Scoliosis

Have you ever been told you have scoliosis? Did you know that scoliosis is not only an “S” shape or curve of the spine but also abnormal shifting and rotation of the back bones? Scoliosis comes in several different forms.

The type of scoliosis that we most commonly hear about is called adolescent idiopathic scoliosis. As the name suggests this type of scoliosis affects adolescents and more commonly girls. However, there are other types of scoliosis that affects infants, elementary aged children as well as adults in their fifth, sixth or seventh decades of life. This page will briefly touch on all types of scoliosis; from diagnosis, symptoms, and causes to treatment and frequently asked questions.

Scoliosis: What is it?

Scoliosis in the simplest form is curvature of the spine. In order to be diagnosed as true scoliosis the curve magnitude must be over 10 degrees in the coronal plane (view of the spine from the front). Traditionally people imagine the letter “S” or “C” when they think of scoliosis. The spine curve does appear to have an “S” shape when viewed from the front. In addition to the “S” shape the spine also rotates in the axial plane (think of a ring on a post rotating) and the sagittal plane (looking at the spine from the side). In other words the spine twists and there is loss of the normal sway or curve in the low back (called kyphoscoliosis). Often thought of as only one-dimensional, scoliosis is indeed 3-dimensional which plays an important role when discussing treatment methods.

Symptoms: What does Scoliosis feel like?

Causes

It is important to know the different types of scoliosis to understand the causes.

Congenital Scoliosis: Congenital scoliosis, as its name implies, is a type of scoliosis that occurs as a result of fetal (congenital) development. There are two types; failure of segmentation and failure of formation. When the bones only partially form or do not separate properly, a curve of the spine can develop.
Idiopathic Scoliosis: Idiopathic scoliosis is the type of scoliosis that occurs for no known reason or cause. Idiopathic scoliosis is the most common type of scoliosis in children. It is broken down into infantile, juvenile adolescent and adult idiopathic scoliosis with the adolescent type being the most common.
Neuromuscular Scoliosis: Neuromuscular scoliosis is a type of scoliosis that occurs in kids or adults with neuromuscular or neurologic disorders. Some examples of neuromuscular disorders are cerebral palsy, muscular dystrophy, spinal muscular atrophy, and polio.
Degenerative Scoliosis: Degenerative scoliosis occurs in adults in their 4-7th decades of life. This type of scoliosis develops as the result of degeneration of the spine or spinal arthritis

Evaluation: How is Scoliosis diagnosed?

Physical Exam: includes evaluation of what is called a “rib hump”. A rib hump is caused by spinal rotation which in turns causes the ribs to protrude outward giving the appearance of a bump in the thoracic spine. Shoulder height, chest or waist asymmetry, changes in hip position and leg lengths will also be evaluated. An evaluation for abnormal skin markings, and a full neurologic exam will be performed.
X-rays: X-rays are generally obtained to provide a picture of the bony spine anatomy. This will help determine the magnitude of the curve and also provide details on any bone abnormalities that may be contributing to or causing the scoliosis.
CT Scan: Occasionally a CT scan (or CAT scan) will be ordered to provide even more detail of the anatomy or bone structure. This will provide a 3-dimensional picture of the spine and provide the surgeon with more information on what is causing the scoliosis or for pre-surgical planning.
MRI: An MRI may also be obtained to further evaluate the soft tissue structures. This test is very helpful at looking at muscles, tendons, ligaments, discs, nerves and spinal cord. In some cases, abnormalities of the spinal cord can cause or contribute to scoliosis.

Treatment

There are many variables that go in to determining the appropriate treatment for scoliosis. Age is one of the most important factors.

Pediatric Scoliosis

Observation alone: for idiopathic scoliosis and mild curves
Physical Therapy: for patients with mild to moderate curves and mild symptoms
Over the counter medications: such as acetaminophen or ibuprofen
Casting: for infantile/juvenile scoliosis with moderate curves
Bracing: for juvenile/adolescent scoliosis with curves between 20-45 degrees
Surgery: to correct scoliosis in kids with congenital, idiopathic or neuromuscular scoliosis with moderate to severe curves or other factors. This generally requires screws, hooks and rods to stabilize and sometimes fuse the spine

Adult scoliosis

Observation alone: in patients with mild curves, mild arthritis and/or who are not symptomatic
Physical therapy: to improve flexibility and strengthen core and leg muscles
Anti-inflammatory medications: to treat arthritis associated with the scoliosis
Injections: to treat arthritic spine joints or discs and pinched nerves (if present)
Surgery: to un-pinch nerves, treat spinal stenosis, prevent curve progression and correct scoliosis.

Recovery: What Can Be Expected?

Recovery depends on the treatment that was prescribed or given. Relating to surgical treatment, recovery can vary widely depending on patient age and type of surgery. Recovery after a minimally invasive surgery to un-pinch nerves only can be short with most patients returning to normal activities by 6-12 weeks. On the other end of the spectrum, recovery after major spine reconstruction and fusion can be long and arduous. It some cases patients may need a full year to reach maximal benefit after major scoliosis surgery.

Pediatric patients with idiopathic scoliosis will generally avoid surgical correction if their curve remains below 45 degrees. Those with curves less than 45 degrees when they are finished growing are unlikely to have worsening of their curve into adulthood. Those with curves greater than 50 degrees are likely to have progression of their curve at 1-2 degrees per year and are generally recommended to have surgery to stabilize or fuse their spine. Pediatric patients with curves less than 45 degrees may have slight progression as an adult or require surgery later in life related to arthritic changes of their spine

Frequently asked questions about Scoliosis

What is scoliosis?

Scoliosis is a curve of the spine in an “S” or “C” shape that measures more than 10 degrees on an X-ray.

What causes scoliosis?

Most cases of scoliosis occur for reasons that we do not fully understand. This is called idiopathic scoliosis and is not related to arthritis or neurological disorder. Other cases of scoliosis are caused by arthritis, neurological disorders or injury (trauma).

What DOES NOT cause scoliosis?

Scoliosis is NOT caused by poor posture, carrying heavy backpacks or books, athletic participation, or minimal differences in leg lengths.

Is scoliosis hereditary?

Yes. We do not fully understand all of the details but our genes do play a role in the idiopathic type (and possibly the arthritic type) of scoliosis. Inherited neurologic disorders can also be a cause of certain types of scoliosis passed from one generation to the next.

Is scoliosis painful?

Most kids with scoliosis do not have pain from scoliosis. Occasional back pain in kids is not uncommon, but for scoliosis to cause prolonged or significant pain is uncommon. Back pain is more prevalent in patients with more severe curves or those associated with arthritis or spinal stenosis.

Can a brace cure scoliosis?

Generally speaking, no. Rigid braces are sometimes prescribed for teenagers with scoliosis to help prevent progression or worsening of their curve. Soft or flexible braces have not been shown to be effective in prevention or treatment of scoliosis.

Physicians

The following physicians specialize in the treatment of Scoliosis:

Gregory F. Alvine, MD

Matthew J. McKenzie, MD

Matthew K. Wingate, MD

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