thoracic and lumbar scoliosis

Thoracic and Lumbar Scoliosis: The Real Symptoms and What to Do

Thoracic and lumbar scoliosis is a permanent lateral and rotational deviation of the spine (rachis).

Practically:

  • The body of the vertebra rotates towards convexity (outer side of the curve),
  • While the back (arc) rotates towards the concavity (short part of the curve).

The consequence is a progressive development of a deformity of the vertebra over the years.

Thoracic and lumbar scoliosis does not improve:

  • Standing.
  • In a lying position.

The spine can be tilted:

  1. To the right.
  2. To the left.
  3. The thoracic spine is deviated on one side and the lumbar spine is inclined on the other (S italic scoliosis).

Many children have physiological scoliosis which is around 2 degrees, it is absolutely normal and no therapy is needed.

Contents

Who are they hit by thoracic and lumbar scoliosis?

Scoliosis generally affects:

  1. The thinnest in general and thinnest children,
  2. Females: about 80%.

This deformity develops in the child, but remains even when the child becomes an adult, indeed if it is not treated it can get worse because it is sometimes degenerative. With a targeted and early therapy you can:

  • Block progression.
  • To improve the case.

What is the difference between scoliosis and a scoliotic attitude?

Although visually they may appear similar, thoracic and lumbar scoliosis (dysmorphism) is different from the scoliotic attitude which is instead a paramorphism (something close to normal that is correctable with external maneuvers).

The dysmorphism, on the other hand, is not correctable, it is permanent, I have no correction options. The scoliotic attitude is always a curve of the spine in the frontal plane, but:

  1. It is correctable, it disappears by bending the torso forward
  2. There is no vertebral rotation or hump,
  3. It is not permanent,
  4. There are no structural alterations
  5. It has a better prognosis.

A scoliotic attitude can be caused by several factors :

  • Dysmetry of the lower limbs (if the support is not correct and even, the spine also tilts for compensation);
  • Antalgic posture (so as not to feel the pain): for example in low back pain, in which, as there is pain, the person maintains a scoliotic defensive attitude;
  • Compensation for stiff neck and visual defects.

What are the types of scoliosis?

There are scoliosis:

  • Congenital:

    • Idiopathic (cause unknown): represents 70% of cases.

    • From malformations of the spine : it is 15% of cases and can be caused by:

      • Trisomy 21,
      • 5% of cases of Marfan syndrome (scoliosis above 20 degrees is a diagnostic criterion),
      • Ehler-Danlos syndrome.
  • Caused by other (secondary) diseases:

    • From neurological diseases: Infantile cerebral palsy , poliomyelitis , spina bifida , Recklinghausen’s disease (neurofibromatosis causes true scoliosis), myopathies (some are very debilitating, even preventing the child from sitting).
    • From trauma : displaced fracture of one of the vertebral bodies , therapeutic pneumothorax in childhood.

How do the vertebrae change in case of scoliosis?

The bending of the spine on one side occurs together with a rotation of the vertebrae towards the convex side (i.e. the protruding one) which is proportional to the degree of lateral inclination.

Scoliosis leads to some anatomical deformations of:

  1. Vertebrae.
  2. Ribs.
  3. Discs.
  4. Ligaments.

The vertebrae tend to assume a wedge-shaped shape especially at the apex of the curve, in practice they are narrower in the direction of the curve (concavity).

On the concave side, i.e. inside the curve:

  1. The vertebral foramina are narrower
  2. The nerve roots ( initial part of the nerves originating from the spinal column) that run through them can become compressed and give the symptoms of sciatica (rare) .

The intervertebral disc is squeezed on the concave side and decompressed on the other side, so the nucleus pulposus is pushed out.

What happens to the coasts?

The rotation of the vertebrae causes the formation of the humps:

  • Posterior (i.e. the hump)
  • Front.

Due to the rotation, the transverse process at the thoracic level pushes the ribs and deforms them. The ribs are deformed by the inclination of the vertebrae.

The distance between ribs:

  1. In the convex side it increases.
  2. In the concave side it decreases.

Due to vertebral rotation, the rib cage becomes:

  1. Narrow on one side
  2. Wide on the other.

Gibbo is formed which is easily noticed from the convex side.

