Scoliosis

What is scoliosis?

A normal spine, when viewed from behind, appears straight. However, a spine affected by scoliosis shows evidence of a lateral, or sideways, curvature, and a rotation of the back bones (vertebrae). Scoliosis is defined as a curvature of the spine measuring 10 degrees or greater on x-ray and can occur in any part of the spine.

Scoliosis is a type of spinal deformity and should not be confused with poor posture.

There are many types of scoliosis and they can involve any age group. 

What causes scoliosis?

Children " Most cases of scoliosis in children is unknown (idiopathic). It usually develops in middle or late childhood, before puberty, and is seen more often in girls than boys. 

Although scoliosis can occur in children with neuromuscular disorders such as cerebral palsy, muscular dystrophy, spinal bifida and other miscellaneous conditions, most scoliosis is found in otherwise healthy youngsters. 

Rarely, some children are born with scoliosis.

Adults - Scoliosis usually develops during childhood, but it also can occur in adults. Adult scoliosis may represent the progression of a condition that actually began in childhood, and was not diagnosed or treated while the person was still growing. 

Adult scoliosis may also develop spontaneously during the aging process.  Other spinal deformities such as kyphosis or round back, are associated with the common problem of osteoporosis (bone softening) involving the elderly.

As more and more people reach old age in the U.S., the incidence of scoliosis and kyphosis is expected to increase. If allowed to progress, in severe cases adult scoliosis can lead to chronic severe back pain, deformity, and difficulty in breathing.

What are the symptoms of scoliosis?

The following are the most common symptoms of scoliosis. However, each individual may experience symptoms differently. Symptoms may include:

  • difference in shoulder height
  • the head is not centered with the rest of the body
  • difference in hip height or position
  • difference in shoulder blade height or position
  • when standing straight, difference in the way the arms hang beside the body
  • when bending forward, the sides of the back appear different in height

Back pain, leg pain, and changes in bowel and bladder habits are not commonly associated with idiopathic scoliosis. Breathing difficulty does not typically occur until curves reach more than 90 degrees.  A person experiencing these types of symptoms requires further medical evaluation by a physician.

The symptoms of scoliosis may resemble other spinal conditions or deformities, or may be a result of an injury or infection. Always consult your physician for a diagnosis.

How is scoliosis diagnosed?

In addition to a complete medical history and physical examination, x-rays (a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film) are the primary diagnostic tool for scoliosis. In establishing a diagnosis of scoliosis, the physician measures the degree of spinal curvature on the x-ray.

The following other diagnostic procedures may be performed for non-idiopathic curvatures, atypical curve patterns, congenital scoliosis, or adult scoliosis:

  • magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

  • computed tomography scan (also called a CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones.  CT scans are more detailed than general x-rays.

Early detection of scoliosis is most important for successful treatment.

Treatment of scoliosis

Specific treatment of scoliosis will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the condition
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

The goal of treatment is to stop the progression of the curve, not necessarily to completely correct the curve.

Treatment may include:

  • observation and repeated examinations
    Observation and repeated examinations may be necessary to determine if the spine is continuing to curve.

  • bracing
    Bracing may be used in children when the curve measures between 25 to 40 degrees on an x-ray, but skeletal growth remains. The type of brace and the amount of time spent in the brace will depend on the severity of the condition.

  • surgery
    Surgery may be recommended for children when the curve measures 50 degrees or more on an x-ray and bracing is not successful in slowing down the progression of the curve.   For adults, recommendation for surgery depends not only on the size of the curve, but more on overall spinal balance, specific symptoms, and health status.

According to the Scoliosis Research Society, there is no scientific evidence to show that other methods for treating scoliosis (i.e., manipulation, electrical stimulation, and corrective exercise) prevent the progression of the disease.

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