Scoliosis, commonly known as scoliosis, is a three-dimensional deformity of the spine, including abnormalities in the coronal, sagittal, and axial planes. A normal spine, viewed from behind, should appear as a straight line with symmetrical sides of the trunk.

Scoliosis, commonly known as scoliosis, is a three-dimensional deformity of the spine, including abnormalities in the coronal, sagittal, and axial planes. A normal spine, viewed from behind, should appear as a straight line with symmetrical sides of the trunk. If, viewed from the front, the shoulders are uneven, or if viewed from behind, the back is uneven, scoliosis should be suspected. In this case, a standing full-spine X-ray should be taken. If the frontal X-ray shows a lateral curvature of more than 10 degrees, scoliosis can be diagnosed. Mild scoliosis usually does not cause obvious discomfort, and there are no obvious physical deformities. More severe scoliosis can affect the growth and development of infants and adolescents, causing physical deformities. In severe cases, it can affect cardiopulmonary function and even involve the spinal cord, causing paralysis. Mild scoliosis can be observed, while severe cases require surgical treatment. Scoliosis is a common disease affecting adolescents and children, and early detection and treatment are crucial.

Etiology

Scoliosis is a symptom, and many factors can cause it, each with its own characteristics. For effective treatment, it’s essential to identify the type and treat accordingly.

Scoliosis can be classified into functional and organic types, also known as non-structural and structural scoliosis.

(I) Non-structural Scoliosis

1. Postural scoliosis;

2. Lower back and leg pain, such as from herniated discs or tumors;

3. Lower limb length discrepancy;

4. Hip joint contracture;

5. Inflammatory stimulation (such as appendicitis);

6. Hysterical scoliosis.

Non-structural scoliosis refers to temporary scoliosis caused by certain factors. Once the cause is removed, it can return to normal. However, long-term non-structural scoliosis can develop into structural scoliosis. In general, the scoliosis in these patients disappears spontaneously when lying flat, and X-rays show normal vertebrae.

(II) Structural Scoliosis

1. Idiopathic

The most common type, accounting for 75%–85% of all cases. The cause is unclear, hence the name idiopathic scoliosis. Based on the age of onset, it can be divided into three categories:

(1) Infantile type (0–3 years): ① Spontaneously curable type; ② Progressive type.

(2) Juvenile type (4–10 years).

(3) Adolescent type (>10 years to skeletal maturity).

Of the three types, the adolescent type is the most common.

2. Congenital

(1) Dysformation type: ① Congenital hemivertebrae; ② Congenital wedge-shaped vertebrae.

(2) Segmentation dysplasia type.

(3) Mixed type, combining the above two types.

Congenital scoliosis is caused by incomplete segmentation of the vertebrae during embryonic development, the presence of bony bridges on one side, incomplete development of one vertebral body, or a combination of both, resulting in asymmetrical growth of the two sides of the spine and thus causing scoliosis. It is often accompanied by other malformations, including spinal cord malformations, congenital heart disease, and congenital urinary tract malformations. These spinal developmental abnormalities can usually be detected on X-rays.

3. Neuromuscular Scoliosis

This can be divided into neurogenic and myogenic types. It is caused by imbalances in muscle strength due to neurological or muscular diseases, particularly asymmetry in the paravertebral muscles, leading to scoliosis. Common causes include sequelae of poliomyelitis, cerebral palsy, syringomyelia, and progressive muscular atrophy.

4. Neurofibromatosis with Scoliosis

5. Scoliosis Caused by Interstitial Lesions

Such as Marfan syndrome and congenital polyarticular contractures.

6. Acquired Scoliosis

Symptoms such as those caused by ankylosing spondylitis, spinal fractures, spinal tuberculosis, empyema, and thoracic surgeries.

7. Other Causes

Symptoms such as those caused by metabolic, nutritional, or endocrine factors.

Diagnosis

(I) Early Diagnosis of Scoliosis

Early detection and treatment are crucial to prevent the deformity from worsening. Early signs of scoliosis include: uneven shoulders, deviation of the spine from the midline, one scapula higher than the other, skin folds on one side of the chest, and asymmetry of the back when bending forward. Early detection relies mainly on parents, teachers, and school doctors. A simple examination is the bending test: Have the child remove their shirt, stand upright with both feet flat on the ground. Place their hands together between their knees and gradually bend forward. The examiner sits in front of or behind the child, looking straight ahead, and observes whether both sides of the child’s back are at the same height. If one side is higher, it indicates a possible scoliosis with vertebral rotation causing a bulge. If the flexion test is positive, you should seek medical attention promptly.

(II) Imaging Examinations

(1) X-ray Examination: This is the most important. X-rays can generally differentiate the cause, classification, curvature, location, rotation, bone age, and compensation degree of scoliosis.

Routine X-rays should include standing full-length anteroposterior and lateral views of the spine, including the lower cervical vertebrae at the upper end and the bilateral lumbosacral joints and iliac wing at the lower end. Other special X-rays include supine lateral bending views and traction views, which can assess the flexibility of scoliosis.

(2) CT Scan: This can effectively display bony deformities, especially 3D reconstruction CT of the spine, which can clearly show congenital vertebral deformities. Myelography CT scans can also be performed, which can clearly show the relationship between the spine and nerves in some complex spinal deformities, and whether there is spinal cord malformation, guiding surgical treatment.

(3) Magnetic Resonance Imaging (MRI): Compared to myelography, this is a non-invasive examination with high soft tissue resolution, which can effectively display spinal cord lesions.

(III) Neurological Examination

A detailed and comprehensive neurological examination should be performed on every patient with scoliosis. On the one hand, attention should be paid to whether the scoliosis is causing spinal cord compression, resulting in paraplegia, and whether there are hyperactive tendon reflexes and pathological reflexes in the early stage. On the other hand, attention should be paid to whether there are any spinal cord abnormalities such as myelomeningocele, spinal cord diastasis, and syringomyelia.