The following is an interview between Dr Cotrel and various students

What is scoliosis ?
Let me remind you of a few anatomy notions : the human spine is comprised of 24 mobile vertebrae, piled on top of the other, they form the vertebral column.

From the profile, this vertebral column presents curves moving in different directions.  These are cervical or lumbar kyphosis or lordosis.  These curves are physiological.  Their role: assure anteroposterior balance of the trunk.  However, disease can increase one or several of these curves. This curvature is pathological.  All lateral deviation of the vertebral column is a scoliosis.  It brings about an asymmetry of the trunk noticeable in a standing position at the neckline, the shoulders, the shoulder blade, and the waist. Scoliosis is not a disease in itself; it is a symptom of miscellaneous causes. 

Do different types of scoliosis exist ?
Yes, they are numerous.  

Above all, it is necessary to distinguish the scoliotic attitude from the structural scoliosis. Only these are pathological; the structural scoliosis are the lateral deviations of the spine with a deformation of the all of the components: vertebrae, disks and ligaments. They are present in lying position and evolve in the 3 dimensions of space, creating a true twisting of the vertebral column. The three-dimensional thoracic deformation can have severe respiratory consequences.

A clinical indicator is essential for diagnoses of the scoliosis structure: a lateral protrusion, or gibbosity.
It is a sign that all parents should know and look for periodically.

What are the causes of structural scoliosis ?
For certain scoliosis, the cause is evident. In the case of congenital abnormalities, for example, the diagnostic can be clearly established by an x-ray examination at birth.  In other cases, the scoliosis appears in the context of evolution of a well-known disease.  It is one of the clinical signs. We can see this in bone, neuromuscular, conjunctive tissue, or metabolic diseases, for example.

In 70% of the cases, scoliosis constitutes the only apparent sign of the disease. This is called idiopathic scoliosis.

The twisting is the only known manifestation. The diagnostic can only be made through a process of elimination. 5% of school-aged children suffer from this condition.

How does this idiopathic scoliosis evolve  ?
Some scoliosis will progressively get worse, others will stabilize, and still others will spontaneously decline.  

An x-ray examination is essential. ? Bone age is the capital element in a prognostic to gauge the risks of worsening.  To note, earlier the appearance of a scoliosis, more risk there is for it to evolve.  The infantine forms discovered before 3 years of bone age are often the most progressive and particularly impressive.  The juvenile forms appear between 3 years and puberty.  They don’t evolve in the same rapidity or in the same seriousness but puberty is always a risky stage.  80% of those affected by this form are girls.  Adolescent scoliosis that occurs after puberty is normally less severe and more often stabilized.  At the adult age, especially senior citizens, the scoliotic spine can deteriorate severely causing distress and severe pain.

Idiopathic scoliosis does it remain a vast field of research  ?
So many questions remain unanswered!
What are the causes ? Why is scoliosis so much more frequent in girls than in boys? What determines the localization ? Why do certain evolve more than others ?
Are there other anomalies associated that are unknown? Do the centers of balance play a role ?

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