Safe Scoliosis Management and Treatment Approach

Scoliosis Management and Treatment Approach. Scoliosis is simply the abnormal side to side curvature of the spine. It is also known as a deviation from the normal vertical spine. We need to know about the normal vertebral curvature of the spine in order to rule out scoliosis. Back Pain is one of the causes due to it. so, how to relieve the back pain can be one of the approaches in the scoliosis management and treatment approach principle. You may need to seek for the back pain management doctors and follow scoliosis management guidelines. Before that let’s know about it.

 NORMAL VERTEBRAL CURVATURE:

• Primary curves are the natural curves in the spine that we are born with i.e. thoracic and pelvic curves.
• Compensatory curves aka secondary curves develop after birth in response to learned motor skills i.e. cervical and lumbar.

ETIOLOGY:

• Non- Structural Scoliosis:
  • It is a pure coronal plane deformity with no rotational component. It is due to :
  • – Pelvic tilt saw secondary to leg length inequality
  • – Pain or irritation (seen with disc prolapse, muscle spasm, osteoma, etc.)
  •   It is reversible and can straighten when the cause is removed.
• Structural Scoliosis :
  • It is irreversible and can be due to :

• • • – Idiopathic
    • – Congenital
    • – Neuromuscular
    • – Trauma, tumor, and infection

IDIOPATHIC SCOLIOSIS:

• 80% of all scoliosis is idiopathic scoliosis with no identifiable cause. There is > 10 curve
•  Three different groups of idiopathic scoliosis are there
  • Infantile (0-3 years old),
  • Juvenile (4-9 years old)  and
  • Adolescent (10 years to maturity)

•  Simpler division
  • – Early-onset (before puberty)
  • – Late-onset (after puberty)

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NEUROPATHIC AND MYOPATHIC SCOLIOSIS:

• It is the deformity of the spine which is often severe in patients with neuromuscular scoliosis
•  The greatest problem here is the loss of balance and stability and also difficulty in sitting
•  X-ray with traction  shows extend to which the deformity is correctable
•  Some of the diseases leading to this type of scoliosis are :
  • – Cystic Fibrosis
  • – Various types of muscular dystrophy
  • – Cerebral Palsy, etc.

CONGENITAL SCOLIOSIS:

• Present at birth
•  Usually is due to a deformity in 1 or more vertebrae
•  Associated with other congenital abnormalities

If there is a defect in the segmentation then: It blocks vertebra as Unilateral bar

•  If there is a defect in the formation then: it could be: Hemi vertebra or Wedge vertebra

POSTURAL SCOLIOSIS:

• The deformity is secondary or compensatory to some condition outside the spine(nonstructural/compensatory). There will be following features
  • – Short leg
  • – Pelvic tilt (due to contracture of the hip)
  •  Local muscle spasm occurs associated with PID (sciatic scoliosis)

Usually temporary and disappears if underlying causes is treated

• •  Sit/bend forward

CURVE PROGRESSION:

If  the spinal curve seems to be progressing and it is termed as the curve of progression and classified as follows:

•   < 3O : Will not progress after skeletal maturity
•   30-50 : Progress 10 to 15 in lifetime
•   > 50  : Progress about 1  degredd per year
•   > 90  : Affect cardiopulmonary function

CLINICAL FEATURES OF SCOLIOSIS:

• Obvious skewed back
•  Rib hump in thoracic curve
•  Asymmetry prominence of 1 hip (thoracolumbar curves)
•  Skin pigmentation
•  Look for congenital abnormalities
•  Scapula level unbalanced i.e, one shoulder blade higher than the other.
•  Breast and Shoulder level unequal
•  Lower limb length
•  Cardiopulmonary function ( difficult in breathing )

SCREENING FOR SCOLIOSIS:

• Adam’s test ( bend forward)

Purpose: – Detecting structural or functional scoliosis we need to do a Screening test for scoliosis.

Techniques:

• – Better to check for limb leg discrepancy before this test.
• – The spine needs to be visible.
• – Patient is asked to bend forward at the waist until the back comes on the horizontal plane with feet together, arms hanging and knees extended.

The examiner:

•  Have looks from behind, along the horizontal plane of the column vertebrae.
•  Check for the signs of scoliosis as spinal asymmetry, unleveled shoulders, scapula asymmetry unleveled hips, ribs humps.

Scoliometer

This device measures the angle of trunk rotation and rotation deformity or rib humps.

• 98% of the curves > 20 have ATR of at least 5
• – Fairly high false positive
• – High sensitivity and low specificity

Scoliosis Management and Treatment Approaches

Scoliosis Management is one of the major challenging tasks for doctors or physiotherapists or clinical persons. Scoliosis treatment can be a non-operative and operative approach. scoliosis management guidelines for the doctors or physiotherapists can have proper scoliosis treatment.

NON OPERATIVE TREATMENT APPROACH:

Non Operative scoliosis management and treatment approaches can be initiate by brace treatment if the spine Curves are 25 Degree to 45 Degree. This is an Only effective non-surgical treatment for scoliosis management and treatment. Besides back pain management, back pain management injections are also considered as a non-opertive treatment.

The most common braces used are  Milwaukee, Boston, Charleston, Miami braces. The Effectiveness of brace directly related to brace wear. During the non-operative treatment with braces, there can be  PROBLEMS WITH BRACES as following.

• Argued efficacy
•  Narrow treatment window to initiate
•  Poor compliance
•  Must have good orthotist guide and followups

OPERATIVE scoliosis TREATMENT APPROACH:

Back surgery for scoliosis is also performed when the conservative scoliosis treatment fails. The main aim of surgery for scoliosis can be done according to scoliosis management guidelines. One of the main reasons to choose for it could be lower back pain management for patient compliance too. As per scoliosis management guidelines following major things are considered as a guideline for doing surgery for scoliosis.

• Curves >45 to 50D
•  Surgical correction.
•  High incidence of continued progression after skeletal maturity.
•  Severe curve causes decrease pulmonary function.
•  worse if associated with kyphosis

COMPLICATIONS OF SCOLIOSIS SURGERY ARE :

• Neurological compromise
•  Spinal decompensation
•  Pseudoarthrosis
•  Implant Failure

 POSTOPERATIVE TREATMENT MEASURE

• Pain Management

1. Spinal Opioids or back pain management injections
2. Epidural Opioids
3. Double Epidural Techniques

• Ventilatory Support

1. Post-operative ventilation
2. Restrictive Pattern
3. Low Tidal Volume
4. Increase respiratory rate

PHYSIOTHERAPY for scoliosis management and treatment 

Phyiosi therapy management is also important part in this management. Correction spinal curvature is a major aspect that can be done by lower back exercise, chiropractic scoliosis treatment, manual therapy are some of the physiotherapy management for scoliosis management. The aim of physiotherapy treatment should be following

• – Auto-correction 3D
• –  Coordination
• – Equilibrium
• – Ergonomy
• -Muscular endurance or strength
• – Neuromotor control of the spine
• -Increase of ROM
• -Respiratory capacity or education
• -Sideshift

MANAGEMENT OF NON-STRUCTURAL SCOLIOSIS:

• Pilates
•  Upper rolling
•  Child position

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REFERENCES:

• Scoliosis : review of diagnosis and treatment, J.A Janicki , and B.Alman, pediatric child health.2007 november;12(9)..771-776
• Spinal curves and scoliosis,S.Anderson ,September/ October 2007,vol.79/no.1 RADIOLOGIC TECHNOLOGY
• Apley’s Orthopedics textbook,2010
• Scoliosis: diagnosis and treatment, James M.Eule,MD

Author :Diva KC, Physiotherapist