What Is Scoliosis, Causes and Treatment Options: Scoliosis (pronounced sko-lee-o-sis) is a three-dimensional abnormality that occurs when the spine becomes rotated and curved sideways.
The angle of the curve may be small, large or somewhere in between. But anything that measures more than 10 degrees is considered scoliosis. Doctors may use the letters “C” and “S” to describe the curve of the backbone.
You probably don’t look directly at too many spines, but what you might notice about someone with scoliosis is the way they stand. They may lean a little or have shoulders or hips that look uneven.
In most cases, doctors don’t find the exact reason for a curved spine. Scoliosis without a known cause is what doctors call “idiopathic.”
Some kinds of scoliosis do have clear causes. Doctors divide those curves into three types:
Adolescent scoliosis comprises approximately 80% of all idiopathic scoliosis cases. Adolescence is when rapid growth typically occurs, which is why the detection of a curve at this stage should be monitored closely for progression as the child’s skeleton develops.
A scoliosis curve usually looks a bit like a backward C shape and involves the spine bending sideways to the right, which is also called dextroscoliosis. Sideways spinal curvature on the left side of the back is more like a regular C shape and called levoscoliosis. Here are four common types of scoliosis curves:
Treatment options for idiopathic scoliosis could include:
In nonstructural scoliosis, the spine works normally, but looks curved. Why does this happen? There are a number of reasons, such as one leg’s being longer than the other, muscle spasms, and inflammations like appendicitis. When these problems are treated, this type of scoliosis often goes away.
In structural scoliosis, the curve of the spine is rigid and can’t be reversed.
Congenital scoliosis begins as a baby’s back develops before birth. Problems with the tiny bones in the back, called vertebrae can cause the spine to curve. The vertebrae may be incomplete or fail to divide properly. Doctors may detect this condition when the child is born. Or, they may not find it until the teen years.
Family history and genetics can also be risk factors for idiopathic scoliosis. If you or one of your children has this condition, make sure your other kids are screened regularly.
Scoliosis shows up most often during growth spurts, usually when kids are between 10 and 15 years old. About the same number of boys and girls are diagnosed with minor idiopathic scoliosis. But curves in girls are 10 times more likely to get worse and may need to be treated.
Scoliosis diagnosed during the teen years can continue into adulthood. The greater the angle of the spine curve, the more likely it is to increase over time. If you had scoliosis in the past, have your doctor check your back regularly.
Degenerative scoliosis affects adults. It usually develops in the lower back as the disks and joints of the spine begin to wear out as you age.
A mild scoliosis curve can go unnoticed to the untrained eye. However, if the curve progresses, various signs and symptoms can become obvious.
Oftentimes scoliosis is first suspected when someone notices something slightly off and comments. Some examples could include:
Even if a newly discovered asymmetry appears minor, it should be checked by a doctor because scoliosis is easier to treat when caught early.
Only about 10% of people with idiopathic scoliosis have a curve that progresses beyond mild and needs treatment.3 If that progression happens, the deformity becomes more obvious to other people and more likely to cause noticeable symptoms.
Some of the more common symptoms present in moderate or severe scoliosis could include:
No. So forget the rumors you may have heard, such as, “Childhood sports injuries can cause scoliosis.” Not true.
And what about poor posture? The way a person stands or sits doesn’t affect their chances for scoliosis. But a curved spine may cause a noticeable lean. If your child isn’t able to stand upright, ask your doctor to look at her spine.
involves a healthcare professional observing the patient bending forward at the waist 90 degrees with arms stretched toward the floor and knees straight. From this position, most scoliosis signs that present as asymmetry are clearly visible in the spine and/or trunk of the body, such as:
The first step toward getting an idiopathic scoliosis diagnosis is typically the Adam’s forward bend test, which primarily looks for abnormal spine rotation.
The Adam’s forward bend test can be useful in detecting scoliosis located in the upper or mid back, which is where idiopathic scoliosis usually occurs. However, the forward bend test is not as effective at detecting scoliosis in the low back because it does not involve rib rotation.
