What is scoliosis?

Scoliosis is a laterally curved pathological condition of the spine. Your natural spine (backbone) has a normal slight curvature forward and backward. With scoliosis, your spine curves to the left and right into a C or S shape. Most cases of scoliosis are mild, don't cause symptoms, and do not require treatment. Severe cases can cause uneven posture and pain. Scoliosis treatment may include wearing a brace or surgery.

What are the types of scoliosis?

There are three types of scoliosis:

Idiopathic scoliosis: This is the most common. "Idiopathic" means the cause is unknown. Research does indicate that it runs in families and has a genetic (hereditary) link.
Congenital scoliosis: This is a rare spine disorder, and your health care provider may diagnose it at birth. It is caused by an abnormal formation of vertebrae- the bones that make up your spine-along the way during embryonic development.
Neuromuscular scoliosis: This develops from problems in your muscles or nerves, which have to do with your support system for your spine. In many cases, this condition presents itself as part of other neurological or muscular diseases and conditions such as an injury, cerebral palsy, spina bifida, or muscular dystrophy.
You might hear your provider refer to adult-onset scoliosis or degenerative scoliosis in case of diagnosis at adulthood. You may have had mild, undiagnosed scoliosis all your life. Symptoms may be more severe or develop as your body ages and thus diagnosed late. In fact, adult-onset scoliosis is caused when your disks and joints weaken, or you suffer from a loss of bone density known as osteoporosis.

Healthcare providers refer to idiopathic scoliosis by different names depending on the age of diagnosis:

Infantile scoliosis: Less than age 3.
Juvenile scoliosis: Age 4 through 10.
Adolescent scoliosis: Age 11 through 18.
Adult idiopathic scoliosis: Diagnosed any time after age 18 when the bones are fully grown.

What are the symptoms of scoliosis?

Scoliosis tends not to have symptoms, although they might be:

Back pain.
Trouble standing upright.
Aching muscles in the core.
Leg pain, numbness or weakness.

Sign of scoliosis include:

Unbalanced shoulders.
Curving of the rib cage.
Your head will not be centered over your pelvis.
Waist will not be even.
Raising of your hips.
Permanent lean to one side.
Your leg length is unequal.

There are dimples, hair patches or skin discoloration on your back above portions of your spine. If you have seen any of these symptoms, you should seek a healthcare provider to get tested.

Over time you may note:

Height loss.
Misalignment of your pelvis and hips.

What is the scoliosis curve found on the spine?

Scoliosis can occur anywhere along your spine. A few differences vary by age group:
Teenagers: The majority is located in the thoracic region, such as where the rib cage will be.
Adults: The primary issue is occurring in the lumbar or lowers back. The lumbar spine is the most at risk for the alteration occurring with aging or degeneration, thus leads to worse symptoms, such as pain.

What causes scoliosis?

The cause of scoliosis varies with the type but can include the following:

Malformed vertebrae that grow in the womb.
Genetic mutation.
Spinal injury.
Tumor which develops within your spine.
Disorder that affects either your nerves or muscles.
In most cases, though, doctors cannot pinpoint a cause (idiopathic scoliosis).

What are the risk factors for scoliosis?

You are more likely to have scoliosis if you:

Have an immediate biological family history of scoliosis.
Have an underlying condition or injury that affects your spine, muscles, and nerves.
Scoliosis has an equal chance of affecting males and females regardless of the assigned sex at birth. Both assigned male at birth (AMAB) and assigned female at birth (AFAB) get scoliosis. But investigations showed that AFAB requires treatment more often due to a more extreme curvature.

Is scoliosis hereditary?

You are more likely to have scoliosis if a relative also has the condition. But not everyone who has scoliosis has a family history of it.

What are the complications of scoliosis?

Untreated severe cases of scoliosis may cause:

Chronic pain
Physical deformity
Damage to organs
Damage to the nervous system
Arthritis
Leakage of spinal fluid
Respiratory conditions

Call if you are having difficulty breathing.

What is a screening for scoliosis?

The first stage of a diagnosis of scoliosis is a scoliosis screening. You might recall receiving a scoliosis screening during a pediatric wellness visit with your primary care physician or a school nurse. During a screening, a provider will ask you to:

Remove your shirt to see your back.
Stand up straight.
Bend forward (like you are touching your toes).

A screening enables your physician to look at the curve and how your spine is aligned. If you are not under the care of your personal physician, they will likely send you to one if the screening test indicates that you may have scoliosis.

Scoliosis Screening

Scoliosis screenings occur during childhood and adolescence; therefore, the sooner it can be identified, the more options your doctor may have for treatment, if you need treatment.

How is the diagnosis of Scoliosis made?

Your healthcare provider will evaluate scoliosis by performing a physical exam. Sometimes, providers screen patients in the office which includes having you stand up straight and then bending forward to touch your toes. Your provider will feel your back checking how the shape of your spine is and how you can move. They will also check on your nerves by testing your reflexes and muscle strength.

