Anatomy
The back is made up of box-shaped vertebrae that are held in place partly by the shape of the bones, partly by ligaments and partly by the large and small back and abdominal muscles.
The back from the side:
A. Vertebra prominens
B.Vertebra coccygea I
C. Promontorium
D. L I (1st lumbar vertebra)
E. Th I (1st thoracic vertebra))
F. Axis
Cause
In the vast majority of cases, the cause of scoliosis in adolescents is unknown (idiopathic) and is most common in girls. A distinction is made between functional and organic scoliosis. Functional scoliosis is often caused by unequal leg length.
The cause of organic scoliosis is often unknown, but hereditary factors are involved. Organic scoliosis usually increases gradually during childhood or early adulthood as long as growth continues. They occur in 2-5% of adolescents aged 12-14 years and are equally common in boys and girls. Only one in 10 will require treatment.
Symptoms
Scoliosis can cause pain and tenderness, but in mild cases it does not necessarily cause symptoms and children with scoliosis often have no more back pain than others. In severe cases, it causes back pain and can affect cardiopulmonary function and quality of life.
Examination
Scoliosis is seen from behind (unlike Mb Scheuermann, which is seen from the side). When bending forwards, there is a marked asymmetry in the back. It is important to make the diagnosis as soon as possible as the outcome will improve if treatment is started as soon as necessary. Attention should therefore be paid to early signs of spinal misalignment (unequal shoulder or hip height, prominence of one or both shoulder blades, waist misalignment, although this is an uncertain measure).
A general medical examination will usually be able to make the diagnosis. Functional scoliosis (caused by a difference in leg length) is straightened when the person is sitting down. Organic scoliosis should be assessed by a specialist orthopaedic surgeon.
X-rays (front, side and possibly with scoliosis imaging) and possibly MRI scans will show the severity of the spinal deformity.
Treatment
Treatment is dependent on the severity. Most people will be able to play sports with non-monotonic back loading within the pain threshold. Strength training and stretching of abdominal and back muscles is recommended (Chen Y, Zhang Z, Zhu Q. 2023, Qi X, et al. 2023). If the spinal misalignment worsens (> 20-40 degrees) and the adolescent continues to grow, support bandages can be used (Landauer F, Trieb K Prof. 2022).
Despite the bandage, you can usually play sports at an almost normal level. If the spinal misalignment becomes pronounced (> 40-50 degrees), surgery may be considered. In special cases, surgery may be indicated earlier.
Complications
If the pain does not subside after relief and treatment, you should be (re)examined by a doctor.
In particular, the following should be considered:
- Slipped disc
- Secondary muscle infiltrations,
- Scheuermanns decease
- Fracture of the vertebral arch (arkolyse), low back pain
However, there are many other causes of lower back pain (e.g. arthritis, infections, metabolic disorders, nervous disorders, tumours) that require further specialist investigation.
