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Learning to deal with Scoliosis

Many factors implicate connective tissue disease, diet, enzymes, muscular imbalance, hormones and genes (this makes up for 30% of cases).

The most common form, Adolescent Idiopathic Scoliosis (AIS), generally occurs during the growth spurt of 10 to 16 years of age (onset of puberty), predominantly affecting females, with a ratio of 9:1 over males.

A simple screening test, called the Adams Forward Bend Test, is usually able to detect potential problems. In the test, patients are asked to bend forward 90° from the waist, with their feet together, while the doctor looks for asymmetry of the trunk or abnormal curvature of the spine.

Cardiopulmonary Complications
Severe thoracic curvatures restrict rib cage movement and lung volume, ultimately producing pulmonary hypertension followed by congestive heart failure. Congestive heart failure is the single most common direct cause of death in people with scoliosis. They are also prone to lung infections and breathing difficulties. Dr Ting: Adolescent idiopathic Scoliosis occurs during the growth spurt of 10 to 16 years.

Osteoarthritis of spinal joints
Osteoarthritis is a form of arthritis where the joints degenerate – loss of disc height, osteophytes (bony outgrowths otherwise known as protuberances or spurs), and segmental instability frequently accompany adult scoliosis.

Degeneration is most pronounced on the concave side of the curve, imposing stress on the ribs, pelvis and hip joints. Secondary spinal pain from thoracic scoliosis most often affects the lower back region. This often leads to nerve compression syndromes.

Curvature Progression
Scoliosis is most rapid and severe during the adolescent growth spurt (age 12 – 16 years), where the curve may increase at a rate of 1° per month. In adults, where skeletal maturity has peaked, the progression of curve is minimal, ranging 10 – 15 degrees for the remainder of adult life.

Fatigue and Joint Dysfunction Syndromes
Biomechanical changes frequently produce asymmetric muscle and joint stress loadings. Muscular and ligamentous (relating to the form or structure of ligaments) strains on spinal and pelvic joints give rise to inflammation and these do not retain their normal positions.The following were frequently found to be quite debilitating for people with Scoliosis:

  • Radiation exposure
    Considerable concern about the long-term effects of repeated exposure to radiation has been raised quite often
  • Patients undergoing bracing with conservative therapy over a three- year period are subjected to a minimum average of 22 X-rays.
  • But the chances of increased risk of malignancy in Scoliosis patients appear to be minimal in comparison with other natural incidence in the general population.
  • Pregnancy
    The implication for pregnancy in the presence of Scoliosis is not conclusive. In general, obstetrical difficulties may be associated with severe lumbar curves, while severe thoracic curves may lead to other medical problems.
  • Though a higher incidence of premature delivery has been recorded, Caesarean rates do not appear to have increased.

Treatment
Non-surgical. Bracing is generally prescribed for curves that are flexible, immature, and between 20° to 40°.

The most common is the Milwaukee brace, used to prevent further progression.

A brace is normally worn for 23-hours until skeletal maturity. Patients fitted with braces experience a good deal of mental stress.

In long-term bracing, superficial skin irritations may persist, either due to sweating or allergies or friction between skin and brace – pressure sores may also occur.

Occasionally, nerve compression may occur with numbness and paraesthesia (abnormal sensation of prickling or tingling), especially of the nerves running down the legs.

Vomiting, nausea, loss of appetite can occur as a result of compression around the abdominal region.

Surgical
Common procedures include insertion of Harrington rods and the Dwyer procedure of wire cable and screws.

Surgery carries some risks, where there is a 50% chance that complications may arise.

During the operation, cardiac arrest and spinal cord injury are the most feared complications.

Early postoperative problems include respiratory distress, infection, and loosening of the fixation device.

The most frequent complication is pseudoarthrosis (false joint) amounting to 15% of cases, and instrument failure.

Chiropractic Biophysics (CBP)
It is a relatively new technique (20 years), specialising in curvature and posture correction, based on biomechanical logic of mirror imaging and over correction of incorrect posture.

Analyses of X-rays determine the type of exercises prescribed to correct, with physiological therapy equipment used for muscular and ligamentous hypertonicity, and CBP spinal correction treatment.

Correction may take between six months to two years, depending on the severity of curve. X-rays after six months of treatments, using Cobb's Method*, reveal an average reduction of 10° – 15°.

The Cobb Method is used to measure the amount of curvature in the spine, and is discussed in terms of degrees. Curves measuring 25°-30° are considered to be significant, while severe curves are in the region of 45°-50°.