Scoliosis – Get A Better Understanding
Scoliosis is an abnormal curve in the spine. There are several types of scoliosis based on the cause and age when the curve develops. Depending on the severity of the curve and the risk for it getting worse, scoliosis can be treated with observation, bracing, or surgery. Scoliosis is not a disease, but rather it’s a term used to describe any abnormal, sideways curvature of the spine. Viewed from the back, a typical spine is straight. When scoliosis occurs, the spine can curve in one of three ways:
- The spine curves to the side as a single curve to the left (shaped like the letter C), called levoscoliosis
- The spine curves to the side as a single curve to the right (shaped like a backwards letter C), called dextroscoliosis
- The spine has two curves (shaped like the letter S).
Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown. Because the skeletons of children and young adults grow quickly, there is a reasonable chance that if a curve is detected, the degree of the spinal curve may worsen as the spine continues to grow. In those cases, scoliosis treatment may become advisable. Rarely (in 0.2 to 0.5% of all cases), untreated and an especially severe spinal curve can reduce the amount of space within the chest, making it difficult for the lungs to function properly. Most cases of scoliosis are mild, but some children develop spine deformities that continue to get more severe as they grow. Severe scoliosis can be disabling.
Types and Causes of Scoliosis
- Congenital scoliosis. Caused by a bone abnormality present at birth.
- Neuromuscular scoliosis. In this type of scoliosis, there is a problem when the bones of the spine are formed. Either the bones of the spine fail to form completely or they fail to separate from each other during fetal development. This type of scoliosis develops in people with other disorders, including birth defects, muscular dystrophy, cerebral palsy, or Marfan’s disease. People with these conditions often develop a long C-shaped curve and have weak muscles that are unable to hold them up straight. If the curve is present at birth, it is called congenital. This type of scoliosis is often much more severe and needs more aggressive treatment than other forms of scoliosis.
- Degenerative scoliosis. Unlike the other forms of scoliosis that are found in children and teens, degenerative scoliosis occurs in older adults. It’s caused by changes in the spine due to arthritis known as spondylosis. Weakening of the normal ligaments and other soft tissues of the spine combined with abnormal bone spurs can lead to an abnormal curvature of the spine. The spine can also be affected by osteoporosis, vertebral compression fractures and disc degeneration. Also may even result from traumatic (from an injury or illness) bone collapse, previous major back surgery or osteoporosis (thinning of the bones).
- Idiopathic scoliosis. The most common type of scoliosis, idiopathic scoliosis, has no specific identifiable cause. There are many theories but none have been found to be conclusive. There is, however, strong evidence that idiopathic scoliosis is inherited. Treatment of idiopathic scoliosis is based on the age when it develops. In many cases, infantile idiopathic scoliosis will improve without any treatment. X-rays can be obtained and measurements compared on future visits to determine if the curve is getting worse. Bracing is not normally effective in these people.
- Juvenile idiopathic scoliosis has the highest risk for getting worse of all of the idiopathic types of scoliosis. Bracing can be tried early if the curve is not very severe. The goal is to prevent the curve from getting worse until the person stops growing. Since the curve starts early in these people, and they have a lot of time left to grow, there is a higher chance for needing more aggressive treatment or surgery.
- Adolescent idiopathic scoliosis is the most common form of scoliosis. If the curve is small when first diagnosed, it can be observed and followed with routine X-rays and measurements. If the curve stays below 25 degrees, no other treatment is needed. You may return to see the doctor every three to four months to check for any worsening of the curve. Additional X-rays may be repeated each year to obtain new measurements and check for progression of the curve. If the curve is between 25-40 degrees and you are still growing, a brace may be recommended. Bracing is not recommended for people who have finished growing. If the curve is greater than 40 degrees, then surgery may be recommended.
- Functional: In this type of scoliosis, the spine is normal, but an abnormal curve develops because of a problem somewhere else in the body. This could be caused by one leg being shorter than the other or by muscle spasms in the back.
- Others: There are other potential causes of scoliosis, including spine tumors such as osteoid osteoma. This is a benign tumor that can occur in the spine and cause pain. The pain causes people to lean to the opposite side to reduce the amount of pressure applied to the tumor. This can lead to a spinal deformity.
Approximately 2% to 3% of Americans at age 16 have scoliosis. Less than 0.1% have spinal curves measuring greater than 40 degrees, which is the point at which surgery becomes a consideration. Overall, girls are more likely to be affected than boys. Idiopathic scoliosis is most commonly a condition of adolescence affecting those ages 10 through 16. Idiopathic scoliosis may progress during the “growth spurt” years, but usually will not progress during adulthood. Often detected by school screenings or regular physician visits.
