Scoliosis (pronounced sko-lee-oh-sis) is a three-dimensional abnormality that occurs when the spine becomes rotated and curved sideways. The condition affects between 2% and 3% of Americans, which is about six to nine million people. At Novus Spine & Pain Center, we actively treat the pain of scoliosis.
Though all forms of scoliosis involve some degree of spinal curvature, some are more severe than others. The various types of scoliosis are classified by the age of onset, as well as the speed and mechanism of progression.
In most people, the spine runs straight down the middle of their back. However, a person with scoliosis has a sideways curvature of the spine. As a result, they may lean a little, or their shoulders or hips may look uneven.
The angle of the curve may vary, but anything that measures greater than 10 degrees is considered scoliosis. Doctors may use the letters “C” and “S” to describe the curve of the backbone.
Some key points to know about scoliosis are:
Scoliosis is often first diagnosed in children, but treatment and monitoring may be lifelong.
Scoliosis can develop early in life or be the result of a syndrome that affects adults.
Early intervention yields the best results when treating scoliosis.
Scoliosis does not always cause pain.
Often, the causes of scoliosis are not known.
A few people with scoliosis need surgery.
Scoliosis is more common in females than in males, and females are eight times more likely to need treatment.
Everyone’s spine has subtle natural curves. The spine curves from front to back to naturally position the head over the pelvis and act as a shock absorber to distribute the stress of the body’s movements. When viewed from behind, the spine is a straight line down the middle of the back.
In general, scoliosis is a sideways curvature of the spine. It occurs when the vertebrae (bones of the spine) form an abnormal side-to-side curvature of the spine. Sometimes the vertebrae also rotate (twist), like a corkscrew. With scoliosis, the spine looks more like the letter “S” or “C” than a straight line in an x-ray taken from the front or back of the patient.
Scoliosis can result in someone leaning to one side and make their shoulders or waist appear uneven. Large curves can make the ribs rub against the pelvis, causing pain. Very large curves can damage the joints and cause arthritis of the spine. In extreme cases, scoliosis can cause lung problems.
Scoliosis can appear at any age, but it often presents itself from the ages of 10 to 12 years old, or during the teen years. However, children of any age (even infants) can have scoliosis.
What Are the Different Types of Scoliosis?
There are three categories for the different forms of scoliosis: idiopathic (unknown origin), congenital (birth defect), and neuromuscular (secondary to a neurological or muscular condition).
Adolescent idiopathic scoliosis is the most common form of scoliosis affecting as many as 4 out of 100 children between the ages of 10 and 18. The name for this condition comes from the age of onset (adolescence) and the fact that no single cause has been identified. By the age of 10, spinal growth starts to slow; if the child has already developed a significant degree of spinal curvature by this point, the curve may continue to progress into adulthood.
Adult idiopathic scoliosis is basically a continuation of adolescent idiopathic scoliosis. Spinal curvatures may increase by as much as two degrees a year. Scoliosis can occur in the thoracic (upper) and lumbar (lower) spine, causing shoulder asymmetry, a rib hump, or a prominence of the lower back on the side of the curvature. Curves can worsen in older patients due to disc degeneration.
Congenital scoliosis affects 1 in 10,000 births and is therefore relatively rare. It is the result of the spine not forming correctly before birth. A diagnosis of congenital scoliosis may be made in early infancy if outward signs are present, but many cases are diagnosed in later childhood. Scoliosis may worsen as a child and asymmetries in the body may develop.
Degenerative scoliosis (de novo scoliosis, adult-onset scoliosis, or late onset scoliosis) may develop slowly over time as a part of the natural aging process with the degeneration of the joints and discs in the spine. An uneven degradation can cause the spinal curvature to become more pronounced on one side and is more common in the lumbar (lower) spine.
Early onset scoliosis is the development of scoliosis before the age of 10. It is important to differentiate between adolescent and early-onset scoliosis because children over the age of 10 have already completed most of their spinal growth while children under 10 are still growing. Because children younger than 10 are still growing, early onset scoliosis can affect more than just the spine. It can lead to malformed ribs and affect lung development. In many cases, children with early onset scoliosis do not show any outward signs of spinal problems, especially if the curve is mild.