What is the hump?

It is a bump that forms in the lumbar spine or back due to the deviation of the vertebrae. In practice, if the vertebrae are rotated to the left, a bump in the back can be seen to the left when the patient leans forward. This is because the ribs are attached to the vertebrae, so if a vertebra rotates, the rib also follows the same direction. In our case, it moves posteriorly to the left.

What are the most important features of scoliosis?

The most important aspects that are evaluated are:

  1. The degree of lateral inclination and rotation of the vertebrae,
  2. The age of onset.

The greater the degree of deviation of the spine, the more the subject may have consequences in the future. The earlier thoracic and lumbar scoliosis appears, the worse the prognosis will be because growth tends to increase the inclination of the spine.

Prognosis depends a lot on the age of onset of scoliosis:

  1. If the severity is less than 20/30 ° it only worsens during the growth of the boy,
  2. If you exceed 40 degrees, scoliosis also worsens in adulthood by about 1 degree every year .

It can be divided into three forms based on the age at which it appeared:

Type of ScoliosisAge of appearance
Infantile0-3 years
Youth4-9 years
Adolescent> 10 years
(when they are best diagnosed)

Classification based on the size of the curve

Type of ScoliosisDegree
MildLess than 20 °
Moderate20-30 °
Serious30-45 °
Very serious> 45 °

To be considered scoliosis, the curve must be at least 10 degree. In the case of very severe thoracic and lumbar scoliosis, the person is shorter.

What are the types of scoliosis?

Two curves can arise at the same time, so we speak of Italian S-shaped scoliosis , in which there is an upper and lower curve in the opposite direction. It can form a single curve in one direction.
Cervico-thoracic scoliosis is rare, while the following curves are more frequent:

  1. Thoracic.
  2. Back-lumbar,
  3. Lumbar.

The mixed form with one lumbar curve and the other thoracic to the opposite side affects many boys.

What are the causes of scoliosis?

Many studies have shown in patients who develop scoliosis the presence:

  1. Of a weak musculature
  2. Of a bone growth out of proportion to the increase in muscle tone.

This would strengthen the hypothesis that the muscle-ligament component is at the origin of this malformation. Significant muscular insufficiency of the abdominal and thoracic-lumbar muscles causes the spine to tilt and rotate to one side. According to Wynne-Davies, scoliosis can also have a hereditary component because it is more common in twins.

However, when parents are asked if there is a history of scoliosis in the family, the most common answer is “I had scoliosis, but I am cured”. This is impossible because scoliosis does not heal spontaneously. Children and teenagers usually assume very uncomfortable and unbalanced postures, for example:

  1. The girls write by tilting the trunk, head and long hair to one side,
  2. Many people only place their backpack on one shoulder.

In some cases these postural vices evolve into scoliosis.

What are the symptoms of thoracic and lumbar scoliosis?

Many think that scoliosis is a doom to have perennial back pain. In fact, scientific studies show that this is not true. A study done on 2442 patients with idiopathic scoliosis showed that:

  • Only 23% had back pain on the first visit,
  • A further 9% had back pain during the observation period.

The thing that will shock many people is that there was no correlation between pain and:

  • Gender (male or female).
  • Family history of scoliosis.
  • Different length of the lower limbs.
  • The severity of scoliosis.
  • The type of curve.
  • The alignment of the spinal column (Ramirez et al. – 1997).

Low back pain is common in adolescents, with or without scoliosis (Janicki et al. – 2007). There is however a limitation of movement to one side because the column is rotated or bent to the opposite side.

What is the cure for thoracic and lumbar scoliosis?

Scoliosis needs to be treated because severe scoliosis can cause breathing problems. It is necessary to explain to the parents that it is not just an aesthetic issue, but also a respiratory problem. In fact, severe scoliosis causes a reduction in the vital capacity of the lung.

It must be remembered that:

  • Diagnosis must be early.
  • Checks must be frequent because the curve is evolutionary.

Frequent means every six months if we are in an evolutionary phase.

When to do the control X-ray?

  • You can decide to do a control X-ray:
  • Once a year.
  • Every six months if the situation gets worse.

