Dr Adriaan Liebenberg My Spine Explained | Page 48

My Spine Explained
Many neuromuscular conditions , such as cerebral palsy , spina bifida and muscular dystrophies , cause muscle weakness and abnormal curves ( scoliosis ). This can be troublesome in the patient ’ s everyday usage of a wheelchair . Inadequately treated fractures from trauma may result in both kyphosis and scoliosis . Common causes include the group described as “ idiopathic ” ( where the cause is unknown ). This is a well-recognised group of young , tall , slim girls developing scoliosis during their teenage years as they go through their growth spurt .
In later life , asymmetrical discs and facet joint ( the joints between the vertebrae ) degeneration may cause segmental instability and degenerative ( wear and tear ) scoliosis .
What are the symptoms ?
Symptoms vary based on the cause . Congenital ( inborn ) deformities may be incidentally picked up on a chest X-ray done for other reasons , as these children often have other associated problems with their kidneys and hearts .
The idiopathic group is often noticed at around 10 – 12 years of age when a posterior thoracic ( torso ) prominence is noted or hip or shoulder asymmetry . It is usually not painful . There may be breast asymmetry , which concerns the young teenage girl . The degenerative group usually presents with both back and leg pain due to narrowing of the spinal canal and nerve root foramina , which causes compression of the lumbar nerve roots . These patients may also complain of progressive loss of height and increasingly prominent hip bones .
How is it diagnosed ?
Once the deformity is noticed by the patient , the treating specialist will ascertain the history to define the cause . A clinical examination will include the forward bend test which exaggerates the chest wall prominence around the shoulder blades . The diagnosis is confirmed on a full-length X-ray taken both from behind and the side while standing . Further views in flexed or extended positions may be needed to determine the flexibility of the curve . MRI and CT scans may assist in determining the underlying cause .
47