What Is Scoliosis: Understanding Curvature of the Spine

Scoliosis is characterized by an unusual curvature of the spine, deviating from the typical straight alignment when viewed from behind. This atypical spinal shape often takes the form of an S or C, accompanied by a rotational twist in the vertebrae. This curvature can create the perception that an individual is leaning to one side.

Scoliosis can affect different sections of the spine, including the thoracic (mid) and lumbar (lower) regions, and may manifest on the right, left, or both sides. This condition is categorized as a type of spinal deformity.

At PrimeCare, our mission is to offer you a comprehensive understanding of scoliosis, covering its causes, symptoms, and available treatments. We'll also delve into how orthotics can be part of the strategy for managing this condition.

How Common Is Scoliosis?

Scoliosis is a condition that impacts around 2-3 percent of the population in the United States, which is an estimated six to nine million individuals. It can emerge during infancy or early childhood.

Scoliosis isn't confined to any specific age group; it can affect people from infancy to adulthood. However, it most frequently arises during adolescence, typically between the ages of 10 and 15.

Symptoms of Scoliosis

These are common symptoms that people with scoliosis may experience:

• One shoulder blade appears more prominent than the other;
• Uneven waist;
• One side of the rib cage jutting forward;
• Difference in shoulder height;
• The head isn't centered with the rest of the body;
• Difference in hip height or position;
• When standing straight, difference in the way the arms hang beside the body;
• When bending forward, the sides of the back appear different in height;
• Prominence or asymmetry in the ribs seen from the front or back.

It's important to note that while scoliosis can manifest with these indicators, it may also resemble other spinal conditions or deformities. It can also be the result of injury or infection. If you or someone you know is exhibiting these symptoms, it's crucial to consult a doctor for a proper diagnosis. Additionally, it's worth mentioning that back pain, leg pain, and changes in bowel and bladder habits aren't typically associated with idiopathic scoliosis. If these symptoms are present, we recommend seeking immediate medical evaluation by a doctor to determine their underlying cause.

Types of Scoliosis

Scoliosis is a complex condition that can be classified based on its distinct types: idiopathic, neuromuscular, and congenital scoliosis.

• Idiopathic Scoliosis: This is the most common type, accounting for approximately 80 percent of all cases. It typically manifests during adolescence, often referred to as adolescent idiopathic scoliosis. Growth can exacerbate this condition, and it's a particular concern in children who have substantial growth ahead of them. In cases where it's diagnosed in children aged 2 or younger, it's known as infantile scoliosis.
• Congenital Scoliosis: This condition is present from birth and can occur at any location along the spine. The vertebral abnormalities result in curvature and other deformities of the spine, primarily because one part of the spinal column grows at a different rate than the rest. The nature and location of these abnormalities dictate the rate at which scoliosis progresses as the child grows. Typically, congenital scoliosis is managed through a "watch and wait" approach.
• Neuromuscular Scoliosis: Children with underlying neuromuscular conditions have a higher risk of developing scoliosis. A straight spine relies on normal muscle balance and strength in the torso. Children with neuromuscular scoliosis may have the option of wearing a scoliosis brace to potentially slow or prevent further worsening of the condition. Surgical intervention becomes an option when the curvature reaches a critical point, usually around 50 degrees. Over time, these curves tend to progress, causing increasing torso imbalance. Beyond 80 degrees, breathing difficulties can arise as lung space diminishes.

What Causes Scoliosis?

Understanding the root cause of scoliosis is essential for effective diagnosis and treatment.

- Spinal Cord Trauma: Injuries to the spinal cord can disrupt muscle function and contribute to the development of scoliosis.

- Spinal Muscular Atrophy: This genetic disorder affects motor neurons and can lead to muscle weakness and scoliosis.

Curved Spine Risk Factors

Risk factors associated with the most common type of scoliosis include:

• Onset Age: Signs and symptoms typically emerge during adolescence.
• Gender: Girls have a significantly higher risk than boys of scoliosis curvature worsening over time to a degree requiring treatment.
• Family History: Although scoliosis can have a hereditary component, most children diagnosed don't have a family history of the condition.

Curved Back Complications

Possible complications that can stem from severe and mild scoliosis include:

• Respiratory Issues: Pronounced spinal curvature may exert pressure on the ribcage and lungs, leading to respiratory challenges.
• Persistent Back Concerns: Those with untreated, severe scoliosis face an increased risk of experiencing chronic back pain.
• Changes in Physical Appearance: Severe scoliosis can result in uneven shoulders and hips, prominent ribs, and a noticeable shift in the trunk. These changes in physical appearance may cause people to feel self-conscious.

How Is Scoliosis Diagnosed?

Diagnosing scoliosis is a crucial step in understanding and addressing this condition, which can vary widely in terms of its severity and onset. Scoliosis diagnosis involves several key methods and considerations, depending on the age of the individual and the specific type of scoliosis under investigation.

