What is scoliosis?
Scoliosis is a condition involving abnormal curvature of the spine. Scoliosis affects five to seven million people in the U.S. and can begin at any age. Its prevalence is 1-2% among adolescents and more than 50% in persons over the age of 60. Scoliosis occurs more often in females and tends to run in families.
What are the different types of scoliosis?
Scoliosis is divided into categories based on the age the condition is diagnosed:
- Infantile scoliosis (diagnosed before age three)
- Juvenile (diagnosed from age three to puberty)
- Adolescent scoliosis (diagnosed during puberty)
- Adult scoliosis (diagnosed in adulthood, when the spine is no longer growing)
- Degenerative scoliosis (typically diagnosed after age 40)
Most cases of scoliosis are first discovered and treated in childhood or adolescence-particularly during puberty when the curvature becomes more noticeable. When an adolescent has scoliosis with no known cause, doctors call the condition adolescent idiopathic scoliosis. This form of scoliosis can affect a child who is healthy and not having nerve, muscle, or other spine problems. It is the most common form of spinal deformity doctors see, affecting about three percent of the general population.
Scoliosis that occurs (or is discovered) after puberty is called “adult scoliosis.” Adult scoliosis can be the result of untreated or unrecognized childhood scoliosis, or it can arise during adulthood. The causes of adult scoliosis are usually different from childhood types.
Degenerative adult scoliosis occurs when the combination of age and deterioration of the spine leads to the development of a scoliosis curve in the spine. Degenerative scoliosis usually starts after the age of 40. In older patients, particularly women, it is also often related to osteoporosis. The osteoporosis weakens the bone, making it more likely to deteriorate. The combination of these changes causes the spine to lose its ability to maintain a normal shape. The spine begins to “sag” and as the condition progresses, a scoliotic curve can slowly develop.
What causes scoliosis?
There are many theories as to why scoliosis develops, but the root of the condition has yet to be discovered. Because the disorder tends to run in families, scoliosis appears to involve hereditary factors, however other forms of scoliosis can be caused by neuromuscular conditions, such as cerebral palsy or muscular dystrophy, birth defects that affect the development of the spinal bones, or spinal injuries and infections.
Scoliosis may be idiopathic, congenital, or occur as a consequence of another condition.
When scoliosis is idiopathic, this means no underlying cause can be identified. Most cases of scoliosis are considered idiopathic, with an incidence in the general population of 0.2-3%.
Congenital scoliosis is present at birth, with an incidence of approximately 0.5 to 1/1,000 births.
Scoliosis as a secondary symptom of another condition may occur in concert with neuromuscular diseases such as spina bifida, cerebral palsy, and hereditary musculoskeletal disorders, including osteogenesis imperfecta, Marfan syndrome, Stickler syndrome, Ehlers-Danlos syndrome, and muscular dystrophies. In other cases, scoliosis may arise from physical trauma, spinal stenosis, and bone collapse from osteoporosis.
Where in the spine does scoliosis occur?
A scoliosis curve can occur in the thoracic spine, the lumbar spine, or both areas at the same time. When the vertebrae in the mid and low back curve to the side, the normal appearance and condition of the spine and its muscles changes.
How is scoliosis measured?
The severity of the scoliosis is measured in degrees by comparing the curves to “normal” angles. Curves can range in size from as little as 10 degrees to severe cases of more than 100 degrees. The amount of curve in the spine helps your doctor decide what treatment to suggest. Conservative (nonsurgical) treatment is usually suggested for curves of less than 40 degrees, while curves over this amount may require surgery.
If scoliosis is suspected, a diagnosis must be made before an appropriate treatment plan can be developed, starting with a complete history and physical exam.
In order to make a proper diagnosis and rule out other possible conditions, the first step is to speak with the patient. Your doctor will want to know about the following:
- Family history: Scoliosis tends to run in families, so it may have a genetic cause. Your doctor will want to know if anyone else in your family has a problem.
