Thursday, June 7, 2012

Introduction to Scoliosis, Part 1

This blog will be part 1 of a 2 part series on the condition of scoliosis.  In part 1, we will discuss what scoliosis is, what the signs of scoliosis are, and how scoliosis impacts more than just the spine.  In part 2, which will be at a later date, we will discuss strategies commonly used to treat patients with scoliosis.
What is Scoliosis?
Scoliosis is a condition of the spine in which the spine is curved abnormally.  You may remember from your childhood being checked by the school nurse for scoliosis every year-this is because scoliosis is a very common condition, affecting approximately 7 million people in the United States.  This blog will discuss the anatomy of the spine, the different types of scoliosis, and how scoliosis can negatively impact a child’s development.
The spine, also known in the medical world as the vertebral column, is the set of bones that runs from the base of your skull down to the bottom of your pelvis.  It is made up 24 individual bones called vertebrae and 9 vertebrae that are fused together to form the sacrum and the coccyx.  Each of the vertebrae are separated from each other by a small jelly-filled sac called a disk.  The spine is divided into 4 sections, named for the areas where they are located.  The cervical region of the spine includes the first 7 vertebrae and forms the section of the spine that runs from the base of your skull to the base of your neck.  The thoracic region of the spine includes the 12 vertebrae that run from the bottom of your neck, down your upper back to the base of your ribs.  The thoracic vertebrae are actually the bones that your ribs attach to.  The lumbar region of the spine is what we often refer to as the low back.  It includes 5 vertebrae that run from just underneath your ribs to the top of your pelvis.  The final 9 vertebrae are divided into 2 sections.  The first 5 vertebrae are fused together and form the sacrum, which is the back wall of your pelvis.  The final 4 vertebrae are fused together and form the coccyx, which is commonly called the tailbone. 
Each section of the spine has some degree of curvature to it that is considered normal.  However, normal curves of the spine are in an anterior-posterior plane, meaning that they run front to back or vice versa.  Curves that are associated with scoliosis are in a lateral plane, meaning that the spine curves either to the right or the left and this is not considered normal.  They are usually referred to as a C curve or and S curve depending on the areas of the spine that are involved and the shape of the curve.
There are 3 types of scoliosis.  Congenital scoliosis is caused when one or more of the vertebrae are formed incorrectly when a fetus is developing and is present at birth.  Idiopathic scoliosis is caused by unknown factors and can develop at any age.  Neuromuscular scoliosis is caused as a result of a muscle imbalance and is usually associated with other medical conditions, such as spina bifida, cerebral palsy, Down Syndrome, etc. 
Neuromuscular scoliosis is the most common type of scoliosis that we see at our facilities.  Many neurological conditions such as spina bifida, cerebral palsy, and Down Syndrome impact a patient’s muscle tone.  They may have too much tone in their muscles (hypertonia) or too little tone in their muscles (hypotonia).  For patients with hypertonia, their muscles often pull too hard on their spine, causing it to bend abnormally.  For patients with hypotonia, their muscles don’t pull hard enough to combat the force of the muscles on the opposite side and/or the force of gravity, causing it to bend abnormally.  Some patients have hypertonia in one area and hypotonia in another, causing bending in multiple locations of the spine. 
So how can you tell if your child might have scoliosis or might be developing scoliosis?  There are several signs to look for that might indicate that your child has or is developing scoliosis.  The first and most prominent sign to look for is to look for a curve in the spine when the child is standing up straight, sitting, or lying on their stomach.  It may be C shaped, or it may be S shaped.  You may notice things like one shoulder may be higher/lower than the other, one hip may be higher/lower than the other, one shoulder blade may be more prominent than the other, etc.  See below.

Another sign to look for is called a rib hump.  When your child bends over in standing, if one side of the rib cage stands higher off the back then the other, this is considered a rib hump and may indicate scoliosis.  See below.   

Why should I be concerned if my child has scoliosis?
Scoliosis doesn’t just affect the bones and muscles of the spine.  Scoliosis, if left untreated, can impact many other organs and body functions including vision, feeding and digestion, breathing, and bladder/ bowel function. 
·         Vision- your brain automatically tries to keep your eyes and head in an upright position no matter which way your body goes.  However, if your body is always curved to one side, your head and eyes will always be fighting to stay upright, which can put a lot of strain on neck muscles and eyes.  If it’s too much work for your muscles to keep your head and eyes upright, your head will follow the curve of your body.  Therefore, your eyes will see everything from an unnatural angle, rather then upright. 
·         Feeding-in order for a child to swallow properly, they must have good positioning of the head and neck.  Trying to eat or drink when the head and neck are not in the proper position can lead to choking and potentially aspiration of food particles into the lungs, which can cause infection and even death. 
·         Breathing, digestion, and bowel/bladder function-the spine and the ribs form a protective cage around all of our internal organs that are responsible for breathing, digestion, and bowel/bladder function.  If a child’s spine is curved and the curve is not corrected, the space inside the protective cage is decreased, “squishing” the organs.  If the lungs don’t have enough room to expand properly, it becomes very difficult to breath or cough.  If the stomach doesn’t have enough room to expand and accept food coming in, it can lead to vomiting and acid reflux may develop or worsen in patients who already have it.  If the intestines don’t have enough room to expand and push digested food through, it may lead to constipation or more serious intestinal blockages.  If the bladder doesn’t have enough room to expand and accept urine coming in, it can lead to kidney infections or decrease the ability to control the bladder, leading to frequent accidents.
Stay tuned for Part 2 of Introduction to Scoliosis, where we will discuss common treatment strategies for scoliosis!

Sommer LaShomb, Physical Therapist
Rehab Center (Stafford and Spring) and Home Health