- Scoliosis is an abnormal curve in the spine.
- There are several types of scoliosis based on the cause and age when the curve develops.
- Depending on the severity of the curve and the risk for it getting worse, scoliosis can be treated with observation, bracing, or surgery.
What is scoliosis?
Scoliosis is a disorder that causes an abnormal curve of the spine, or backbone. The spine has normal curves when looking from the side, but it should appear straight when looking from the front. Kyphosis is a curve seen from the side in which the spine is bent forward. There is a normal kyphosis in the middle (thoracic) spine. Lordosis is a curve seen from the side in which the spine is bent backward. There is a normal lordosis in the upper (cervical) spine and the lower (lumbar) spine. People with scoliosis develop additional curves to either side, and the bones of the spine twist on each other, forming a “C” or an “S” shape in the spine.
Scoliosis is about two times more common in girls than boys. It can be seen at any age, but it is most common in those over 10 years of age. Scoliosis is hereditary in that people with scoliosis are more likely to have children with scoliosis; however, there is no correlation between the severity of the curve from one generation to the next.
What causes scoliosis?
Scoliosis can affect about 2% of females and 0.5% of males. In most cases, the cause of scoliosis is unknown (idiopathic). This type of scoliosis is described based on the age when scoliosis develops. If the person is less than 3 years old, it is called infantile idiopathic scoliosis. Scoliosis that develops between 3 and 10 years of age is called juvenile idiopathic scoliosis, and people that are over 10 years old have adolescent idiopathic scoliosis. More than 80% of people with scoliosis have idiopathic scoliosis, and the majority of those are adolescent girls.
What are the symptoms and signs of scoliosis?
The most common symptom of scoliosis is an abnormal curve of the spine. Often this is a mild change and may be first noticed by a friend or family member. The change in the curve of the spine typically occurs very slowly so it is easy to miss until it becomes more severe. It can also be found on a routine school screening examination for scoliosis. Those affected may notice that their clothes do not fit as they did previously or that pant legs are longer on one side that the other.
Scoliosis may cause the head to appear off center or one hip or shoulder to be higher than the opposite side. You may have a more obvious curve on one side of the rib cage on your back from twisting of the vertebrae and ribs. If the scoliosis is more severe, it can make it more difficult for the heart and lungs to work properly. This can cause shortness of breath and chest pain.
In most cases, scoliosis is not painful, but there are certain types of scoliosis than can cause back pain. Additionally, there are other causes of back pain, which your doctor will want to look for as well.
How is scoliosis diagnosed?
If you think you have scoliosis, you can see your doctor for an examination. The doctor will ask questions, including if there is any family history of scoliosis, or if you have had any pain, weakness, or other medical problems.
The physical examination involves looking at the curve of the spine from the sides, front, and back. The person will be asked to undress from the waist up to better see any abnormal curves. The person will then bend over trying to touch their toes. This position can make the curve more obvious. The doctor will also look at the symmetry of the body to see if the hips and shoulders are at the same height. Any skin changes will also be identified that can suggest scoliosis due to a birth defect. Your doctor may check your range of motion, muscle strength, and reflexes.
The more growth that a person has remaining increases the chances of scoliosis getting worse. As a result, the doctor may measure the person’s height and weight for comparison with future visits. Other clues to the amount of growth remaining are signs of puberty such as the presence of breasts or pubic hair and whether menstrual periods have begun in girls.
If the doctor believes you have scoliosis, you could either be asked to return for an additional examination in several months to see if there is any change, or the doctor may obtain X-rays of your back. If X-rays are obtained, the doctor can make measurements from them to determine how large of a curve is present. This can help decide what treatment, if any, is necessary. Measurements from future visits can be compared to see if the curve is getting worse.
It is important that your doctor knows how much further growth you have left. Additional X-rays of the wrist or pelvis can help determine how much more you have to grow. If your doctor finds any changes in the function of your nerves, he or she may order other imaging tests of your spine including an MRI or CT scan to look more closely at the bones and nerves of your spine.
What is the treatment for scoliosis?
Treatment of scoliosis is based on the severity of the curve and the chances of the curve getting worse. Certain types of scoliosis have a greater chance of getting worse, so the type of scoliosis also helps to determine the proper treatment. There are three main categories of treatment: observation, bracing, and surgery.