What is Thoracolumbar Scoliosis?
Thoracolumbar scoliosis is a medical condition and is a type of scoliosis where the patient has an abnormal curvature of the spine in the thoracic and lumbar segments of the spine, which contains the lower thoracic vertebrae (mid-back) and upper lumbar vertebrae (lower back). Thoracolumbar scoliosis is usually a congenital condition, i.e. this condition develops in utero during the third to sixth week of pregnancy. Thoracolumbar scoliosis is commonly detectable at birth. Thoracolumbar scoliosis can also be of neuromuscular nature occurring as a secondary condition and developing in consequence to other medical conditions, such as cerebral palsy or spina bifida. There are some cases of thoracolumbar scoliosis for which the cause is not found, this is termed as idiopathic thoracolumbar scoliosis. Thoracolumbar scoliosis usually presents with the curve towards the right side.
The thoracic segment of the spine is also referred to as the upper back and lumbar spinal area is also known as the lower back. In thoracolumbar scoliosis the spinal curvature is at the highest point in the region between the thoracic and lumbar segments. Treatment of thoracolumbar scoliosis depends on the causes and as well as the severity of the curvature.
Causes of Thoracolumbar Scoliosis
Hereditary: Some of the causes for thoracolumbar scoliosis include hereditary, where this condition is inherited from a parent.
Pregnancy: In some cases, thoracolumbar scoliosis occurs in pregnant women as the physiological changes in pregnancy can sometimes cause fusion of the bones of the ribcage, which ultimately pulls on the thoracolumbar area of the spine forming the curvature.
Muscle Problems: Another cause of thoracolumbar scoliosis includes muscle weakness and poor muscle control, which leads to this type of curvature of thoracolumbar scoliosis.
Other Medical Conditions: Other types of medical conditions, which are neuromuscular in nature, such as cerebral palsy or spina bifida can also lead to secondary development of thoracolumbar scoliosis.
Gender: Females are more likely to develop this condition than males, as the curves in girls are at a greater risk for progression.
Signs & Symptoms of Thoracolumbar Scoliosis
- Pain is felt in the thoracolumbar region.
- One shoulder being higher than the other shoulder can be a symptom of thoracolumbar scoliosis.
- There is projection of one shoulder blade more than the other.
- The waist appears uneven.
- The rib cage appears uneven where one side is higher than the other side.
- There is prominence of one hip than the other, or one appears higher than the other hip.
- Yet another symptom of thoracolumbar scoliosis can be of one leg appearing shorter than the other leg.
- There is tilting of the body to one side.
Diagnosis of Thoracolumbar Scoliosis
- Medical history & physical exam where the doctor also looks for any neurological deficits present as a result of thoracolumbar scoliosis.
- X-ray of the spine helps in confirming the diagnosis and also helps in assessing the severity of the spinal curvature. X-ray also helps in giving indication about the skeletal maturity which will influence the treatment.
- MRI scan can also be done to rule out any lesion in the spine.
Treatment for Thoracolumbar Scoliosis
Treatment for thoracolumbar scoliosis, where there is abnormal spinal curvature of both the thoracic as well as the lumbar regions, depends on various factors which include:
- The severity and nature of the spinal curvature.
- The underlying cause of the curvature of thoracolumbar scoliosis.
- The presence of other diseases or medical conditions, such as neuromuscular disorders.
- The overall health and age of the patient.
- If the functions of the body, such as breathing, are affected by thoracolumbar scoliosis.
- The chances of worsening or progression of the curvature of thoracolumbar scoliosis.
Observation: Treatment is not needed in patients who are having mild form of thoracolumbar scoliosis except for regular checkups to ensure that there is no worsening of this condition. Some patients with thoracolumbar scoliosis can lead active and healthy lives with the use of physical therapy and other non-surgical treatment methods.
Exercises to Treat Thoracolumbar Scoliosis: Treatment for thoracolumbar scoliosis which develops due to weak muscle control is focused of increasing the strength of the specific vital group of muscles through strengthening exercises.
Braces: Wearing a custom-molded back brace, which applies three-point pressure to the spinal curvature, is also beneficial as it helps in slowing the progression of the curvature of thoracolumbar scoliosis and helps in stabilizing the spine and straightening the curve. Brace can be worn by the patient when doing their regular physical activities. However, braces should be avoided in cases where thoracolumbar scoliosis develops as result of muscle weakness, as wearing braces for a long period of time can lead to further weakness of the back muscles.
Other treatment options for thoracolumbar scoliosis include exercises, which increase flexibility and strength of the back. Massage and practicing yoga can also be beneficial.
Surgery: Surgery is needed in patients with more severe thoracolumbar scoliosis where the curvature is more serious. Surgery for thoracolumbar scoliosis comprises of spinal fusion with instrumentation, which helps in correcting the curvature and stabilizing the affected segments of the vertebra. The curved bones are attached to straight metal rods and gradually there is fusion of the bones and straightening of the spine. In many patients, the rods are left in place.
Risks & Complications of Surgery for Thoracolumbar Scoliosis
- Excessive blood loss.
- Breaking or dislodging of the rods, screws or hooks.
- Cerebrospinal fluid leak, which is rare.
- The curvature of thoracolumbar scoliosis can continue to worsen or progress even after the surgery.
It is important to diagnose thoracolumbar scoliosis as early as possible so the treatment can be more effective. Treatment differs from patient to patient; however, early detection of thoracolumbar scoliosis is important.
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