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 📚 SCOLIOSIS – Detailed Explanation & Management

🔍 1. What is Scoliosis?

  • Definition:
    Scoliosis is a three-dimensional deformity of the spine characterized by:
    ✅ Lateral curvature of the spine (Cobb angle > 10°).
    ✅ Vertebral rotation (spine twists along its axis).
    ✅ Often accompanied by rib cage deformities or shoulder/pelvic asymmetry.

🧠 2. Types of Scoliosis

🌱 A. Structural (fixed curve)

🔸 Idiopathic scoliosis (most common) – usually appears in adolescence.
🔸 Congenital scoliosis – due to vertebral malformations at birth.
🔸 Neuromuscular scoliosis – associated with neuromuscular conditions like cerebral palsy, muscular dystrophy.
🔸 Syndromic scoliosis – linked with syndromes (e.g., Marfan, Ehlers-Danlos).

🌿 B. Non-Structural (functional curve)

🔸 Caused by factors outside the spine (e.g., leg length discrepancy, muscle spasm).
🔸 Curve is flexible and corrects when the underlying cause is addressed.

🧪 3. How is Scoliosis Diagnosed?

✅ Physical examination:

  • Observe for shoulder height differences, scapular prominence, waist asymmetry, pelvic tilt.

  • Adam’s forward bend test: checks for rib hump due to rotation.

  • Measure leg length discrepancy.

✅ Radiographic evaluation:

  • X-rays (PA and lateral) to measure Cobb angle (angle between most tilted vertebrae above and below the curve).

  • Assess skeletal maturity (Risser sign) – important in planning treatment.

🔬 4. Severity of Scoliosis (Cobb Angle)

  • 10–20°: Mild scoliosis.

  • 20–40°: Moderate scoliosis.

  • >40°: Severe scoliosis.

🏃‍♂️ 5. Management of Scoliosis

Management depends on:
✅ Curve severity.
✅ Skeletal maturity (growth potential).
✅ Type and progression of scoliosis.

🧡 A. Observation

  • For mild curves (<20°) in skeletally immature patients.

  • Monitor every 6–12 months with physical exam and X-rays.

  • Often used for non-progressive curves or near skeletal maturity.

🤸 B. Physiotherapy (Conservative Management)

  • Aim: Strengthen muscles, improve posture, maintain flexibility.

  • Techniques:

    • Schroth method – scoliosis-specific exercises focusing on breathing, posture correction, and muscle symmetry.

    • SEAS (Scientific Exercise Approach to Scoliosis) – promotes active self-correction.

    • Core stabilization and postural training.

    • Stretch tight muscles (e.g., concave side) and strengthen weak muscles (e.g., convex side).

  • Not a cure, but helps manage mild curves and prevent progression.

🦴 C. Bracing (for moderate curves in growing children)

  • Indicated for curves between 20–40° with growth potential.

  • Goals:

    • Prevent curve progression during growth.

    • Avoid surgery if possible.

  • Common braces:

    • Boston brace (TLSO) – worn under clothes, ~18–23 hours/day.

    • Milwaukee brace – for higher curves, includes neck ring.

  • Compliance is critical for effectiveness.

🏥 D. Surgery (for severe or progressive curves)

  • Indicated for:

    • Curves >45–50° in growing children.

    • Severe deformity causing pain, breathing difficulties, or cosmetic concerns.

  • Procedure:

    • Posterior spinal fusion with rods, screws, and bone grafts.

    • Anterior approaches may be used for specific cases.

  • Goals:

    • Correct deformity, stabilize spine, prevent progression.

  • Post-op: Rehabilitation, bracing, gradual return to activities.

📝 6. Summary Table

Severity (Cobb) Skeletal Maturity Management
<20° Immature/Mature Observe, physiotherapy
20–40° Immature Bracing, physiotherapy
>40–50° Immature/Mature Surgery

🎓 7. Key Takeaways for a Student

🔸 Scoliosis is a 3D deformity with lateral curvature + rotation.
🔸 Most common form is idiopathic scoliosis.
🔸 Cobb angle is used to measure curve severity.
🔸 Management includes observation, physiotherapy, bracing, and surgery depending on severity and growth.
🔸 Physiotherapy plays a supportive role, especially in mild cases or alongside bracing.
🔸 Severe curves (>50°) often require surgery to correct deformity and prevent complications.


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