As part of the forward bend test, the clinician might use a scoliometer, also called an inclinometer, to estimate the angle of trunk rotation (ATR). While the patient is still bending forward, the clinician can put the scoliometer flat on the back in the area or areas where the asymmetry looks the greatest.
As a general rule, if an ATR of at least 5 degrees is recorded, the patient will either be scheduled for a follow-up exam or referred to a doctor who can image the back for more accurate scoliosis testing.7,8 X-ray imaging is needed to measure the degree of the curve and confirm scoliosis.
The lateral curve of scoliosis is described by the Cobb angle. Using an X-ray of the full spine, the Cobb angle is found by drawing a perpendicular line from the spine’s most-tilted vertebra above the sideways curve’s apex and a second perpendicular line from the most-tilted vertebra beneath the apex. The angle formed where those two lines meet is the Cobb angle.
A Cobb angle of at least 10 degrees is typically considered the borderline for a scoliosis diagnosis.
When diagnosing idiopathic scoliosis, there are 3 key components to take into consideration:
Understanding these components of a scoliosis diagnosis can help the medical team evaluate the severity of the curve, likelihood for progression, and which treatment options could be best.
Idiopathic means a condition is of unknown cause. As such, idiopathic scoliosis technically cannot be diagnosed until other types of scoliosis are ruled out. Other types of scoliosis could include:
If scoliosis starts to cause a noticeable deformity or is at high risk of doing so, a doctor might prescribe a brace to prevent the curve from getting any worse. Typically, a brace is worn until the adolescent has reached full skeletal maturity.
Knowing if a person’s scoliosis curve is likely to worsen is crucial to developing a treatment plan. Bracing is a major time commitment and uncomfortable for adolescents—both physically and emotionally—and is usually not prescribed unless the curve is at significant risk for progressing.
There are two general treatment options for scoliosis bracing:
Choosing between full-time bracing and nighttime bracing can depend on size and location of curves, as well as what the patient is willing to do. Some studies have found that nighttime bracing tends to be more effective because patients are more likely to wear a brace at night as prescribed, but other studies have found that full-time bracing—when adhered to as directed—could work even better.
While some people claim that treatments such as physical therapy and manual manipulation can help stop the progression of scoliosis, there is little scientific evidence to support these claims. Bracing is currently the only nonsurgical treatment that has been proven to reduce the natural progression of idiopathic scoliosis curves.
However, if given the okay by a doctor, exercise is healthy for people with scoliosis and helps keep the back strong and flexible.
Sometimes an idiopathic scoliosis curve continues to progress despite bracing. If this happens and the curve progresses past 40 or 50 degrees, surgery may be considered.
Scoliosis surgery typically has the following goals:
In addition, any adjustment of the spine must also consider the possible effect on the spinal cord. The health of the spinal cord must be monitored throughout the surgery.
There are 3 general categories of scoliosis surgery:
An advantage to spinal fusion surgery is that it has a long-term record of safety and efficacy for treating scoliosis. While a drawback to the procedure is that any fused vertebrae will lose mobility, which can limit some of the back’s bending and twisting, today’s spinal fusions tend to fuse fewer vertebrae and maintain more mobility than in the past.
If a spinal fusion is done at too young of an age (typically younger than age 10 in girls or less than 12 in boys), that could leave less room for the lungs to develop in addition to the child having an unusually short trunk compared to the limbs. To avoid these complications, the growing systems method helps guide the spine as it grows, preventing the curve from worsening as the spine matures and eventually becomes ready for a fusion if needed.
One fusionless method uses a vertebral tethering system, which involves placing screws on the outer side of the curve and then pulling them taut with a cord so the spine straightens. Compared to spinal fusion, fusionless surgery has the potential benefit of retaining more spinal mobility. However, this is a newer approach and long-term data about the risks and benefits are not yet available.
For an adolescent or young adult opting for scoliosis surgery today, by far the most commonly performed surgery is a spinal fusion.
If you or a family member are experiencing symptoms or discomfort from Scoliosis or suspect scoliosis, the experts in Spine Care, Interventional Spine and Back, Orthopedics and Physical Therapy here at TOCA are here to help! For questions or to schedule an appointment call us today at: 602-277-6211!
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