Treatment depends on:

  • Curve severity.
  • Patient’s age.
  • Evolution of the curve, i.e. the presumed course of scoliosis (it is necessary to make at least 2 subsequent evaluations).

Does therapy depend on the severity of the thoracic and lumbar scoliosis curve?

Yes, the degrees of the curve are fundamental because there are different treatments based on the entity.

Usually, the treatment of scoliosis is conservative:

Curve <20 degrees:

Conservative treatment which consists in watchful waiting, that is, you wait and control the evolution. Children need to be physically active. Any sport is fine. Sport does not cure scoliosis, but it allows a strengthening of the back muscles and by doing sport. It is assumed that the person is forced to have correct attitudes.

Curve 20 degrees -50 degrees: the treatment includes:

  • Medical gymnastics or corrective gymnastics: It is a set of exercises studied and taught by kinesiologists with which you try to act on the spine through muscle contraction.
    It can be done alone (physical activity + medical gymnastics) or in the period in which a corset is used.

  • Busts : the torso causes pushes on the protruding parts of the trunk to correct the curve or to avoid worsening (Willers et al. – 1993), it is one of the objectives of the treatment of scoliosis. The curve may decrease a few degrees as the back lengthens, but it never completely corrects itself. There are different types of busts, which we explore in the next paragraph:

    • Milwauke – occipitomental support corsets for back curves,
    • Lyonnais
    • Boston – corsets without occipitomental support (Boston TLSO type) for thoracolumbar and lumbar curves

This is only held at night or day and night (depending on the size of the curve). During the period in which it is used, medical and respiratory gymnastics must also be done because they tend to weaken the respiratory muscles. Initially the muscles were made of plaster, today they are thermoplastic, which are less visible and more wearable. They are poorly tolerated by boys especially because scoliosis occurs mainly in adolescents.

Curve> 50 degree : the treatment includes:

  • Surgical intervention : it is indicated when there are important and developmental curves, in growing children or when there are congenital forms, therefore:

  • Adolescents with deformities (> 50 °) and asymmetrical trunk, such as: congenital deformities or hemisponilia (in which only half of the body of the vertebra is formed);
  • If pain appears: generally in scoliosis it does not appear, if it appears it is because there is inflammation on a joint between the vertebrae;
  • Thoracic lordosis (inversion of the curve);
  • Significantly unsightly deformity.

You have to wait as long as possible to do the surgery, better at the end of the growth phase of the child in order not to reduce the height. In fact, this consists of a vertebral arthrodesis (union of several vertebrae), usually posterior.

In practice, it is carried out:
  • A bone graft in the posterior part of the vertebral arches affected by scoliosis,
  • The insertion of a scaffold and a metal rod (usually titanium), which blocks the vertebrae that are at the end of the curve,
  • The spine is tensioned to make the correction stable and permanent.

In simple terms, it corrects and then locks the curves with bars. Once the bars were long and ran down the entire back, decreasing mobility, now they are shorter. The principle is to pull from the concave side and compress from the convex side , then a bone graft is made between one vertebra and the other.

We therefore have:
  • Distraction of the concave side.
  • Compression of the convex side.
  • Vertebral graft.

The immediate complication of an operation of this type is temporary paresis. The thing that children are promised is that they will grow tall, and it is the thing that often makes them accept the surgery.

Treatment summary table (although with possible exceptions)

Degree of ScoliosisSuitable therapy
0 – 20 degreeWatchful waiting
20 – 50 degreeOrthosis
> 50 degreeSurgical treatment

Exercises that are used to correct or stop the progression of mild scoliosis of lumbar spine or severe scoliosis aim to:

  • Strengthen weaker muscles.
  • Stretch those that are short.

Children with scoliosis are those with underdeveloped muscles, often females, so working out in the gym is also essential for those who perform other therapies (for example osteopathy).

Which sports can I do for treating thoracic and lumbar scoliosis?

  • Swimming is not suitable for scoliosis because it causes symmetrical reinforcement, while this deformity is asymmetrical.
  • Tennis may be indicated, especially if the arm used to play is on the convex side.
  • Volleyball and basketball are suitable sports .

