Scoliosis is a condition characterized by a sideways S- or C-shaped curve of the spine (backbone). Most cases are idiopathic. This means the cause is unknown, typically a congenital defect (one that was present at birth).
While the condition can affect those of all ages, it most commonly appears in boys and girls 10-15 years old, during their growth spurt. Children with mild curves may require no treatment. Girls are eight times more likely than boys to progress to a stage that requires treatment.
Scoliosis that occurs or is discovered after puberty is known as called "adult scoliosis.” Adult scoliosis can result from untreated or unrecognized childhood scoliosis, or it can actually arise during adulthood. The condition in adults can be of unknown cause (idiopathic) or it can be related to degeneration of the discs or arthritis. Some cases appear in adults who had previous spinal surgery for scoliosis or for degenerative low back problems.
There are two main types of scoliosis. Patients with neuromuscular scoliosis have another serious disorder such as cerebral palsy or muscular dystrophy. Congenital scoliosis is present at birth and is caused by the failure of a baby’s spine bones or ribs to develop properly.
In nonstructural curves, the spine is structurally normal. The curve is temporary and doctors will seek to find and correct the cause. In structural curves the spine has a fixed curve, which may be caused by a disease, injury, infection or birth defect. A curve can be on the right or left side, or on both sides in different sections of the spine.
Severe curves can cause significant discomfort and can lead to other medical problems. An uncorrected curve can cause persistent pain and can contribute to nerve or spine damage or deformity.
The most typical symptom of scoliosis is a visible curvature of the spine, which can most easily be seen from behind. The curve makes it appear that the person is leaning to the side. Other symptoms:
- Variation in shoulder height
- Variation in hip height or position
- The head does not appear centered on the body
- Variation in shoulder blade height or position
- A difference in the way the arms hang beside the body when the person is standing straight
- The sides of the back appear different in height when the person bends forward
- Backache or low back pain
- A tired feeling in the spine after sitting or standing for a long period
Because the symptoms of scoliosis may be similar to those of other spinal conditions, it’s important to visit your Wellstar physician to confirm or rule out a diagnosis of scoliosis.
Wellstar neurologists and orthopedic surgeons are expert in diagnosing and treating scoliosis. Make an appointment to see your doctor if you have any of these symptoms or other reasons to believe you or a child has scoliosis.
While the causes of scoliosis are not generally known, experts have identified other contributing factors including:
- Age. Symptoms of scoliosis typically begin during the growth spurt that occurs prior to puberty.
- Sex. Boys and girls develop mild scoliosis at about the same rate, but girls have a significantly higher risk of a worsening condition that requires treatment.
- Family history. Having a parent or other family member with scoliosis can increase one’s chances of getting it.
Most cases of scoliosis cannot be prevented. An exception is scoliosis caused by osteoporosis (brittle bones). Research has not shown that actions like improving posture or doing exercises can prevent the condition.
Taking steps to increase bone mass and strengthen bones, including getting enough calcium and vitamin D and doing weight-bearing exercise, may help prevent scoliosis caused by spinal fractures. Early detection, including through school evaluations and regular pediatric examinations, may prevent the condition from getting worse.
Early diagnosis is considered quite important for successful treatment of scoliosis. Most children and adolescents are checked for scoliosis at each routine physical examination. Many states require public schools to screen for scoliosis, usually in the fifth or sixth grade. Depending on the result of the school exam, the patient may be referred to a spine specialist for further examination.
Although screening in school and by pediatricians is common, researchers have not concluded the overall value of routine screening.
In both children and adults diagnosis starts with a detailed medical history and physical examination. Your Wellstar physician will ask a variety of questions. The doctor will ask you or your child to stand and bend forward from the waist to detect any irregularity. A neurological exam will be performed to test for symptoms that may suggest a neurological cause or complication. These include:
- Muscle weakness
- Abnormal reflexes
Tools and Tests
Wellstar physicians use a number of tools and tests to help make a diagnosis of scoliosis. X-rays can confirm a diagnosis and reveal the severity of the curve.
Your Wellstar physician may recommend other tests especially if he or she believes that there is an underlying cause of the scoliosis, such as a tumor. These include:
- Magnetic resonance imaging (MRI) uses a combination of large magnets and a computer to produce detailed images of organs and structures within the body.
- Computed tomography (CT) scan uses a combination of X-rays and computer technology to produce images (known as slices) of the bones, muscles and organs. The images are more detailed than those produced by x-rays.
- Bone scan involves injection of a radioactive substance that settles in the areas of the bones that are injured or healing.
While scoliosis cannot be cured, the goal of treatment is to halt the progression of the curve and prevent deformity. Your Wellstar physician will recommend a treatment plan depending on age, overall health, medical history, causes (if known) of the scoliosis, extent of the condition, tolerance for medications and procedures and patient preferences.
Non-surgical treatment options
- Observation and regular examinations. This is an option when the patient is still growing and when the curve is less than 25 degrees. The purpose is to monitor whether the spine is continuing to curve.
- Bracing. Scoliosis braces exert pressure on the back and ribs to push the spine into a more normal alignment. There are two types of braces. The underarm (low profile) brace is made of plastic and is contoured to the body. It fits under clothing. If a low-profile brace cannot be used, a Milwaukee (full torso) brace may be an option. This is a more cumbersome brace that includes a neck ring with rests for the chin and the back of the head. Your Wellstar physician will discuss the various types of braces and answer your questions about how long it will need to be worn and what you can and cannot do while wearing it.
Surgery may be recommended for patients:
- With severe curves.
- With curves that have worsened during the course of monitoring.
- Have a significant deformity of the spine or trunk.
- Are developing a neurological problem due to a spinal cord problem.
Types of Surgery
There are several surgical options for patients with severe scoliosis. The choices, and the goals for surgery, are based on the factors including the presence of neurological problems.
- Spinal fusion is used to fuse together the abnormal vertebrae so that they heal into a single, solid bone. This stops the growth in the abnormal area of the spine.
- Hemivertebra removal involves the fusion of two to three vertebrae together.
- Growing rods are rods that are inserted into the spine to straighten it while a child is still growing. The rods can be lengthened with minor surgery that is repeated every six to eight months. This permits continued growth while the curve is corrected. Once growth stops, the rods are replaced and a spinal fusion is performed.
Ongoing Care for Scoliosis
The long-term outlook for people with scoliosis varies considerably. Mild curves may improve over time with little or no treatment and no lasting damage. For children and adults with severe scoliosis, spinal fusion and other options can vastly improve the quality of life and help reduce other complications.
Your Wellstar neurologist and neurosurgeon are part of a multidisciplinary team that can include therapist, orthopedic surgeons, chiropractors, pain specialists, and other practitioners team that may also include an orthopedic surgeon and a physical therapist.