The column has a normal rectilinear distribution in its frontal projection (looking at it from the front), but the sagittal contour (looking at it in profile or sideways) usually has three curves: cervical and lumbar in lordosis and dorsal in kyphosis. The loss of this rectilinear alignment in the anteroposterior plane has been classically defined as scoliosis, although its alteration is actually three-dimensional, that is, with rotation of the vertebra and the thoracic cage. Therefore, we can find asymmetry of the shoulders, of the pelvis, shortening of the trunk, dorsal or lumbar gibbus, and even one part of the chest more prominent than the other.
The scoliosis that occupy us, above 10º of magnitude, is between 1.5% and 4% of children and adolescents, although only 1 in 10 of these will require treatment by a specialist. Oh, and girls are more affected than children.
According to their origin, scoliosis can be idiopathic (of unknown cause), congenital (present at the time of birth), paralytic (polio) and other rare diseases. We will focus on the IDIOPATHIC SCOLIOSIS that constitute 75% to 85% of all scoliosis.
It is not enough to diagnose a scoliosis, you have to look for the cause and ensure its prevention, but you should not confuse scoliosis with ESCOLOGICAL ATTITUDE, with absence of gibbosity and absence of vertebral rotation. The scoliotic attitude corresponds, 8 out of 10 times, to a dysmetria of lower extremities and disappears in decubitus (lying down).
When do you have to think about scoliosis?
– At puberty, systematically examine a child’s back.
– Before any family history (hereditary factor of unknown pattern).
– Whenever there is pelvic obliquity or flank asymmetry.
– Before any kyphosis or thoracic deformity.
– Before any child that is poorly supported.
Idiopathic scoliosis is a family disease. It is necessary to examine parents and all children, especially girls.
As a general rule, all scoliosis that shows signs of evolution will have to be treated, whatever its angulation, although it will serve as reference and classically:
– from 0º to 20º — expectant treatment (normal life, gymnastics, swimming, etc.)
– from 20º to 50º — orthopedic treatment (corset)
– above 50th — surgery.
These are general values because the treatment will also depend on other important factors such as: the speed with which the curve progresses, type of curves, etc …
It should be noted that conservative methods can not be expected to improve a scoliotic curve or to slow down evolution. However, they are recommended as they strengthen the muscles, especially if they are symmetrical exercises, such as walking or swimming
As for the blissful corset, orthopedic treatment with it at best will maintain the magnitude of the scoliosis, but it will never reduce the curve. Each city, hospital and orthopedic surgery service will have their own school and opinion.
There are three problems in the evolution of a scoliosis that justify the practice of surgery: the progression in the adolescent and adult, a serious aesthetic alteration and the medical problems related to large curves (respiratory, pain, destabilization of the spine).
Almost always the ideal moment is the end of bone maturation, but it is not always possible.