In general, you need to talk to your doctor to understand if there are any contraindicated sports, but there are no contraindications to sport in general, not even in a competitive way. Sports activity does not replace remedial gymnastics.

You can contact Dr. kyrillos Mina here: Physical TherapyServices

Why do you wear an orthopedic corset or corset?

The bust is a tool that is used in severe cases of scoliosis, but not very serious. According to the orthopedist’s indication, the torso can be used in :

  • Plaster.
  • Plastic.
  • Metal.

The pinstripe corset is applied and replaced periodically for a maximum period of 5-6 months.
After having brought the plaster, we move on to the brace of:

  1. Plastic.
  2. Metal.

In subjects with minor scoliosis, only the latter can be carried. To apply the plaster corset, the patient must be put in traction and extension. The plaster is then adapted to the patient.

There are many types of plastic or metal corsets , the most used are:
  • The “Lyonnais”,
  • The “Milwaukee”
  • Lumbar “La Padula”.

Based on the degree of scoliosis, your doctor may recommend wearing the brace :

  1. All day (at least 18 hours), if the degree of scoliosis is at least 35-40 °, it is usually inevitable.
  2. Only in the evening and at night.

The Lyonnais brace (Lyonnais) is composed of an underarm belt and one at the level of the pelvis, from here start an anterior and a posterior rod that reach up to the height of the collarbone.

Two rigid bands start from the vertical rods that press:

  1. On the area of ​​the trunk that protrudes
  2. On the hump.

After applying the brace, the x-ray checks whether the thoracic and lumbar scoliosis is correct.

The  Milwaukee brace consists of:

  1. ring at the level of the neck,
  2. A  belt at the level of the pelvis from which 3 rods originate which end at the level of the boy’s chin ( Kotwicki et al. – 2013 ).
  3. lateral band pushes against the ribs in the protruding part of the rib cage.

A metal rod reaches the chin and causes the spine to pull. The head is not put in traction with respect to the pelvis passively, but the support under the jaw stimulates the patient to an active work of self-traction.

The success rate of treatment with the Milwaukee brace is 77% according to Lonstein et al. (1994). However, according to a study by Noonan et al. (1996), the results are not comforting.

In fact, the authors’ conclusion is:

“The results of this study do not agree with the previously reported favorable results with the brace and there are doubts that the natural history of progressive idiopathic thoracic and lumbar scoliosis is truly altered by the use of the Milwaukee brace.”

How many hours do you have to keep it?

This corset is not very popular with children and young people because the upper part is visible and because it must be worn 24 hours a day, it can only be removed for showering.

According to a study by Rowe et al. (1997), use for 8-16 hours gives a worse result than use for 23 hours a day. Furthermore, the use of this corset can cause some deformations of the face (Olin et al. – 2011), including:

  1. Protrusion of the front teeth, especially the upper ones;
  2. Facial height reduction due to maxillary and mandibular growth block.

The La Padula brace is lumbo-thoracic, it is used:

  1. For middle back scoliosis with little rotation,
  2. For lumbar scoliosis.
What can I do with the corset?

During the period in which the brace is being worn, it is necessary to strengthen the muscles in order not to lose strength and therefore remain with weak and inadequate muscles when taking it off .

When to use the corset in case of thoracic and lumbar scoliosis?

The corset must be kept for the time that the orthopedist prescribes, often until the child’s growth is complete, you gradually stop wearing it so as not to nullify the results.

How will thoracic and lumbar scoliosis evolve? The prognosis

Hard to say because there are no rules, but some factors generally give a worse prognosis.

Negative prognostic factors

  • Gender: females have a worse prognosis than males.
  • Age: the earlier it is, the more likely evolution is.
  • Pre-menarche (first menstruation).
  • Risser 0 (the lower the Risser, the worse the prognosis).
  • Double curves worse than single curves.
  • Thoracic curves worse than lumbar curves.
  • Curves of greater magnitude.

Please, dear reader, if you suffer from back pain or confirmed that you suffer from thoracic and lumbar scoliosis, you should contact an orthopedist or a physiotherapist. You can contact Dr. Kyrillos Mina (physiotherapist) to diagnose your condition Designing a customized rehabilitation program for your condition.

References:

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