- Date of onset: When did you first notice the appearance of your spinal condition?
- Measured curve progression: If X-rays have been taken of your spine in the past, the doctor will want to see if the curve is getting worse. The condition can be measured by comparing new X-rays with old ones, measuring the size of the rib hump, or measuring changes in your height.
- Presence or absence of pain: Not all cases of scoliosis produce pain. If there is a pain, your doctor needs to know where it is, what brings it on or intensifies it, and if there is any radicular pain (pain that radiates away from the spine).
- Bowel or Bladder Dysfunction: Are you having problems knowing when you have to urinate or have a bowel movement? This is extremely important because it could signal the presence of pressure on the spinal cord or the nerves that go to the pelvis.
- Motor Function: Has there been a change in how your muscles work? This may be the result of pressure on the nerves or the spinal cord.
- Previous Surgery: If you have had any surgery on your spine, it may have caused some degenerative scoliosis due to weakened bones or muscles. In order to evaluate your condition properly, it is important that your doctor knows about any previous spinal surgeries.
You will then be given a physical exam. Your doctor will want to get an understanding of the curve in your back and how it is affecting you. This means first trying to get a “mental picture” of how the spine is curved from examining your back and watching you move. The doctor will look at the flexibility you have by asking you to bend in certain directions.
- Curve Assessment: This is an observation of the three-dimensional characteristics of the spine. During your physical exam, your doctor will have you bend forward to make the curve evident.
- Rib Hump: When bending forward, the ribs form a “hump” on the side where the spine is bent. This hump is formed by the altered angle of the ribs where they connect to the curved spine.
- Flexibility of the Spine: Checks are done to see if the deformity is fixed in place (rigid) or if the curve changes with your position (flexible).
- Neurological Exam: Your doctor will check your nerves by testing sensation, reflexes, and muscle strength.
Usually, after the exam, X-rays will be ordered that allow your doctor to see the structure of the spine and measure the curve.
Doctors use the Cobb technique to measure curves in the spine. Lines are drawn on the X-ray to form an angle. The doctor measures the angle formed by the line and assigns the number of degrees to the size of the curve.
Depending on the outcome of your history, physical examination, and initial X-rays, other tests may be ordered to look at specific aspects of the spine. The most common tests that are ordered are: an MRI to look at the nerves and spinal cord; a CT scan to get a better picture of the vertebral bones, and special nerve tests to determine if any nerves are being irritated or pinched.
Scoliosis may produce specific, progressive signs and symptoms resulting in lowered quality of life. The main diagnostic criterion for scoliosis is spinal curvature exceeding ten degrees in a single plane. The spine may appear to bend in a “C” or “S” shape.
Other signs of scoliosis may include uneven musculature on one side of the spine, uneven hips, uneven leg lengths, imbalance, anxiety, and a prominent rib or shoulder blade caused by rotation of the ribcage. In severe cases, patients may experience difficulty breathing, pain, and reduced functionality. Infections and damage may also occur in the heart and lungs due to the friction of the rib cage against these vital organs.
A scoliosis-specific rehabilitation program attempts to prevent, improve, or minimize the signs and symptoms of scoliosis by using exercises, braces, and other therapies. Recommended treatment programs include physical therapy, occupational therapy, and chiropractic care.
Surgery is usually reserved for patients whose curves are greater than 45 degrees, have a high likelihood of progression, and impair physiological functions such as breathing. Fortunately, most curves can be treated non-operatively if they are detected before they become too severe.
Although scoliosis can have a dramatic impact on the quality of life, its signs and symptoms can be mitigated with a variety of therapies. As with most medical conditions, early intervention in scoliosis is associated with improved outcomes.
If scoliosis is neglected, spinal deformity may progress dramatically. In general, treatment is based upon severity and location of the curvature, as well as the age of the individual.
Procedures / Surgeries
Below are procedures available for the treatment of scoliosis.