deformity that occurs in sagittal, frontal and coronal planes.
Idiopathic scoliosis can be categorised based on the age of the patient:
- Infantile scoliosis - aged 0-3
- Juvenile idiopathic scoliosis - aged 4-10
- Adolescent idiopathic scoliosis - aged 10-skeletal maturity
Scoliosis can also be divided based on cause, including:
- Idiopathic
- Congenital (failure in vertebrae formation or segmentation)
Division can be based on changes to the vertebrae:
- Non-structural (postural) scoliosis where curves are due to another issue such as limb inequality
- Structural curves due to rotation and sometimes wedging of the vertebrae
Or finally, based on associated conditions:
- Scoliosis caused by neuromuscular conditions
- Scoliosis caused by associated syndromes
- Scoliosis caused by generalised diseases (e.g. neurofibromatosis, Marfans)
Idiopathic scoliosis
Of the three types of idiopathic scoliosis, the most common type is adolescent which develops during the adolescent growth spurt and is commoner in girls than boys. The most common consequence is alteration to the thoracic curves, which become convex to the right. Most forms pass unnoticed, while about 10% will lead to obvious chest asymmetry. In the most severe cases that generate unchecked there can be a deformation of the back creating a hunch (it is thought that the hunchback of notre dame had a neurofibromatosis due to his facial deformity and back deformity).
The clinical features are five:
- Spine is curved, best seen by asking the patient to bend forward and inspect the contour of the spine from behind. Structural curve sin the spine will be exaggerated and postural curves reduced
- The shoulders are not level
- Waist is asymmetrical
- There is asymmetry of the chest or loin on forward bending
- There may be features of an underlying disorder (e.g. cafe-au-lait patches in neurofibromatosis or hairy patches in spina bifida
The patient themselves may suffer from back pain or indeed observe their own deformity when presenting to the doctor.
Most cases of idiopathic scoliosis will not require treatment (where less than 25 degrees, leave alone), however patients should be reviewed to ensure that the deformity does not progress beyond acceptable limits. Where treatment is indicated, there are three main forms:
- Corrective casts that may stop infantile idiopathic curves progressing if applied early