Scoliosis can be a confusing topic, especially when trying to distinguish between functional and anatomical scoliosis. Both types involve a curvature of the spine, but their causes, implications, and treatments differ significantly. Let's delve into the key differences and understand why proper evaluation methods are crucial.
Functional Scoliosis
Functional scoliosis is caused by external factors, primarily pelvic torsion and a functional leg length discrepancy (LLD). When the pelvis is misaligned or one leg is functionally shorter than the other, the spine compensates by curving to maintain balance. This type of scoliosis is not due to structural abnormalities within the spine itself. Instead, it's a compensatory mechanism that can often be corrected by addressing the underlying issues, such as realigning the pelvis or correcting the leg length discrepancy.
Anatomical Scoliosis
In contrast, anatomical scoliosis is due to inherent structural abnormalities within the spine, such as vertebral deformities or congenital factors. This type of scoliosis involves a fixed curvature that cannot be corrected by addressing external factors. Treatment typically focuses on managing the structural issues, which may include bracing or surgery in severe cases.
Prevalence and Patterns
Research indicates that anatomical scoliosis affects approximately 2-3% of the population, with varying degrees of severity. It is more common in females, particularly during the adolescent growth spurt. Functional scoliosis, however, is less commonly discussed in statistics, but it is frequently seen in clinical practice, especially in individuals with significant pelvic torsion or leg length discrepancies.
Evaluation Techniques
One of the most critical aspects of managing scoliosis is accurate evaluation. Many people don't realize that evaluating scoliosis in a standing position can be misleading. When a person stands, their body makes compensatory adjustments to maintain balance, which can obscure the true nature of the spinal curvature.
That's why I always evaluate scoliosis in a supine position. When lying down, the body's compensatory mechanisms are minimized, allowing for a more accurate assessment of the spine's alignment. This method helps distinguish between functional and anatomical scoliosis, ensuring that the underlying cause is correctly identified and appropriately treated.
Understanding the difference between functional and anatomical scoliosis is essential for accurate diagnosis and effective treatment. While anatomical scoliosis is due to structural issues within the spine, functional scoliosis results from external factors like pelvic torsion and leg length discrepancies. Proper evaluation, particularly in a supine position, is crucial for identifying the true nature of the scoliosis and determining the best course of action. By recognizing these distinctions, we can better manage scoliosis and improve outcomes for those affected by this condition.
References:
Qiao, J., Xu, L., & Zhu, F. (2018). Characteristics and differences between functional and structural scoliosis: a review. Journal of Orthopaedic Surgery and Research, 13(1), 102. https://doi.org/10.1186/s13018-018-0816-5
Weinstein, S. L., Dolan, L. A., Wright, J. G., & Dobbs, M. B. (2013). Effects of bracing in adolescents with idiopathic scoliosis. The New England Journal of Medicine, 369(16), 1512-1521. https://doi.org/10.1056/NEJMoa1307337
Pappou, I. P., & Girardi, F. P. (2015). Adult scoliosis. European Spine Journal, 24(S1), 59-64. https://doi.org/10.1007/s00586-014-3704-8
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