Symptoms, diagnosis and treatment of scoliosis / kyphosis
The spine has a number of normal curvatures. These curvatures go both forward and backward. Lateral (to the side) curvatures are never normal. The most common type of abnormal spine curvature is called scoliosis. There are two major types of scoliosis, congenital and idiopathic. The other relatively common type of abnormal spine curvature is called kyphosis. This can be divided into juvenile scoliosis (Scheuermann’s disease) and acquired kyphosis. There are also combinations of kyphosis and scoliosis known as kyphoscolioses.
Normal Spine
Scoliosis
Kyphosis
Congenital scoliosis occurs as a result of various spinal abnormalities. The main types of abnormalities seen are failure of a part of a vertebral body to develop or failure of vertebral bodies to separate (block vertebrae). These are also seen together in the same patient.
Idiopathic scoliosis is seen in adolescents. It is commonly discovered by pediatricians. Idiopathic scoliosis has a strong genetic tendency.
Juvenile kyphosis (Scheuermann’s disease) is a result of a wedge deformity of anywhere from 3 to 5 adjacent vertebral bodies.
Acquired kyphosis is usually the result of some form of trauma with associated spinal fracture. Acquired kyphosis is commonly seen in the setting of osteoporosis forming the so-called “dowager’s hump”. Finally, metastatic disease in the spine can result in vertebral collapse and kyphosis.
Symptoms
The symptoms of either kyphosis or scoliosis depend on the cause and severity of the deformity. The abnormal curvatures may be asymptomatic, may cause back pain, respiratory problems and neurological problems (from pressure on the spinal cord).
Diagnosis
As always, a careful history and physical examination are the first steps in diagnosis. The diagnosis of scoliosis is often made on physical examination. X-rays, CT scans may be needed.
Treatment
Treatment of kyphosis depends on whether it is congenital or idiopathic. Congenital scoliosis is much less likely to respond to non-surgical measures and therefor is frequently treated with surgery. The decision to operate is complex and must be individualized for each patient. Types of surgery include posterior fusion, posterior fusion with instrumentation, anterior fusion, excision operations and combinations of these.
Idiopathic scoliosis generally responds to treatment with a Milwaukee brace. Exercise, manipulation and electrical stimulation have not been shown to be adequate treatments.
The treatment of juvenile kyphosis is a controversial subject. The recommendation to treat with surgery depends on the age of the patient and the degree of deformity. More commonly, treatment with a Boston brace is recommended.
In cases of acquired kyphosis, treatment depends on the cause of the kyphosis and whether or not there is neurological injury.