Signs of Scoliosis
What your Doctor will look for:
- Curvature of the spine
- Uneven shoulders, or protrusion of one shoulder blade
- Asymmetry of the waistline
- One hip higher than the other.
Once scoliosis is detected, a physician will continue to monitor the curvature. The progression of spinal curvature is very well understood and is measured in degrees.
- Mild curvature that remains at 20 degrees or less will most likely require monitoring and observation, but further treatment is rarely needed.
- Curvature greater than 20 degrees may require non-surgical or surgical intervention, including treatments such as a back brace for scoliosis or scoliosis surgery, both of which prevent further progression of the curve.
Preventing severe curvature is important for the physical appearance and health of the patient. Curves greater than 50 degrees are more likely to progress in adulthood. If a curve is allowed to progress to 70 to 90 degrees, it will produce a disfiguring deformity. A high degree of curvature may also put the patient at risk for cardiopulmonary compromise as the curve in the spine rotates the chest and closes down the space available for the lungs and heart.
Symptoms of Scoliosis
- Uneven shoulders
- One shoulder blade that appears more prominent than the other
- Uneven waist
- One hip higher than the other
If a scoliosis curve gets worse, the spine will also rotate or twist, in addition to curving side to side. This causes the ribs on one side of the body to stick out farther than on the other side. Severe scoliosis can cause back pain and difficulty breathing.
The most common symptom of scoliosis is an abnormal curve of the spine. Often this is a mild change and may be first noticed by a friend or family member. The change in the curve of the spine typically occurs very slowly so it is easy to miss until it becomes more severe. Those affected may notice that their clothes do not fit as they did previously or that pant legs are longer on one side than the other. Scoliosis may even cause the head to appear off center or one hip or shoulder to be higher than the opposite side. You may have a more obvious curve on one side of the rib cage on your back from twisting of the vertebrae and ribs. In most cases, scoliosis is not painful, but there are certain types of scoliosis that can cause back pain. Additionally, there are other causes of back pain, which your doctor will want to look for as well. If you think you have scoliosis, you can see your doctor for an examination. The doctor will ask questions, including if there is any family history of scoliosis, or if you have had any pain, weakness, or other medical problems. Your doctor may check your range of motion, muscle strength, and reflexes.
Treatment for Scoliosis
Treatment of scoliosis is based on the severity of the curve and the chances of the curve getting worse. Certain types of scoliosis have a greater chance of getting worse, so the type of scoliosis also helps to determine the proper treatment. There are three main categories of treatment: observation, bracing, and surgery. In cases with back pain, the symptoms can be lessened with physical therapy, massage, and exercises, including yoga. These can help to strengthen the muscles of the back. They are not, however, a cure for scoliosis and will not be able to correct the abnormal curve.
Remember if the curve stays below 40 degrees until the person is finished growing, it’s not likely to get worse later in life. However, if the curve is greater than 40 degrees, it is likely to continue to get worse by 1-2 degrees each year for the rest of the person’s life. If this is not prevented, the person could eventually be at risk for heart or lung problems. The goals of surgery for scoliosis are correcting and stabilizing the curve, reducing pain and restoring a more normal curve and appearance to the spinal column.
Unlike back braces, which do not correct spinal curves already present, surgery can correct curvature by about 50%. Furthermore, surgery prevents further progression of the curve. There are several approaches to scoliosis surgery, but all use modern instrumentation systems in which hooks and screws are applied to the spine to anchor long rods. The rods are then used to reduce and hold the spine while bone that is added fuses together with existing bone. Once the bone fuses, the spine does not move and the curve cannot progress. The rods are used as a temporary splint to hold the spine in place while the bone fuses together, and after the spine is fused, the bone (not the rods) holds the spine in place.
However, the rods are generally not removed since this is a large surgery and it is not necessary to remove them. Occasionally a rod can irritate the soft tissue around the spine, and if this happens the rod can be removed. If a tumor such as osteoid osteoma is the cause of the scoliosis, surgery to remove the tumor is generally able to correct the curve. There are two general approaches to the scoliosis surgery – a posterior approach (from the back of the spine) and an anterior approach (from the front of the spine). Specific surgery is recommended based on the type and location of the curve. Scoliosis surgery is extensive surgery and is only recommended when scoliosis curves are progressing rapidly enough to potentially cause severe deformity. It’s important for patients to understand the risks of surgery and the post-surgery experience.
Go to your doctor if you notice signs or symptoms of scoliosis in your child. Mild curves, however, can develop without the parent or child knowing it because they appear gradually and usually don’t cause pain. Occasionally, teachers, friends and sports teammates are the first to notice a child’s scoliosis.