What is scoliosis?
Scoliosis is one of three main types of spine curvature disorders. The National Institute of Arthritis and Musculoskeletal and Skin Diseases defines scoliosis as a disorder in which there is a sideways curve of the spine, often S-shaped or C-shaped.
Types of scoliosis
There are two general categories of scoliosis–structural and nonstructural.
Structural scoliosis is the most common and includes the types of scoliosis in which spinal rotation is present in addition to the side-to-side curvature of the spine. These are:
- Idiopathic Scoliosis is the most common type, accounting for about 80% of all cases. While it can start as early as infancy, it most often occurs in children ages 10 to 12 years old. Some research suggests that genetics are a factor, but the cause of idiopathic scoliosis is currently unknown.
- Degenerative scoliosis, commonly referred to as adult scoliosis, develops as the joints in the spine degenerate.
- Neuromuscular scoliosis, sometimes called myopic scoliosis, refers to cases that develop in those who are unable to walk as a result of a neuromuscular condition like muscular dystrophy or cerebral palsy.
- Congenital scoliosis develops in utero and remains present in infancy. This type is considered rare, only affecting 1 in 10,000 babies.
Nonstructural scoliosis is not caused by a spine condition or disease, but rather another underlying condition that pushes or pulls the spine in one direction such as:
- Muscle spasms
- A difference in leg lengths
What are the symptoms of scoliosis?
The early signs of scoliosis are often subtle at first, but detected early can yield better treatment results. The most common symptoms include:
- Uneven shoulders
- Head is not centered above the pelvis
- One or both hips are raised unusually high
- One side of the rib cage is higher than the other when bending forward
- Waist is uneven
- The entire body leans to one side
These symptoms are often noticed when they cause clothing to fit awkwardly or hang unevenly. In some cases, the sideways curvature of the spine may be noticeable just upon looking at a person’s back.
As scoliosis progresses, it may result in changes in the way a person walks or causes a reduced range of motion, difficulty breathing, cardiovascular problems, pain, or low self-esteem.
How is it diagnosed?
Scoliosis is typically diagnosed through a physical examination by a physician and confirmed with diagnostic imaging such as an X-ray, spinal radiograph, computed tomography scan (CT scan) or magnetic resonance imagining (MRI).
Using a full spinal X-ray, your doctor will examine the Cobb Angle which is found by drawing two perpendicular lines from most tilted vertebrae above and below the sideways curve’s peak. The angle formed where these two lines meet is the Cobb Angle.
There are several treatment options available for scoliosis, both surgical and nonsurgical. Your doctor will recommend the best treatment options based on the following factors:
What treatment options are available?
- Gender: Scoliosis is more likely to worsen over time in females than males.
- Degree and extent of the curve: In many cases, children with a mild curvature don’t require treatment but your doctor may recommend a follow-up every 4 to 6 months to monitor as your child grows. At any age, larger curves or S-shaped (double curves) are more likely to worsen over time.
- Location of curve: A curve that is located in the center part of the spine has an increased likelihood of requiring treatment, as they are more likely to worsen compared to curves in the lower or upper sections of the spine.
- Spinal maturity: If the person’s bones have stopped growing, the risk of worsening over time is lower.
Taking these factors into account, the following treatment options may be recommended.
- Observation: Children diagnosed with mild scoliosis should be monitored every 4 to 6 months for signs of progression. Unless symptoms progressively worse, it is recommended that adults with scoliosis get X-rays every 5 years.
- Casting: This treatment method is most often used for the treatment of infants with scoliosis. A cast is attached to the outside of the patient’s body to help the spine move back to its normal position as it grows. A cast must be worn at all times but will need to be changed frequently due to an infant’s rapid growth rate.
- Braces: Commonly recommended for children and adolescents, a brace can help prevent the curvature from worsening. However, unlike casting, it does not correct the curve. In most cases, a plastic thoracolumbosacral orthosis (TLSO) brace is used, which is typically not visible under clothing. If a TLSO is not possible or effective, a Milwaukee brace that includes a full-torso brace and neck ring with chin and headrests may be recommended. Unless your child requests to take the brace off to participate in physical activity, a brace should be worn at all times including while sleeping.
- Surgery: For severe cases of scoliosis that are likely to progress over time, spinal surgery may be recommended. Spinal fusion surgery can help reduce the curve of the spine and prevent it from worsening. With this procedure, two or more vertebrae are grafted together. Metal rods, hooks, screws or wires may be used to support the spine while the bone heals.
How Pacific Spine Specialists Can Help
Dr. Timothy Keenen of Pacific Spine Specialists has more than years of experience in treating a wide variety of spinal conditions including scoliosis. If you are experiencing any of the symptoms commonly associated with scoliosis, complete our new patient self-referral form to request an appointment with Dr. Keenen today.