Scoliosis changes the normal shape of the spine. Normally, when viewed from the side, the spine’s natural curves form an S shape. The cervical (neck) spine curves slightly forward; the thoracic (middle back) spine curves backward; and the lumbar (lower back) spine also curves forward. Viewed from the back or front, however, the spine should appear straight. When your spine twists and develops side-to-side curves, we call it scoliosis. Scoliosis can occur in either the thoracic or lumbar spine, or both. Orthopedists measure the severity of scoliosis in degrees of curvature, ranging from as little as ten degrees to extreme cases of more than 100 degrees.
In childhood, scoliosis seldom causes any pain. You may learn that your child’s back doesn’t look quite right—often during a routine physical exam or school health screening.Specifically, you may notice that when bending over:
- One shoulder or hip appears higher than the other
- One shoulder blade appears higher and sticks farther out than the other
- One arm hangs longer than the other because of a tilt in the upper body
- A rib hump, a hump on the back that sticks up when the spine bends forward, which forms because the ribs on one side tilt more than those on the other side
As the condition progresses, your child may experience back pain. The curvature of the spine may put pressure on certain nerves and possibly on the spinal cord, which can lead to weakness, numbness, and pain in the lower extremities. In rare and severe cases, the chest may become deformed due to scoliosis, a deformity that may affect the lungs and heart, leading to breathing problems, fatigue, and even heart failure.
To diagnose scoliosis, we start with a physical exam and family and medical history. We may ask about when the symptoms began, whether you have had back surgery, and any pain or bowel, bladder, or motor dysfunction. We may also need to use imaging tests to gather more information. These tests might include X-rays to measure the degree of your curvature, magnetic resonance imaging (MRI) to look at the nerves and spinal cord; and a computerized tomography (CT) scan to get a better picture of the vertebral bones. In addition, we might order special nerve tests to see if the scoliosis has irritated or pinched any nerves.
Doctors divide scoliosis into four categories based on the age at which the condition is diagnosed:
- Infantile scoliosis is diagnosed before age 3
- Juvenile scoliosis is diagnosed from age 3 to 10
- Adolescent scoliosis is diagnosed between ages 10 and 15
- Adult scoliosis is diagnosed after the spine has stopped growing
When we see scoliosis in infants, we usually just observe them because most of the cases are relatively minor and almost 90 percent of them resolve themselves without any treatment. However, it is still important for your baby’s pediatrician to monitor the curve because if it progresses, surgery may be necessary.
Juvenile and Adolescent Scoliosis
We usually discover scoliosis in childhood or adolescence, when rapid growth tends to accelerate the progression of spinal curves. If your child is otherwise healthy and we can find no specific cause, we call the condition idiopathic scoliosis. Idiopathic scoliosis represents 80 to 85 percent of all forms of scoliosis. By far the most common form of spinal deformity, idiopathic scoliosis affects about three percent of the general population.
Scoliosis that is first diagnosed in adults may actually be juvenile or adolescent scoliosis that went untreated or unrecognized earlier. But scoliosis can also develop during adulthood. We can usually determine the cause of adult-onset scoliosis. Degenerative adult scoliosis occurs when a combination of age and deterioration of the spine leads to the development of a scoliotic curve. It usually appears after the age of 40. In older patients, particularly women, it is often related to osteoporosis, which weakens the bone, leading to deterioration. As the deteriorating spine sags or bends downward, a curve can slowly develop.
The remaining types of scoliosis are rare and can be categorized as congenital curve, paralytic curve, myopathic (abnormal) deformity, and secondary scoliosis.
Our expert physicians will develop a treatment plan based on your age when scoliosis began, the degree of curvature, and your other symptoms. For curves of less than 40 degrees, conservative treatment often suffices to halt progression. Curves greater than 40 degrees, however, may require surgery.
Conservative treatments may include medication, bracing, physical therapy, and exercise.
We typically use bracing for medium-range curves in children and adolescents, when the spine is still growing. Scoliosis often affects more than one area of the spine, and a brace can be used to support all the curved areas that need to be protected from progression. Though the brace can help a curve from getting worse, adolescents often feel self-conscious about having to wear a brace, so it may take some time to become used to it.
For adults, we begin by treating osteoporosis, if that is present. Treatment of osteoporosis may also slow the progression of scoliosis. Current recommendations include an increase in calcium and vitamin D intake, hormone replacement therapy, and weight-bearing exercises. Exercise may help to relieve pain, but it will not affect the natural history of the curve.
Surgical Treatment for Scoliosis
After the skeletal structure has completely matured, smaller curves tend not to progress, seldom cause significant back pain, and, therefore, do not require surgery. With medium and large curves, however, adult progression and the presence of secondary symptoms become more likely, making surgery a treatment option to consider. If you have severe pain, difficulty breathing, or increasing deformity, you would probably benefit from surgery.
Frequently, surgery for scoliosis involves spinal fusion with instrumentation. We almost always use rods to help straighten the spine. Your surgeon may use a posterior approach, which involves entering the spine through the back; an anterior approach, which is performed from the front or side; or a combined approach. We work with you and your family to decide whether you should have surgery. Surgery for scoliosis is never an emergency and there’s always plenty of time to make everyone comfortable with the decision.