Scoliosis
What is
scoliosis?
In its normal
state, your spine should follow a straight vertical line when viewed from the front or back. Scoliosis is a
lateral, or sideways, spinal curvature. In most cases the curve forms a “C” shape to either the left or right,
but in some cases will curve to both sides creating the appearance of an “S” shape.

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Scoliosis can
occur at any age, but is most commonly diagnosed during adolescence between 10 and 16 years old. While as many
as 3% of Americans have some degree of scoliosis by age 16, less than one tenth of 1% have curves measuring
greater than 40 degrees which may require corrective surgery.
Most cases of
scoliosis never progress past a mild curve. Even without treatment, 80% of these will never progress beyond 20
degrees. Mild scoliosis is equally likely in both genders, but females are eight times more likely to progress
to a more severe degree of scoliosis requiring treatment.
Four primary
types of scoliosis
Congenital scoliosis is a relatively rare bone abnormality in the spine
present at birth. Hemivertebra is the most frequent birth defect causing congenital scoliosis, where half of a
vertebra does not form. The side with bone present grows faster after birth causing a spinal curvature. About
75% of patients with congenital curves eventually require treatment.
Neuromuscular scoliosis is caused by abnormal muscles or nerves. Most commonly
this is seen in patients with cerebral palsy, spina bifida, spinal cord injuries or muscular dystrophies. Cases
of neuromuscular scoliosis tend to be progressive and usually require some form of individualized
treatment.
Degenerative scoliosis is the only major form of scoliosis likely to start in
later years, usually after 65 years of age. As spinal discs and facet joints degenerate in the back of the
spine, they can turn and create a sideways curve in the vertebrae. Degenerative scoliosis can cause back pain
due to degeneration of these joints leading to arthritis and spinal stenosis.
Idiopathic scoliosis is by far the most common form of scoliosis, causing
about 85% of all scoliosis cases. It’s also the most common spinal deformity in children. The term “idiopathic”
itself means “unknown” – but there does appear to be a strong hereditary link in cases of idiopathic scoliosis.
Researchers have recently identified the first specific gene, CHD7, associated with idiopathic scoliosis.
However, a specific cause for idiopathic scoliosis has yet to be found.
What are the
symptoms of scoliosis?
Most cases of
scoliosis, especially during childhood and adolescence, are not associated with back pain. Scoliosis in children
is usually first observed by a parent, pediatrician, or during a routine school screening exam.
More severe
curves often create significant differences in shoulder or hip alignment, a noticeable leaning to one side, a
walk with a rolling gait, or a shoulder blade that juts out.
Progressive
cases of scoliosis may cause back pain as muscles forced to conform to the unnatural curvature of the spine lead
to muscle spasms. Joint deterioration related to degenerative scoliosis may also cause pain from inflammation
and pinched nerves.
Because most
scoliosis curvatures occur in the thoracic area (at the level of the chest), patients with scoliosis may tend to
experience back pain or tire more easily during activities that require excessive chest and stomach
movement.
Options for
treating scoliosis
“Do nothing” is a reasonable decision in many cases of scoliosis depending on
the individual situation. Usually this is an appropriate decision when the abnormal curvature is under 40
degrees and is not expected to progress.
Wearing a brace either part-time or full-time (about 23 hours per day) is one
method to prevent curves from progressing in younger patients who are still growing. Back braces are usually
considered for children and adolescents with a curve between 20 and 40 degrees. Back braces usually won’t
correct a curve, but is often effective at stopping curves from worsening.
Spinal fusion surgery is often recommended for scoliosis patients with curves
of greater than 40 degrees, due to the normally progressive nature of severe curves. There are significant risks
associated with any spinal surgery, not the least of which is the patient may continue to have even debilitating
pain after surgery. Surgery for scoliosis may be the right option, but all risks must be considered
first.
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