When looking at the spine from the front or back, it should appear straight up and down. While looking from the side, there should be a slight curve forwards in two places: the neck and the low back. This is the normal shape of the spine. Scoliosis is an abnormal curvature of the spine from side to side, and also often has a rotational or twisting component. The curvature can be a C-shape or an S-shape. A scoliosis is described by the direction it points and its rotational component. For example, a dextrorotary lumbar scoliosis indicates a curvature to the right with rotation in the lumbar spine.
Signs & Symptoms
It is typically a parent, teacher, coach, or even class mate that first notices the signs of scoliosis. It may be noted that one shoulder appears lower than the other or protrude further than the other. The back may appear to twist or lean. The head may appear to be displaced to one side. One hip may appear to be cocked forward or to the side. The rib cage may appear to stick out on one side. One leg may appear to be longer. These general asymmetries are usually the first signs. In addition, the person may have symptoms and complain of pain or spasm in the back, neck, shoulders, or hips.
Nobody knows exactly what causes scoliosis in the wide majority of cases. Hence most scolioses are idiopathic in nature. If the scoliosis is due to some other process, then it is called a secondary scoliosis. Most cases of secondary scoliosis are due to pathology of the nerves, muscles, connective tissue, or some irregularity in the vertebral bones or discs. Other pathologies like tumors or infections or degenerative changes that warp the shape of the vertebra or cause a person to lean away from the side of pain can also cause a scoliosis. If a scoliosis is due to a permanent and fixed abnormality in the shape of the vertebra, this is termed a structural scoliosis. On the other hand, if the scoliosis is not permanent and the spine can actually straighten with certain positions, then it is a functional scoliosis. A functional scoliosis can be due to a short leg or muscle spasm or muscle imbalance. A simple test called Adam’s Test can determine the difference between a structural and functional scoliosis. Names are also given depending on when the scoliosis begins. If a person is born with an abnormality such as a misshapen vertebra, then the term congenital scoliosis is used. If it is discovered from birth to 3 years old, we use the term infantile. From 3-10 years old the term juvenile is used, from 10-18 we use the term adolescent, and in adults we logically use the term adult onset scoliosis.
Most scolioses develop between the ages of 10-20 and females are often more affected than males. There is a genetic component as the risk of developing a scoliosis is higher in those individuals who have one parent with scoliosis and much higher in those with two parents. But, as with almost all diseases, environmental factors play a role as well. The earlier the onset of scoliosis, the worse the prognosis. Scoliosis tends to worsen over time and the curvature is at risk of increasing as the spine grows.
Treatment of scoliosis is tricky. First off, a side to side curvature in the spine has to be over 10 degrees before it is considered a true scoliosis. This is because almost everybody has some amount of curvature in the thoracic spine to accommodate the space for the heart. If the curvature is over 10 degrees and especially if the patient is younger than 18, then the curvature needs to be monitored over time by X-ray: typically every 3-6 months depending on age. Scoliosis can be treated with manipulation, massage, stretches, and exercises: all in an attempt to straighten the spine, or at least stop the curvature from increasing. Scoliosis can also be due to a problem with anatomical or functional leg length causing the pelvis and spine to tilt, therefore an assessment of the lower extremity must be performed. If the problem is due to abnormal biomechanics of the lower extremity, then the use of orthotics, lifts, or functional rehab to correct the dysfunction should be employed. Braces can be used in more severe curves. If the curve becomes very severe measuring 50 degrees or more, a surgical consult is warranted because at this stage the heart and lungs can begin to be affected.
Generally, the prognosis of scoliosis depends on the likelihood of progression. The general rules of progression are larger curves carry a higher risk of progression than smaller curves, thoracic curves carry a higher risk of progression than lumbar or thoracolumbar curves, and double curves carry a higher risk of progression than single curves. In addition, patients not having yet reached skeletal maturity have a higher likelihood of progression
If you think you or someone you know may have scoliosis, give us a call today. The earlier we catch it, the better the outcome.