The backbone of the normal subject when standing, horizontal basin:
– In the frontal plane, is projected along a rectilinear and vertical axis;
– In the sagittal plane, has a set of physiological curves, cervical lordosis, thoracic kyphosis, lumbar lordosis;
– In the horizontal plane, has no rotation the vertebrae relative to each other.
It is defined by a non-completely reducible anatomical disorder of the spine in all planes of space, frontal, sagittal, horizontal. So this is a three-dimensional deformation, which opposes deformation developed in one plane, such as kyphosis and lordosis. For convenience in describing, in clinical practice, we retain the combination of two essential parameters:
– The lateral deviation;
– Rotating set of interested vertebrae in the curvature; This implies, on a more or less extended area of the column, a structural deformation on the vertebrae and discs.
For the diagnosis of scoliosis should be required on clinical examination and radiological examination:
– A lateral deviation;
– Vertebral rotation, resulted in a hump;
– And, usually, a profile of disorder.
This is a structural deformation of the spine appearing and evolving during the growth period without any relation to other detectable disease process, unlike secondary scoliosis.
Vertebrae limits determine the extent of the curvature.These are the most inclined to the horizontal vertebrae.The angle between the upper plate of the upper end vertebra and the lower plate of the vertebra below li-mite (Cobb angle) measures the scoliotic angulation to finally assess the degree of maturation on the appearance of growth plates residual hips that completely disappear when appears the beginning of ossification of the iliac crests. This is the test Risser side of 1 to 5. The solder this complementary apophysis which begins at the posterior part of the iliac crest (Risser 4) indicates the end of the growth of the spine.
These are simple occasional lateral deviations without vertebral rotation, a normal spine. There are no hump on clinical examination, no vertebral rotation in the radiological examination and no structural deformation. It is indeed an attitude, because any clinical or radiological deviation disappears when lying down. Theoretically, there is no passage between scoliosis and true structural scoliosis. The causes of these attitudes scoliosis are numerous:
– Unequal leg length, whatever the cause. This underlines the importance of balancing the basin before any examination of the spine upright. The establishment of a wedge compensation equal to the length inequality under the foot side of the shorter leg eliminated the scoliosis. It is the same if one examines the patient sitting or prone.Radiography may help to distinguish which shows the front of the photograph standing pelvic obliquity, the curvature of overlying rebalancing without vertebral rotation, while on the plate in the supine position, the spine is straight;
– Any asymmetry of the basin will have the same effect on spinal posture and that, whatever the cause, malformation, trauma or particularly vicious attitude of hip stiffness, ankylosis, dislocation, etc. ;
– Certain position asymmetries of the neck muscles, a position defects of the head, may require the subject to rebalance to shift the shoulders and thus influence its spine. This is true of most atti-tudes in torticollis that the origin is congenital, traumatic or ENT;
– Some visual impairment or balance problems can cause spinal curvature underlying rebalancing;