Scoliosis

What is Scoliosis?

Scoliosis is an abnormal curvature in the spine to one side. This causes the spine to appear shaped like the letter "C." There is often an opposite curve in the spine to compensate, and the spinal column may appear like a letter "S." Scoliosis is measured in degrees (a technique called the "Cobb Angle"). By definition, the term "scoliosis" refers to any curve over 10 degrees. Because scoliosis may become worse, it is often measured at more than one point in time to monitor it.

Causes

  • Adolescent Iodipathic Scoliosis: Also known as AIS, it is present in up to 5% of children after puberty. The word "idiopathic" refers to the fact that there is no known cause for the curvature in the spine. People with a family history of AIS have a higher risk of inheriting it.

  • Congenital Scoliosis: During fetal development in some patients, there may be additional vertebrae formed or some vertebrae fused together before birth. These additional or fused vertebra may cause more growth on one side of the spine, leading to a curvature. For these patients, it is important to screen for additional problems, as other organs may have been affected by the same cause that led to the congenital scoliosis. This may occur anywhere in the spine, sometimes in multiple vertebrae.

  • Degenerative Scoliosis: Unlike the first two, degenerative scoliosis develops in adulthood. When natural aging process occurs, some intervetebral discs and vertebrae may wear out more on one side than the other. This may lead to an abnormal curvature, more often in the lumbar spine.

Symptoms

For most patients with Adolescent Idiopathic or Congenital Scoliosis, there is no pain associated with the curvature except in very severe cases. Most often, scoliosis does not occur with noticeable symptoms. In severe cases, patients may lean to one side, or one shoulder may appear higher than the other. Occasionally, a visible hump may appear on the spine.

Diagnosis

"Scoliosis screening" programs are often performed for adolescent children in grade school. Children are asked to lean forward as an examiner looks over the back of the spine. (This is also known as an Adams Forward Bend Test.) If one side appears higher, this may be a sign of scoliosis. This happens when vertebrae rotate, and the ribs or lumbar spine musculature appear higher on one side than the other.

 

The most important part of the diagnosis is a proper evaluation by a specialist.

  • History: Your medical provider should appreciate that your medical history may affect the type of scoliosis that develops. It is important to know the timeframe of scoliosis development, because it provides information on the type or cause of your scoliosis. Your provider will also learn all previous treatments you have had, and if they have provided any relief.

  • Physical Examination: In addition to a good medical history, a thorough physical examination is the most important part of the diagnosis for any spine-related problem. During the physical examination, your provider will assess your overall symmetry and assess how scoliosis may affect your overall gait and balance.

  • X-rays: X-rays are often the first step for imaging. Even if other images have been taken, x-rays provide unique information that is not available from other studies. Special x-rays in children may be necessary to estimate the "skeletal maturity," to estimate how much growth is remaining.

  • MRI: An MRI scanner uses a magnetic field and radio waves that are not harmful to visualize the body in 3D. In most circumstances, it is the best way to see the soft tissues of the body, including nerves, intervertebral discs, and other parts of the spine other than the bones. An MRI or a CT scan is not necessary to diagnose scoliosis. However, it may be helpful to determine the type or cause of scoliosis.

  • CT: A CT scan uses many x-rays to produce a 3D image of the body. It is often the best way to visualize the spinal bones or bone spurs.

Above: Xray showing adolescent idiopathic scoliosis

 

Treatment

​For all patients, the three treatment options include observation, bracing, or surgery.

  • Adolescent Iodipathic Scoliosis: The treatment for AIS is based on the degree of curvature in the spine. It is very important to have a discussion with your surgeon about expectations and treatment. A good surgeon will discuss prognosis and expectations with the parents and patient. In general, treatment is prescribed as follows:

    • Mild curves (less than 20 degrees): Observation

    • Moderate curves (20 to 45 degrees): Brace wear

    • Severe curves (over 45 degrees): Surgery for scoliosis correction and fusion

  • Congenital Scoliosis: The most important part of treating congenital scoliosis is diagnosing and treating any other congenital abnormalities that may be present. For that reason, it is important to see multiple specialists to assess for other conditions that may be present. Because congenital scoliosis is unique for every patient, it is important to see a specialist before considering any treatment. Bracing may be required to avoid an operation until the patient is an ideal age for operation.

  • Degenerative Scoliosis: Degenerative scoliosis may lead to radiclopathy or sciatica (pain in the leg), as the nerves become pinched in a spine with scoliosis. In general, bracing is not effective for degenerative scoliosis. In addition to any surgical options that may be considered, it is important to have your bone density checked, as osteopenia/osteoporosis may lead to progression of the curvature or failure of surgery.

For more information on surgical treatment of scoliosis, see Lumbar Fusion. Where appropriate, a thoracic fusion may be beneficial.

Below: Xray showing adult degenerative scoliosis