• Physical Examination: The process of diagnosing scoliosis often begins with a thorough physical examination. During this examination, a healthcare professional may assess various aspects of the patient's physical health, including their range of motion, balance, reflexes, muscle strength, sensation, and neurological function. One examination technique is the Adam's Forward Bend Test, where the patient leans forward with their feet together, bending 90 degrees at the waist. This test helps identify any asymmetry in the trunk or abnormal spinal curvatures, providing an initial screening for potential issues.
• Imaging: While physical examinations offer valuable insights, definitive scoliosis diagnosis typically relies on imaging techniques. These methods include:

In Children

Scoliosis in children is categorized by age, such as infantile (0 to 3 years), juvenile (3 to 10 years), and adolescent (age 11 and older, or from the onset of puberty until skeletal maturity). The most common type during adolescence is idiopathic scoliosis. Evaluation of the neurological, genitourinary, and cardiovascular systems is essential when congenital scoliosis is diagnosed in children, as it's often linked to other congenital abnormalities.

In Adults

Diagnosing scoliosis in adults differs from childhood scoliosis because of the underlying causes and treatment goals. Three main categories of adult scoliosis patients exist; those who underwent surgical treatment as adolescents, those who didn't receive treatment during their youth, and those with degenerative scoliosis. Degenerative scoliosis primarily affects the lumbar spine and commonly occurs in individuals aged 65 and older. It may be associated with spinal stenosis, leading to pain and activity-related discomfort. In many cases, surgery is considered when conservative methods fail to alleviate pain associated with degenerative scoliosis.

Scoliosis Treatment Options

Here's a comprehensive overview of treatment approaches for scoliosis. Each is different depending on the patient.

Observation

The "watch and wait" approach involves closely monitoring the condition, especially in individuals with a curve measuring less than 20 degrees who are still growing. Regular examinations can help determine if the spine is continuing to curve.

Surgery

Surgical intervention is typically reserved for severe cases of scoliosis, especially when the curve has worsened to more than 50 degrees. The surgical team, consisting of pediatric spine surgeons, nurses, and anesthesiologists, takes a family-centered approach to ensure the best care for the child. High-volume spinal curve centers continually refine their surgical techniques and postoperative care. Surgery for adult scoliosis is a complex decision and depends on various factors. Age alone isn't the sole determinant; overall health plays a crucial role in evaluating surgical candidacy. Surgical success and recovery are also influenced by factors like diet, weight, and exercise routines before and after the procedure.

• Spinal Fusion Surgery: This is a common approach that involves fusing vertebrae to stabilize the spine, preventing excessive motion and deformity. Surgery aims to correct the curve by 50 percent or more. In some cases, a more minimally invasive approach, such as the transpsoas approach or extreme lateral interbody fusion, may be considered to reduce tissue trauma and improve recovery.
• Decompressive Laminectomy: This procedure involves the removal of the laminae (roof) of the vertebrae to create more space for the nerves. Spinal fusion with or without instrumentation is often recommended for scoliosis and spinal stenosis cases. Devices like screws or rods may be used to enhance fusion and support unstable areas of the spine.
• Minimally Invasive Surgery (MIS): Fusion can sometimes be performed through smaller incisions to minimize tissue trauma and enable quicker rehabilitation. Advanced technologies like fluoroscopy and endoscopy improve how accurate these procedures are.

Orthotics for Scoliosis

The primary goal of brace treatment isn't to correct an existing curve but rather to prevent it from worsening. While a brace may temporarily straighten the spine and appear corrective, this effect typically diminishes once the brace is no longer worn.

Spinal orthotics for scoliosis are typically employed for children who are still growing, specifically to address moderate spinal curves. Treatment with braces is often continued until the child's skeletal growth is complete. Two common types of braces are used:

• CTLSO (Cervical-Thoracic-Lumbar-Sacral Orthosis): This brace includes a customized pelvic girdle and a metal structure extending to the neck. It's used to treat upper back issues like kyphosis, often yielding positive corrections.
• TLSO (Thoracic-Lumbar-Sacral Orthosis): Customized to fit the child, this brace uses a trunk and pelvic girdle to make it suitable for mid and lower-back curves. It's less visible under clothing compared to the CTLSO.

It's worth noting that braces aren't typically effective for curves exceeding 45 degrees. Research on idiopathic scoliosis indicates that braces can be effective in preventing curve progression, particularly when worn consistently. Immediate curve control is often observed when the brace is initially applied. However, the curve could come back if the brace is no longer worn.

To maximize the benefits of orthotic brace treatment for spinal curvature, early initiation, a moderate curve severity, proper fit, adherence to prescribed wear time, and strong family support are essential factors to consider.