Idiopathic scoliosis is a type of scoliosis with unknown (idiopathic) origins. Onset is usually at adolescence, or around the age of 10. Doctors are most concerned about scoliosis in children because the child still has significant growth remaining. When diagnosed in children 2 or younger, this type of scoliosis is called infantile idiopathic scoliosis.
Neuromuscular scoliosis is a type of idiopathic scoliosis that develops secondary to various disorders of the spinal cord, brain, or muscular system (such as cerebral palsy, spina bifida and muscular dystrophy). Spinal curvature occurs when the nerves and muscles are unable to maintain the proper alignment and balance of the spine and trunk. The curvature is likely to progress into adulthood and may become increasingly severe, making patients unable to walk.
Scheuermann’s Kyphosis is a type of scoliosis in which the front sections of spinal vertebrae grow more slowly than the back sections, making them smaller and causing a forward rounding of the spine. It usually affects the cervical and thoracic spine. Typically diagnosed during adolescence, it develops secondary to some structural deformity in the vertebrae. In most cases, the symptoms generally do not worsen over time.
Syndromic scoliosis is a form of scoliosis that develops secondary to another syndrome. Some of the syndromes that are most commonly linked to syndromic scoliosis include Rett’s syndrome, Beale’s syndrome, muscular dystrophy, Marfan’s syndrome, and various connective tissue disorders. The connection between the various disorders and syndromic scoliosis is well-known, and doctors usually screen children for scoliosis who develop these disorders at an early age.
While most people with scoliosis have a mild form of the disorder, scoliosis can sometimes cause serious complications, including:
Lung and heart damage. If the rib cage presses against the lungs and heart, breathing is more difficult, and the heart works harder to pump blood.
Back problems. An adult who had scoliosis as a child is more likely to have chronic back pain than other adults.
Appearance. As scoliosis worsens, it can cause more noticeable changes that include unlevel shoulders, prominent ribs, uneven hips, and a shift of the waist and trunk to the side.
What Causes Scoliosis?
Scoliosis can be classified by its cause or origin. However, some kinds of scoliosis have no apparent cause (idiopathic scoliosis), though there may be hereditary factors that tend to run in families.
Idiopathic scoliosis is the diagnosis for the disorder when all other causes are excluded. Adolescent idiopathic scoliosis is the most common type of scoliosis and is usually diagnosed during puberty.
In cases where scoliosis has a clear cause, doctors classify the condition as either structural or nonstructural.
In nonstructural scoliosis, the spine works normally but looks curved. There can be several reasons for this, such as one leg being longer than the other, muscle spasms, and inflammations like appendicitis. With the proper treatment of the underlying problems, this type of scoliosis often goes away.
In structural scoliosis, the curve of the spine is rigid and can’t be reversed. Some of the causes can include:
Genetic conditions like Marfan syndrome and Down syndrome.
Congenital scoliosis begins as a baby’s back develops before birth. Problems with the tiny bones in the back (vertebrae) can cause the spine to curve improperly. Doctors may detect this condition when the child is born. Or, they may not find it until the child reaches the teen years.
Some cases of scoliosis may develop as a result of degeneration of the spinal discs (arthritis, osteoporosis).
What Are the Risk Factors for Scoliosis?
Some of the risk factors for developing the most common types of scoliosis include:
Age: Signs and symptoms typically begin during the growth spurt that occurs just before puberty.
Genetics: People with scoliosis may have a close relative with the condition.
Gender: Although both boys and girls develop mild scoliosis at about the same rate, girls have a much higher risk of the curve worsening and requiring treatment.
It is important to note that an individual cannot cause scoliosis. The condition is not the result of carrying heavy backpacks, active participation in sports, poor posture, or anything else a person might do. Furthermore, the abnormal curves in the back cannot be corrected by “learning to stand up straight.”
What are the Signs and Symptoms of Scoliosis?
Sometimes scoliosis is easy to see (signs). The symptoms of scoliosis, however, can resemble other spinal condition or may be a result of an injury or infection. A curve in the spine can make the body appear to be leaning to one side. Often, however, scoliosis isn’t evident. That’s why health care providers do a scoliosis exam as part of a regular checkup with children.
