Rotoscoliosis: A Twisted Tale of the Spine
Are You Living With Rotoscoliosis?
The human skeleton is designed to be balanced and aligned so that our muscles, tendons, ligaments, and organs can work optimally. But variation still exists within the bones and joints of individual skeletons. In some cases these variations go unnoticed unless picked up incidentally on imaging. In other cases they are visible to the naked eye and can affect the functioning of the body in small and large ways. In this article we will be discussing a condition of the spine that can have large implications on movement and daily functioning called rotoscoliosis.
LET’S TAKE A LOOK AT THE SPINE ITSELF
Balance between stability and mobility allows the spine to keep you standing tall but allows you the flexibility to bend, twist, and arch your back. Whether you are reaching down to pick your child up from the floor or hitting a hole-in-one on the golf course, appropriate spinal alignment and flexibility are essential. Let’s take a closer look at the anatomy of the spine.
The spine is made up of five distinct segments. The seven vertebrae that make up the neck, known as the cervical spine, the 12 vertebrae that make up the mid back, or thoracic spine, and the 5 vertebrae that make up the lower back, or lumbar spine, create a long canal that houses the spinal cord. The broad and flat sacral bones sit beneath the last lumbar vertebrae and act as connectors between the pelvic bones and the spine. Beneath that, lies the coccyx or tailbone.
If you look at a model of a typical, healthy spine from the back or front it appears to be a straight column of vertebrae stacked on top of one another. When you view the spine from the side, however, you will see that the spine is actually curved in several places. In the neck the spine curves toward the front creating a small arch or “lordosis” in the neck. It then switches directions and a gentle backwards curve or “kyphosis” can be seen in the thoracic spine followed by another reversal and lordosis in the lumbar spine. Even the sacrum and coccyx are slightly curved. This normal alignment of the spine allows for all of the movement we expect from the spine, proper shock absorption capabilities, and good alignment from the head to the feet.
WHAT IS ROTOSCOLIOSIS?
Scoliosis is an abnormal curvature of the spine. It affects about 2% of women and 0.5% of men and can begin in infancy, childhood, adolescence, or adulthood. While a certain amount of curvature in the spine from front to back is normal, curvature that goes from left to right is characteristic of scoliosis. Several subsets of scoliosis exist based on the location of the abnormal curvature and its characteristics. Rotoscoliosis is used to define one of the most severe forms of scoliosis. The name comes from the word “rotation”. In this type of scoliosis the vertebral column is both curved toward the side and rotated. All scoliosis has a degree of rotation or twisting of the spine but in rotoscoliosis it is severe.
Scoliosis can be congenital, meaning it is present before birth (usually caused by abnormal formation of spinal bones)--or idiopathic, in which case it develops after birth. The cause of a scoliosis can typically be identified as one or more of three causes. A functional scoliosis develops in response to a skeletal or movement abnormality elsewhere in the body. For example, a discrepancy in length between the legs could cause a functional scoliosis to develop because the hips are not even. A scoliosis can also be neuromuscular in origin meaning it is associated with a condition that affects the nerves or the muscles. Finally degeneration of the vertebral bodies and weakening of their supporting ligaments can cause scoliosis to develop in adults.
HOW IS THIS CONDITION IDENTIFIED?
If scoliosis is mild it may be hard to identify without an X-ray, CT, or MRI of the spine. If moderate or severe, the following are visible signs that may indicate scoliosis:
-One shoulder is higher than the other
-One hip is higher than the other
-A “rib hump” can be seen on one side of the back as the person bends forward
-One shoulder blade is more prominent than the other
-The spine appears twisted
-Clothing appears to hang unevenly
Radiologists use certain measurement techniques to quantify the degree of curvature of a rotoscoliosis. This allows them to monitor progression over time and to guide treatment decisions.
HOW DOES IT FEEL?
A mild rotoscoliosis may not cause any symptoms. As the rotation and sidebending of the spine increase, discomfort or pain in the back or rib cage may develop. A person may notice changes in their walking gait or in their ability to perform daily tasks like reaching, bending, or even sleeping. If the degrees of curvature and rotation are severe enough, the heart and lungs can even be affected. With the changes in rib cage position, taking a full breath may become restricted.
WHAT CAN BE DONE?
Observation: In young children with a mild scoliosis observation may be the first course of treatment. If a child has a mobility impairment it can be helpful to use proper positioning equipment to make sure their spine is aligned optimally, for example while they are sitting to help limit curvature and rotational progression.
Physical Therapy and Exercise: Advances in conservative treatment for scoliosis have come a long way. Exercise and physical therapy are important tools to help manage a condition like rotoscoliosis. At Evolve, we utilize the Schroth Method, a physical therapy technique that can help stop the progression of scoliosis and has been proven to reduce pain.
Bracing: Bracing is often helpful in stopping the progression of skeletal maturity in those with moderate scoliosis who have not yet reached skeletal maturity. Bracing is customized to fit the individual’s body and needs to be regularly reassessed to ensure proper fit. They may need to be worn for 16-23 hours a day until skeletal maturity is reached.
Surgery: Surgical intervention to straighten and stabilize the spine may be recommended in children with severe curvature and adults with severe curvature who are also experiencing signs of nerve damage or compression such as leg weakness and bowel or bladder issues.
The appropriate treatment measures for your rotoscoliosis should be decided upon by you and your physicians. Whether observation, bracing, or surgery is the route you are taking, physical therapy can be an important treatment strategy to improve your pain, slow the progression of rotoscoliosis, and help maximize your ability to participate in all the activities of daily life.
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