Scoliosis has been categorized into four types; they are Idiopathic, Congenital, Neuromuscular and Adult Scoliosis.
Idiopathic Scoliosis
The term Idiopathic means “from an obscure or unknown cause”. Though the cause is unknown, it is believed that, Idiopathic Scoliosis is a genetic spine disorder. It is the most common type of Scoliosis. As this type of scoliosis can affect children at different ages and in different location and direction in the back, it has been further broken down into an even more specific set of conditions. There are therefore eight sub-types of idiopathic scoliosis that affect children depending on:
- (Age) Infantile, Juvenile, and Adolescent
- (Direction) Dextroscoliosis, Levoscoliosis
- (Location) Thoracic scoliosis, Lumbar scoliosis and Thoracolumbar scoliosis.
Age
Infantile Idiopathic Scoliosis is rare and occurs before the age of 3. It is mostly found in males characterized by left thoracic curve (upper spine). Major proportion of cases resolve spontaneously, but some may progress to more severe deformity. Infantile curves that reach 30 degrees tend to continue to worsen without treatment. Girls with right sided curves tend to have more progressive curves than other infants.
Signs and Symptoms
The characteristic finding on physical examination is that the curve is typically between the shoulder blades or in the thoracic region of the spine and the spine curves to the left. The MRI is normal in infantile idiopathic scoliosis.
Juvenile idiopathic scoliosis occurs in children between the ages of 3 and 9. Juveniles behave similar to infants in the younger ages, making them more common in boys than girls; left sided curves are reported more in this age group. The older children behave more like adolescent idiopathic scoliosis- most common in girls with right-sided thoracic curves. The abnormal spinal curvatures in children with juvenile scoliosis are generally at a high risk for progression to more severe curves. They usually require bracing and many will go on to require surgery.
Signs and Symptoms
In the early stage, left sided curves are present and MRI show normal results. The Older children may show visible symptoms like shoulder height asymmetry and mild lower back pain due to over activity.
Adolescent idiopathic scoliosis occurs between the age of 10 and young adulthood. This condition is also called AIS, is by far the most common type of scoliosis, as well as the type with the best positive treatment results. Girls, or young women, are at higher risk than boys, or young men. The progression of the condition is faster than any other Scoliosis types as it occurs in the growth period. With early diagnosis and treatment, best results can be obtained.
Signs and Symptoms
In some cases of Adolescent idiopathic Scoliosis, notable symptoms are present. Depending on the curve pattern and the angle of deformation of the curve, scoliosis may be barely seen or it may have significant visible symptoms. One of the common visible symptoms is shoulder height asymmetry, in which one shoulder appears higher than the other. A shift of the body to right or left can occur especially when there is a single curve in the thoracic (chest-part) or the lumbar (lower back) part of the spine. A prominence on the back or a rib hump secondary to the rotational aspect of the scoliosis is the most visible sign of Scoliosis.
Direction
Dextroscoliosis is a type of scoliosis that is characterized by a spinal curve to the right (“dextro” = right) and usually occurs in the thoracic part of the spine. Dextroscoliosis is the most common type of curve. It can occur on its own (forming a “C” shape) or with another curve bending the opposite way in the lower spine (forming an “S”)
Levoscoliosis describes a spinal curve to the left (“levo” = left). It mostly occurs in the lumbar spine, the occurrence of levoscoliosis in the thoracic spine indicates a higher probability that the scoliosis may be secondary to a spinal cord tumor.
Location
- Thoracic scoliosis is curvature in the middle (thoracic) part of the spine. This is the most common location for spinal curvature.
- Lumbar scoliosis is curvature in the lower (lumbar) portion of the spine.
- Thoracolumbar scoliosis is curvature that includes vertebrae in both the lower thoracic portion and the upper lumbar portion of the spine.
Congenital Scoliosis
Congenital refers to a condition existing at birth and often before birth, or that develops during the first month of life. A small number of children develop a lateral curvature of the spine even before birth, during the period of fetal growth in the womb. These cases are referred as congenital scoliosis resulted from the abnormal development of fetus. Congenital scoliosis occurs when bony portions of the spine fail to form properly or normally separated segments fuse together during fetal development. This connection will slow growth on that side of the spine. Unopposed growth on one side with slowed growth on the other leads to a spinal deformity.
Congenital scoliosis
Signs and Symptoms
Main symptom is the presence of deformity in the form of an asymmetrical rib hump, spinal curve and limb length inequality. This will become more visible on forward flexion. Very severe deformity can reduce chest expansion.
Neuromuscular Scoliosis
Neuromuscular scoliosis occurs in patients with abnormalities of the myoneural pathways of the body. Neurological or muscular disease, like cerebral palsy or muscular dystrophy may cause this condition. There are a wide variety of neuromuscular diseases that may cause scoliosis, so the clinical presentation and severity of this condition is extremely variable. Unlike the other types of scoliosis described here, treatment of neuromuscular scoliosis varies, mostly because the abnormal curves of the spine are unpredictable.
The main causes of neuromuscular scoliosis are:
Cerebral palsy, Spina bifida, Muscular dystrophy, Paralysis from spinal cord injury, myopathy, Poliomyelitis, Spinal cord tumors, Spinal muscular atrophy.
Adult Scoliosis
Adult scoliosis is characterized by a side-to-side curvature of the spine caused by degeneration of the facet joints. The condition occurs most frequently in people over 65 years of age. While there are adults with scoliosis, these are cases that usually begin in childhood or adolescence and persist into adulthood. Adult degenerative scoliosis is a distinct condition that results from wear and tear on the spinal column with disc collapse and actually begins in adulthood. Adult scoliosis is also known as “de novo” (new) Scoliosis, degenerative scoliosis or adult onset scoliosis.
Signs and Symptoms
- Trunk imbalance, making the patient appear as though listing to one side
- Spinal instability
- Rib prominence on either side
- Humpback
- Irregular gait caused by a discrepancy in leg length
- Pain
- Difficulty sitting or standing
- Spinal rigidity and stiffness
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Reference:
1. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) 2. Idiopathic Scoliosis (The Harms Study Group Treatment Guide) 3.Scoliosis research society.
