What is Scoliosis?
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 a disorder that causes an abnormal curve of the spine, or backbone. The spine has normal curves when looking from the side, but it should appear straight when looking from the front. Kyphosis is a curve seen from the side in which the spine is bent forward. There is a normal kyphosis in the middle (thoracic) spine. Lordosis is a curve seen from the side in which the spine is bent backward. There is a normal lordosis in the upper (cervical) spine and the lower (lumbar) spine. People with scoliosis develop additional curves to either side, and the bones of the spine twist on each other, forming a “C” or an “S” shape in the spine.
Scoliosis is about two times more common in girls than boys. It can be seen at any age, but it is most common in those over 10 years of age. Scoliosis is hereditary in that people with scoliosis are more likely to have children with scoliosis; however, there is no correlation between the severity of the curve from one generation to the next.
What Causes Scoliosis?
Scoliosis can affect about 2% of females and 0.5% of males. In most cases, the cause of scoliosis is unknown (idiopathic). This type of scoliosis is described based on the age when scoliosis develops. If the person is less than 3 years old, it is called infantile idiopathic scoliosis. Scoliosis that develops between 3 and 10 years of age is called juvenile idiopathic scoliosis, and people that are over 10 years old have adolescent idiopathic scoliosis. More than 80% of people with scoliosis have idiopathic scoliosis, and the majority of those are adolescent girls.
There are three other main types of scoliosis:
- 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.
- Neuromuscular: 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: Unlike the other forms of scoliosis that are found in children and teens, degenerative scoliosis occurs in older adults. It is 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.
- 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.
What are the symptoms and signs of Scoliosis?
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. It can also be found on a routine school screening examination for scoliosis. Those affected may notice that their clothes do not fit as they did previously or that pant legs are longer on one side that the other.
Scoliosis may 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. If the scoliosis is more severe, it can make it more difficult for the heart and lungs to work properly. This can cause shortness of breath and chest pain.
In most cases, scoliosis is not painful, but there are certain types of scoliosis can cause back pain.
How is Scoliosis diagnosed?
The physical examination involves looking at the curve of the spine from the sides, front, and back. The person will be asked to undress from the waist up to better see any abnormal curves. The person will then bend over trying to touch their toes. This position can make the curve more obvious. The doctor will also look at the symmetry of the body to see if the hips and shoulders are at the same height. Any skin changes will also be identified that can suggest scoliosis due to a birth defect. The doctor may check your range of motion, muscle strength, and reflexes.
The more growth that a person has remaining increases the chances of scoliosis getting worse. As a result, the doctor may measure the person’s height and weight for comparison with future visits. Other clues to the amount of growth remaining are signs of puberty such as the presence of breasts or pubic hair and whether menstrual periods have begun in girls.
If the doctor believes you have scoliosis, you could either be asked to return for an additional examination in several months to see if there is any change, or the doctor may obtain X-rays of your back. If X-rays are obtained, the doctor can make measurements from them to determine how large of a curve is present. This can help decide what treatment, if any, is necessary. Measurements from future visits can be compared to see if the curve is getting worse.
It is important that your doctor knows how much further growth you have left. Additional X-rays of the hand and wrist or pelvis can help determine how much more you have to grow. If your doctor finds any changes in the function of your nerves, he or she may order other imaging tests of your spine including an MRI or CT scan to look more closely at the bones and nerves of your spine.
What is the treatment of 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.