Scoliosis

Scoliosis is a deformation of the spine characterized by directional shifts in one or more levels of the frontal and sagittal planes, accompanied by axial rotation.

It is therefore a three-dimensional morphological deformation of the spine.

This condition results in lateral curvatures of the vertebrae, causing them to tilt to the side and rotate, along with rib rotation, which leads to the formation of a hump adjacent to the spine. Consequently, there is often a visible deformation of the thorax and, in many cases, a rotational misalignment at the level of the pelvis.

There are multiple types of scoliosis, varying in shape, with one or several curves, and variations in the number of curves.

Clinical Assessment:

The patient undergoes a thorough examination in various positions:

• standing
• sitting
• lying down
• through respiratory capacity tests

Measurements are taken to check:

• the hump (bending forward)
• deformations and angulations
• imbalance relative to the intergluteal crease
• leg balance
• flexibility of the spine

These assessments provide critical insights into the type and severity of scoliosis, guiding treatment planning.

Radiology:

Radiological imaging plays a crucial role in diagnosing and assessing scoliosis.

X-Rays:
X-rays are used to determine the severity of scoliosis, with a primary focus on Cobb’s angle, which measures the lateral curvature of the spine. Additionally, torsion values are calculated using methods such as the Nash & Moe or Perdriolle techniques, providing further insight into spinal rotation.

Risser Test:
The Risser Test involves a pelvic X-ray to evaluate bone maturity. It assesses the level of skeletal development and growth potential.

These radiological evaluations are essential for accurate diagnosis and for planning effective treatment strategies.

Formetric 4D:

Formetric 4D is a surface measurement technique for the back using a camera. This method provides detailed imaging to measure concavities and convexities, assess vertical alignment, and determine whether the pelvis is horizontal or tilted.

• Idiopathic: The most common type, accounting for 80–90% of cases.
• Congenital
• Scaring from major burns
• Antalgic scoliosis caused by pain
• Compensatory scoliosis resulting from conditions like leg length discrepancy, pelvic rotation, or torticollis.

Scoliosis can also have a familial component, with recurrent cases observed within families.

Irreversible Scoliosis

In severe cases, scoliosis is often irreversible. Causes include:

• Congenital spondylitis and neuromuscular conditions.
• Tumors.
• Trauma.
• Metabolic causes.
• Forms belonging to Idiopathic scoliosis, the largest and most significant group.

Reversible Scoliosis

Some forms of scoliosis are reversible, such as antalgic scoliosis, which may occur:

• After recent trauma.
• During or following a herniated disc.
• As a result of poor posture.

By Number of Curves:

A single curve is only possible in infants or individuals who remain lying down. A scoliosis with a single curve while standing is physiologically impossible. To maintain vertical balance, at least a second curve is required. However, scoliosis with 3 or 4 curves are also observed. These forms are quite frequent, but cases with even more curves can also be found.

By Structural Forms:

• Fixed: The boney structure is deformed, and the patient cannot achieve full spinal extension.
• Non-Fixed: The patients movements are more or less restricted.

Both fixed and non-fixed curves result in a measurable loss of height.

By Affected Part of the Body:

1. Thoracic scoliosis
2. Lumbar scoliosis
3. Thoraco-lumbar scoliosis
4. Combined forms:
   • double majeure
   • courbures multiples