Scoliosis, types- Postural,Structural Scoliosis,causes, treatment

 A lateral (sideway) curvature of the spine which exceeds by 10° from the normal is termed as scoliosis. 

Types:- it is basically of two types they are:

• Postural or Non - structural scoliosis
• Structural scoliosis. 

Postural or Non-Structural Scoliosis

This is Grade 1 scoliosis. This occurs without any bony changes or muscle weakness. 

Causes:-

1. Impairment of the reflex mechanism. 
2. Wrong postural habits, eg: Standing with stress on one leg or psychological factors. 

The postural scoliosis may get organized into a structural one, due to secondary soft tissue contractures in muscles and ligaments on the concave side of the curve. 

Structural scoliosis:-

This is Grade 2 and 3. In this type there is defect in the bone which results in contractures of the soft tissue on the concave side of the curve and reciprocal stretching on the convex side. 

Classification:-

1. Idiopathic Scoliosis
2. Paralytic Scoliosis
3. Congenital Scoliosis. 

Idiopathic scoliosis:-this is again divided into:

Infantile Scoliosis: The onset of this is at the age of three years. Usually there is a spontaneous resolution of the curve. If the curve progress then need an early surgical intervention. 

Juvenile Scoliosis: The age of onset is between three and 10 years. Rapid progression of the curve occurs due to the growing age. If bracing fails to control the deterioration, surgery becomes necessary. 

Adolescent Scoliosis: The age of onset is between ten and twenty years if this is detected earlier acceptable correction is achieved by bracing. 

Adult scoliosis:- The age of onset is over twenty years. Scoliosis may develop as a result of disc degeneration. When the deterioration is rapidly progressive, surgery maybe indicated. 

Paralytic Scoliosis:-

This occurs in conditions like Poliomyelitis, Cerebral palsy or Spina bifida. This is complicated by the greater degree of the muscle imbalance and growing age complications. Scoliosis will rapidly deteriorate in the children. Surgery because necessary where there is rapid progression of the curve. 

Congenital Scoliosis:-

This scoliosis occurs by birth It is of milder and severe forms. The milder form is treated with a brace, the severe form need a surgery. 

Prevention:- it plays a very important role. 

1. Early detection plays an important role in the prevention of scoliosis
2. Screening programme of all the children between the age group of 10-14 years is necessary because they are more vulnerable. 
3. Parents can also play an important role in the early detection of a  scoliosis curve. So education of the parents on observational techniques may be helpful. 

Treatment:-

Curve less than 40° :- Conservative treatment is sufficient in growing children. This is given in the form of

Active correction: This is postural correction. This is again divided for the Grades -1, 2,3.

Grade 1-Management od Postural Scoliosis

The correction of the deformity is obtained by progressive reduction of the bad postur. 

• General body relaxation
• Posture maintenance
• Free mobility exercises to the whole spine, Spinal extensor exercises and abdominal exercises. 
• Deep breathing exercise
• Balance exercises
• Stretching of the soft tissues. 
• After the correction the patient should be advised to continue with exercises avoiding especially the positions and the activities prone to product the existing deformities. 
• The patient must report regularly for screening. 

Grade 2:-

The curves are associated with compensatory curves. So need a brace called Milwaukee or Boston brace to prevent deterioration of the curve and to maintain correction with active exercises. This brace immobilizes the spine and maintain a stretching effect. 

Exercise programme:-

1. Mobility exercises are important, as the spine remains immobilized in brace
2. Deep breathing exercises are also important, as the expansion of the ribs is limited due to the brace. 
3. Lumbar lordosis is associated with these curves so correction of the anterior pelvic tilt is important
4. Correction of the major curves is also achieved by putting a pad over a rib hump on the convex side of the curve in the brace. 
5. Repeated stretching exercises for the hip flexors and hamstrings are important as these have a tendency to shorten due to the pelvic tilt. 
6. Hanging in head suspension apparatus or on the stall bars can provide effective stretch to the whole spine. 
7. The whole programme and the brace need to be continued for long-term. As the child grows brace needs repeated adjustment and continued till the child attains skeletal maturity. It can be taken gradually thereafter. The needed to be worn  day and night expect during exercise programme of spinal mobilization and deep breathing exercises. The thoracic flexion exercises should be taught with the brace on position because this reduces vertebral rotation. 

Grade - 3 Severe Structural Curves

These curves are greater than 40° and a surgical intervention. 

Passive Correction

Hanging is the best method Eg: suspension apparatus. Two physiotherapist gives axial traction. One will be grasping the pelvis and gives traction towards the occiput. 

Maintenance of Correction:

The most important aspect is to educate the patient to maintain their correction by active efforts or with the help of spinal brace. The patient needs education for continuous awareness an exact methodology.