Scoliosis

What is scoliosis?

Scoliosis is an abnormal curvature of the spine. While all spines have a natural curve, patients with scoliosis have excessive side to side spinal curvature in a C or S shape, and a rotation of the spine.

There are two predominant types: idiopathic scoliosis and degenerative scoliosis. Scoliosis can affect children and adults.

• Children: Idiopathic scoliosis is the most common spinal deformity that develops in healthy children. It is often discovered during periods of rapid growth in girls from age 9-14 and in boys 11-16. In 80% of cases the cause is unknown. Adolescent scoliosis is often discovered in adulthood because scoliosis in childhood may cause no symptoms until it progresses and the patient ages. Adults: Adult may have been diagnosed with scoliosis that was treated with surgery when they were young, or they did not receive treatment when they were young and have developed symptoms or worsening of their condition.
• Degenerative scoliosis is commonly seen in older adults over 65. The curvature is usually mild, caused by degeneration of the spinal discs and vertebrae. It may be related to arthritis or osteoporosis. Degenerative scoliosis is typically found in the lumbar spine. Symptoms are similar to those found in degenerative disc disease and spinal stenosis including sciatica, low back pain, leg pain, tingling and numbness. Pain and reduced mobility negatively impact quality of life. It is usually managed with conservative measures such as physical therapy and if conservative measure fail to alleviate pain, surgery may be recommended.

Less common types of scoliosis include:

• Syndromic scoliosis which is caused by a primary disease or genetic condition. Examples include spinabifida, connective tissue disease such as Marfan’s syndrome, and genetic conditions such as dwarfism.
• Neuromuscular scoliosis is caused by primary conditions such as cerebral palsy or traumatic spinal cord injury.

What causes scoliosis?

Usually, scoliosis develops during the growth spurt before puberty, between the ages of 9 and 15. Although some cases are congenital, and some are the result of underlying neuromuscular conditions, such as cerebral palsy or muscular dystrophy, most cases of scoliosis are idiopathic, meaning their cause is unknown. Both girls and boys can develop scoliosis, but cases in girls are more likely to require treatment. In some cases, scoliosis appears to be hereditary.

What are the symptoms of scoliosis?

Symptoms vary depending on the severity and location of the spinal curve. Patients with mild cases of scoliosis have no symptoms apart from the irregularity of their appearance.

Common symptoms include:

• Uneven shoulders or hips
• A prominent shoulder blade or rib cage
• Leaning to one side
• An uneven waist
• Back pain
• Fatigue and discomfort after standing or physical activity
• Reduced flexibility or range of motion in the back
• Respiratory problems (in severe cases)

How is scoliosis diagnosed?

In addition to a physical examination of the back, shoulders, waist and hips, patients suspected of having scoliosis typically undergo neurological examinations to evaluate muscle strength, reflexes, and areas of numbness. Imaging tests can confirm a diagnosis.

However, spinal instability can be difficult to detect unless the body is in motion. For this reason, dynamic x-rays may be taken while the patient is moving, such as bending forward or backward, to evaluate abnormal movement and instability.

Imaging studies are also important to determine the severity of the condition and to rule out other possible reasons for the curvature of the spine, such as tumors. Diagnostic imaging tests may include CT, MRI and bone scans.

Why is early intervention important?

Early intervention can achieve a few goals. First, the earlier that an accurate diagnosis is made, the more opportunity a patient may have for non-surgical treatment (bracing). The more a curve progresses, the more likely it is that surgical intervention will be necessary.

A worsening spinal curve also presents daily physical challenges. The patient with scoliosis may suffer back pain when they sit or stand for a period of time. Range of motion may become affected, and quality of life may degrade.