Scoliosis typically becomes apparent from infancy with signs such as:
A bulge on one side of the chest.
A baby might consistently lie curved to one side.
In more severe cases, there may be problems with the heart and lungs resulting in shortness of breath and chest pain.
Other signs may indicate the possibility of scoliosis in adolescents and adults. The signs vary but can include:
A difference in shoulder blade height or position, or one shoulder blade appears more prominent than the other.
A difference in shoulder height.
The head is not centered directly above the pelvis.
One or both hips are raised or unusually high.
Prominence or asymmetry in the ribs seen from the front or back.
The rib cage is not symmetrical, or the ribs may be at different heights.
The waist is uneven.
The entire body leans to one side.
When bending forward, the sides of the back appear different in height.
When standing straight, there is a difference in the way the arms hang beside the body.
There is a change in the appearance or texture of the skin overlying the spine (dimples, hairy patches, color abnormalities).
There are additional symptoms in adults with idiopathic scoliosis, because of disc and joint degeneration leading to a narrowing of the openings for the spine and nerves (spinal stenosis). Some of the symptoms of adults with degenerative scoliosis include:
Shooting pain down the legs.
Low back pain and stiffness are the two most common symptoms.
Numbness and cramping in the legs.
Fatigue resulting from strain on the muscles of the lower back and legs.
These symptoms can worsen and lead to a gradual loss of function. Some patients may lean forward to try to relieve pressure on the nerves. Others may lean forward because of the loss of their natural curve in their lumbar spine (low back), causing them to bend their hips and knees in an effort to maintain an upright posture.
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.
How is Scoliosis Diagnosed?
To diagnose scoliosis, a doctor will take a detailed medical history. For a child, the doctor will also want to know about recent growth. Because scoliosis often runs in families, the medical history will include questions about the patient’s family health.
The doctor will also conduct a physical examination of the spine, ribs, hips, and shoulders. The doctor will check to see if one side of the rib cage is more prominent than the other. The doctor may also perform a neurological exam to check for:
Using a tool called an inclinometer (or scoliometer), the doctor can measure the degree of a scoliosis curve. A positive diagnosis is made if the curve is greater than 10 degrees. Scoliosis is generally considered significant if the back has a curve greater than 25 to 30 degrees. Curves exceeding 45 to 50 degrees are considered severe.
Confirmation of a scoliosis diagnosis is usually made with an imaging test to reveal the severity of the spinal curvature. The imaging tests can include:
X-ray. An x-ray can show the structure of the vertebrae and the outline of the joints, while also used to search for other potential causes of pain (infections, fractures, or deformities). The X-ray may be taken from both the back and the side to better determine the degree of curvature.
Computed tomography scan (CT or CAT scan). Computer-aided X-rays can show the shape and size of the spinal canal and surrounding structures. More detailed than an X-ray, a CT scan can show detailed images of any part of the body, including the bones, muscles, fat, and organs.
Magnetic resonance imaging (MRI). This powerful, three-dimensional image of body structures can show the spinal cord, nerve roots, and surrounding areas, as well as degeneration and deformities. An MRI is usually ordered if there is pain associated with scoliosis, the physician finds neurologic abnormalities during the physical examination, or if the patient has an “atypical” curve pattern.
If the doctor suspects an underlying condition, such as a tumor causing the scoliosis, additional tests may be ordered.
How is Scoliosis Treated in Children?
While there are guidelines for mild, moderate, and severe curves, the decision to begin treatment for a child is always made on an individual basis. Some of the factors the doctor will consider regarding treatment include:
Gender. Girls tend to have a much higher risk of scoliosis than boys.
Severity of curve. Severe curves are more likely to worsen with time.
Curve pattern. Double curves, also known as “S-shaped” curves, tend to worsen more often than do “C-shaped” curves.
Location of the curve. Curves located in the center (thoracic) section of the spine worsen more often than do curves in the upper or lower sections of the spine.
Maturity. If a child’s bones have stopped growing, there is less risk of curve progression. Braces are more effective in children whose bones are still growing.
