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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