Before your doctor can prescribe a treatment plan, he or she will interview you about the following:

Your health history and family health history.
The date when you first noticed a change in your spine or the date of your first screening.
The symptoms, if any.
Bowel, bladder, or motor symptoms, which may be signs of deeper nerve damage or pressure from scoliosis.

If it's thought that imaging tests are necessary, your doctor will order them. X-rays viewed from the front and side will provide a complete picture of your spine. Your doctor will then know whether you have scoliosis and to what extent. Other imaging tests may include an MRI, or CT scan.

If your physician decides that you do indeed have scoliosis and it needs to be treated, then he will send you to a specialist in orthopaedic spines.

When is scoliosis diagnosed?

A diagnosis of scoliosis is most often made in adolescence, between the ages of 10 and 15.

As you age, your spine degenerates, or starts curving, this is why you can get a diagnosis of scoliosis at an older age. That's usually how it goes, anyway-if your scoliosis isn't severe and no one noticed during childhood.

How is scoliosis measured?

A doctor will measure the number of degrees your spine is curved. They'll grade the severity based on degree of curve:

No scoliosis diagnosis: Less than 10 degrees.
Mild diagnosis of scoliosis: Between 10 and 24 degrees
Moderate diagnosis of scoliosis: Between 25 to 39 degrees
Severe diagnosis of scoliosis: More than 40 degrees.

This is similar to measuring angles with a protractor in your geometry class. An instrument known as a scoliometer will be placed on your back by your provider to measure the curve. Your provider may also obtain an X-ray of your spine to measure the curve.

How is scoliosis treated?

Treatment for scoliosis is not necessary for everyone.

If your provider recommends treatment, they will consider several factors:

The type of scoliosis.
Degree of the curve.
Family history of scoliosis.
Age
Number of remaining years till skeletal maturity.

Treatment of scoliosis is symptomatically relieving and does not have to correct the curve. The aim of treatment is to get rid of or decrease the extent of symptoms and therefore minimize curve progression, thus enhancing function in the spine.

There are two forms of therapy for scoliosis:

Non-surgical or conservative treatment.
Surgery.

Conservative Scoliosis Treatment:

Most cases of scoliosis will not call for surgery, and providers will recommend conservative treatments primarily. Such may include the following:

Regular visits to a healthcare provider to check on the degree of the curve (usually every six months).
Taking over-the-counter pain relievers or anti-inflammatories as needed or even according to the prescription by your provider.
Exercise to help in the strengthening of core muscles and flexibility.
Utilizing a back brace to aid in the straightening of the spine.
Managing any underlying conditions.

Your doctor might refer you to a physiotherapist. This is done to enhance your muscles, which automatically alleviates the pain. The following are some ways your physiotherapist may engage with you:

Improving your stance.
Low-impact exercises, such as swimming.
Stretching daily.
Directing you on physical activity.

Scoliosis surgery:

The conditions for scoliosis will in some cases not respond to conservative treatment, and surgical therapy is necessary. Your doctor may recommend surgery when to:

Stop the compression on nerves.
Balance has to be regained.
To stabilize the spine.

There are many techniques your surgeon can use to treat scoliosis. In one, your spine is stabilized by fusing the bones with your surgeon, and then they place metal braces to keep your spine in place. In another, a surgeon implants an expandable rod along the vertebrae of a child to support their growing spine. He or she will periodically adjust the length of the rod so that it grows as the child grows.

Advancements in surgical techniques and computer-assisted technologies make lesser invasive approaches possible and recovery time quicker.

Complications of Scoliosis Surgery:

Scoliosis surgery is a safe procedure, but complications are possible and may include:

Infection
Bleeding
Blood clots
Nerve damage
Limited movement
Prevention

Can scoliosis be prevented?

There's no known way to prevent scoliosis.

If you have scoliosis, your healthcare provider may advise you to strengthen your back and abdominal muscles with stretching and exercises. They can help prevent the curve in your spine from getting worse.

What to expect if you have scoliosis?

Though scoliosis is usually asymptomatic, symptoms might develop as your body ages and natural spine degeneration occurs. A healthcare provider can help you manage symptoms if they become bothersome.

Scoliosis may change the way you look, depending on the amount of curvature of the spine. This can also have emotional impact. A mental health provider can help you with planning how you may wish to cope with your thoughts about your own body.

What are the outlooks for scoliosis?

The prognosis of scoliosis varies with the type and extent. Most people live very typical lives with few modifications to their daily activities.

Living With

What activities are safe when you have scoliosis?

Discuss all activities with your provider or physical therapist. Most people with scoliosis can safely engage in physical activities and exercise. Routine movement can help minimize the severity of symptoms. If activity increases pain, stop.