In cases of mild scoliosis in a child, the doctor will take a “wait-and-see” approach with checkups every four to six months to monitor any change in the curvature of the spine.
When treatment is used for children, it can include:
Braces. If a child is still growing (has not reached skeletal maturity) and has a curve between 25 degrees and 40 degrees, a brace may help prevent the curve from progressing. However, a brace will not cure or reverse scoliosis. Braces are usually worn all the time, even at night. The brace tends to be more effective when worn more hours per day. Braces are discontinued after the bones stop growing. The long-term use of braces in adolescents is discouraged because braces can weaken the core muscles.
Casting. Casting instead of bracing is sometimes used for infantile scoliosis to help the infant’s spine to go back to its normal position as it grows. Made of plaster of paris, the cast is attached to the patient’s body and worn at all times. Because an infant grows rapidly, the cast is changed regularly.
Most children with scoliosis have mild curves and probably won’t need treatment with a brace or surgery. In fact, slight curves that are found in 90% of scoliosis cases don’t typically require treatment.
How is Scoliosis Treated in Adults?
For adults with degenerative scoliosis, non-operative treatment is appropriate for most adults who don’t have disabling symptoms. Treatments can include:
Periodic observation. For adults, X-rays are usually recommended once every five years, unless symptoms progressively worsen.
Over-the-counter pain relievers.
Although physical therapy and exercises can’t stop scoliosis, general exercise or participating in sports may have the benefit of improving overall health and well-being. The goal is to strengthen the core muscles of the abdomen and back to help improve flexibility.
In cases of degenerative scoliosis that produces disabling pain in the back or legs, treatment can include:
Epidurals or nerve block injections. These can provide temporary relief for persistent pain.
Brace. Used for short periods, a brace can help relieve some pain.
Surgery can improve spinal balance and relieve spinal nerve pressure, which helps reduce pain. The spinal bones can be fused together to correct the alignment.
Surgical Treatment for Scoliosis
For children that require surgery, the primary goal is to stop the curve from progressing during adulthood and to diminish spinal deformity. Surgery is usually recommended only when the spinal curvature is greater than 40 degrees, and there are signs of progression.
The surgery (spinal fusion) straightens the spine as much as possible and holds it in place with rods and screws. Bone grafts then join (fuse) some of the vertebrae together.
In adults, surgery may be recommended when the spinal curve is greater than 50 degrees, and the patient has nerve damage in the legs and/or is experiencing bowel or bladder symptoms. The goal is to restore spinal balance, reduce pain and discomfort by relieving nerve pressure (decompression), and maintain correct alignment by fusing and stabilizing the spinal segments.
The surgical procedures for scoliosis include:
Decompression surgery removes the roof of the spinal canal (laminectomy) and enlarges the spaces where the nerve roots exit the canal (foraminotomy), resulting in decompressed nerve roots and pain relief. Typically, surgery is only used at one or two vertebral levels in patients with leg pain from stenosis and spinal curves that are less than 30 degrees. For degenerative scoliosis, spinal fusion is also done in conjunction with decompression surgery.
Surgical stabilization involves anchoring hooks, wires, or screws to the spinal segments and using metal rods to link the anchors together. They stabilize the spine and allow the spine to fuse in the corrected position. It is also performed with the addition of a fusion.
Fusion uses the patient’s own bone, or cadaver or synthetic bone substitutes, to “fix” the spine into a straighter position.
Osteotomy is a procedure in which spinal segments are cut and realigned.
Vertebral column resection removes entire vertebral sections prior to realigning the spine. This type of surgery is used when an osteotomy and other operative measures cannot correct scoliosis.
Approximately 90% of people identified with idiopathic scoliosis have curves that never progress enough to require bracing or surgery.
Do Other Treatments Work?
Studies indicate that many alternative treatments for scoliosis are ineffective. Chiropractic treatment, nutritional supplements, and electrical stimulation of the muscles have not been shown to stop changes in spinal curves.
While exercise doesn’t have a direct effect on scoliosis, it’s essential to stay fit and maintain a healthy weight at every age. Activities like running, walking, and soccer can help keep bones strong, which is especially important in coping with scoliosis as the patient ages.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating scoliosis pain. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.