Scoliosis is an abnormal lateral (side to side instead of forward or backward) curvature of the spine. This condition often develops in adolescence during the growth spurt before puberty. It is more common in girls than in boys. The exact cause of the most common type of scoliosis is unknown, but it is thought to be familial.
In less severe cases where the curvature of the spine does not exceed 20 degrees, treatment may be minimal or unnecessary. In cases where the curvature exceeds 20 degrees, the condition may require the placement and use of a back brace or spinal surgery to correct the curvature.
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Scoliosis often does not cause pain. Symptoms are more likely to be uneven shoulders or hips where one side is higher than the other or a shoulder blade protrudes. Other visible symptoms may be a protruding or twisted rib cage. In only a very small percentage, scoliosis causes twisting of the rib cage that interferes with lung capacity and function.
Scoliosis is normally divided into five types:
- Congenital: When someone is born with this condition it is usually because of an abnormality in one or more vertebrae that didn’t form properly. This is usually detected at three stages: Infantile, juvenile and adolescent.
- Idiopathic: The most common form, with unknown origin. Normally the bones show no abnormalities. It progresses six to seven times more frequently in females.
- Neuromuscular: Occurs in people with nervous system diseases such as cerebral palsy.
- Postural: This is not a true deformity but a misalignment due to pain where there no abnormality of the spine.
- Syndromic: This occurs in people with syndromes such as Marfan syndrome or others.
Curvatures of the spine are often discovered during school screening processes or by the family physician. Once scoliosis is discovered, it is important to monitor changes in the spine throughout the period of growth. Adolescent scoliosis accounts for about 80% of all cases and is the period of time in which rapid skeletal growth occurs.
A sideways spinal curvature of 10 degrees is considered scoliosis but it typically presents with no symptoms or signs of deformity. As the curve progresses beyond 20 degrees, it might be noticed that the body is tilted to one side or that clothes are uneven.
Although idiopathic scoliosis generally does not cause pain, it can throw the entire body out of balance and generate other issues like muscle spasms and joint misalignments that can in turn cause pain.
Types of Scoliosis Spinal Curves
Scoliosis can curve to the right (dextroscoliosis) or to the left (levoscoliosis). The most common curves are the following:
- Right thoracic curve: an upper back curve that bends to the right.
- Right thoracolumbar curve: also bends to the right, but extends from the upper back (thoracic) to the lower back (lumbar).
- Right lumbar curve: a curve bending to the right that starts and ends in the lower back.
- Double major curve: usually involves a right thoracic curve on top and a left lumbar curve on bottom. Because the two curves may counteract each other in appearance, the deformity may be less obvious.
When Scoliosis has been detected and it is less than 25 degrees, the recommended course of action is to take x-rays every 4 to 6 months to see if the scoliosis is progressive. If it is found to be progressive and goes past 20 or 25 degrees, the first course of action is usually bracing. A back brace is worn throughout the full skeletal development which is usually till the eighteenth year. The objective is to minimize the progression and to avoid the need for surgery.
In cases that aren’t severe, medical treatment may be unnecessary. If the condition progresses into further severity as shown by x-rays and more pronounced physical symptoms, medical intervention should be considered, including corrective spine surgery. The most common recommended surgery today is a posterior spinal fusion, which has the benefit of offering better corrections with fewer fusion levels and preserves more back mobility than earlier procedures.
Depending on the type and severity of the scoliosis, spinal surgery to correct scoliosis can involve the placement of multiple pins in the spine which are then used as anchors for a rod that straightens the curvature of the spine and holds it in place. Surgically correcting the scoliosis at earlier ages can prevent further spinal curvature and complications or pain as a result of scoliosis later in life.
At Hunt Spine, we are skilled at evaluating scoliosis on a case by case basis. About 90% of those who have been diagnosed with idiopathic scoliosis have curves that never progress to the point where bracing or surgery is necessary. If you have scoliosis, your next step is a comprehensive consultation with our spine specialist, whose primary goal is a sharp analysis of your scoliosis to determine the best possible treatment plan moving forward. Our skilled neurosurgeon and orthopedic spine surgeon will help you achieve pain relief. To set an appointment, please call our office today for arguably the best treatment for scoliosis Los Angeles has to offer.
Frequently Asked Questions
Can It Be Prevented?
Idiopathic, congenital, and neuromuscular scoliosis are not preventable but can be effectively managed with appropriate treatment and scoliosis surgery. Exercise, maintaining a healthy body weight, and the right nutrition plays an important role in preventing degenerative scoliosis. Bone health nutrients including calcium, vitamin D, and phosphorus can help prevent the bone mineral loss that often leads to osteoporosis.
Idiopathic scoliosis accounts for about 80% of scoliosis cases. Idiopathic refers to “unknown cause” when all other causes have been ruled out. Congenital scoliosis stems from the malformation of vertebrae that occurs in the embryonic stage. Neuromuscular scoliosis is a consequence of muscular or neurological diseases including spinal cord trauma, spina bifida, cerebral palsy and so on. This type of scoliosis is why many people seek scoliosis surgery. Degenerative scoliosis is an adult-onset scoliosis attributed to the degeneration of the spine due to the normal process of aging or conditions such as osteoporosis, disc diseases, and osteoarthritis.
Does It Run in the Family?
According to National Institute of Health (NIH), it is possible that genes are involved in idiopathic scoliosis. Researchers have also found evidence that idiopathic scoliosis tends to run in families. According to available data, one-third of adolescents with idiopathic scoliosis have a family history of this condition. There is 11% chance of developing idiopathic scoliosis if first degree relatives have the condition.
How Early Should Children Be Screened for Scoliosis?
American Academy of Orthopedic Surgeons (AAOS), Scoliosis Research Society (SRS), Pediatric Orthopedic Society of North America (POSNA), and American Academy of Pediatrics (AAP) issued a position statement on scoliosis screening. According to these agencies, screening for scoliosis should be done at age 10 and 12 for girls and at age 13 for boys.
Scoliosis screening should be “part of the medical home preventative services visit” according to these agencies.
What Does NOT Cause Scoliosis?
A common myth is that bad posture or slouching causes scoliosis. Although a bad posture and persistent slouching can have a negative impact on the overall health, these do not lead to scoliosis. Scoliosis is also not caused by carrying a heavy rucksack or school bag on one shoulder or carrying heavy loads on both the shoulders.
While slouching, carrying weight on one shoulder and so on do not cause scoliosis, they may have other detrimental health effects including resulting in hyperkyphosis which is another type of forward curvature of the spine. With appropriate physical training and posture correction, these types of curvatures can be reversed and prevented.
Does Scoliosis Hurt?
Children or teens with scoliosis typically do not experience any pain until the curvature of the spine becomes severe. Severe curvature can press against the nerves, ligaments, discs of the spine and facet joints resulting in back pain.
At times, teachers, doctors or parents can find mild curvature. It is important to get the child or teen evaluated by a qualified scoliosis surgeon to ensure accurate diagnosis and early intervention.