Scoliosis

Overview

By Sarah Maurer

Scoliosis is an abnormal curvature of the spine. The human spine is made of bones called vertebrae that are stacked on top of one another. This flexible structure allows us to bend and twist our bodies in all directions.

A healthy spine curves from front to back at the neck, chest and lower back. However, in people with scoliosis, the spine also develops a side-to-side curvature. This usually happens during the growth spurt that begins just before puberty.

A scoliosis curve can be C- or S-shaped. In severe cases, the spine will rotate and twist, causing the ribs to stick out more on one side.

Most cases of scoliosis are mild and cause no health problems. In severe cases, the twisting of the spine and ribs reduces space within the chest cavity. This can interfere with breathing and put strain on the heart. Untreated scoliosis can also compress and damage the spinal nerves, leading to paralysis. However, these complications are very rare in the United States, because most cases are treated in their early stages.

Scoliosis affects about 3 in every 100 people, or about 6 million people in the United States. It can appear at any age, but usually starts between ages 9 and 15. While scoliosis is equally common in boys and girls, girls are eight times more likely to have severe curves that require treatment.

Causes

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Scoliosis

In 80–85 percent of scoliosis cases, the cause is unknown. This type of scoliosis is called "idiopathic," meaning "of unknown origin." Genetics may play a role in cases of idiopathic scoliosis; about 30 percent of children with this type of scoliosis have a close relative with the condition.

In a few cases, scoliosis is caused by another underlying medical condition such as cerebral palsy, muscular dystrophy, injury or infection. These conditions can cause muscle weakness and imbalance, which in turn can cause the spine to curve as it grows.

Scoliosis can also result if the bones of the spine do not form properly or separate before birth. Cases of this kind are called "congenital scoliosis."

Symptoms

Mild scoliosis can be difficult to detect, because it usually doesn't cause pain or discomfort. Early symptoms include:

  • Uneven shoulders
  • Uneven waist
  • One shoulder blade sticks out more than the other
  • One hip is higher than the other.

In more severe cases, you might notice:

  • Ribs stick out further on one side than the other
  • Back pain
  • Difficulty breathing.

See your doctor if you or your child have symptoms of scoliosis. Early detection and treatment can help to prevent the curve from worsening.

Diagnosis

About half of all schools routinely screen students for scoliosis. The test involves bending over and touching your toes so that a doctor or nurse can examine the position of your spine and ribs.

Diagnosis for scoliosis starts with a physical exam. Your doctor will have you assume different postures to check for evenness of the shoulders, hips and ribs. You also might receive a neurological exam to detect weakness, numbness or abnormal reflexes.

In most cases, a simple X-ray can confirm a diagnosis of scoliosis and show how far the curve has progressed. Children with scoliosis are usually referred to a specialist called an orthopedist or orthopedic surgeon for treatment.

4 scoliosis curve patterns

Treatment

Many cases of scoliosis do not require treatment. However, your doctor may recommend treatment if the condition is severe or progressing rapidly. Some factors to consider:

  • Scoliosis tends to be more serious in girls.
  • People with large curves, S-shaped curves or curves in the thoracic spine (the chest portion) are at increased risk.
  • Curves that are progressing quickly (growing by more than 5 degrees per year) may require more aggressive treatment.
  • Age makes a difference. Once you stop growing, mild scoliosis probably will not worsen. However, severe curves (those greater than 50 degrees) may continue to enlarge over time.
  • For some children, genetic testing can show whether idiopathic scoliosis is likely to get worse. At present, the test is only available for Caucasian girls between 9 and 13. Researchers are working to expand this test to a wider group of people.

Treatment options for scoliosis include:

  • Watching and waiting. In mild cases (curves less than 20 degrees), no treatment is necessary. The patient is usually monitored with X-rays every 4 to 6 months to make sure the condition is not worsening.
  • Brace. Wearing a brace won't permanently correct the curve, but it can stop the curve from worsening as you grow. In most cases, an "underarm" brace that covers the lower part of the torso works sufficiently. However, a full-torso brace may be necessary for curves affecting the upper spine or neck. The brace can be removed for showering and (if needed) during physical activity. In most cases, it would be worn both day and night, though this varies from person to person.
  • Surgery. A type of surgery called spinal fusion may be used to slow the progress of severe scoliosis and correct the curvature. During the operation, two or more vertebrae (spinal bones) are grafted together using a bonelike material. Plates, screws and other hardware are bolted to the spine to protect the area while the graft hardens. The surgeon also implants a metal rod that attaches to the top and bottom of the affected area. The rod can be lengthened every few months so that it grows with you.
  • Social and emotional support. Having a good support system can help teens with scoliosis cope with appearance changes and treatments. Many children find support groups helpful.

Fortunately, scoliosis is rarely life-threatening. While the condition has the potential for severe complications, these are extremely rare, thanks to the treatments now available.

Most people with scoliosis can lead normal, active lives with no restrictions on their activities. Some activity restriction may be necessary in severe cases or following surgery.

There is no known way to prevent scoliosis.

Spine shown from behind and from the side

Sources

  • "Information and Support." The National Scoliosis Foundation. http://www.scoliosis.org/info.php. Accessed Sept. 3, 2014.
  • "Introduction to Scoliosis." American Academy of Orthopaedic Surgeons, 2011. http://orthoinfo.aaos.org/topic.cfm?topic=A00633. Accessed Sept. 3, 2014.
  • "Scoliosis." Mayo Foundation for Medical Education and Research, 2012. http://www.mayoclinic.org/diseases-conditions/scoliosis/basics/definition/con-20030140. Accessed Sept. 1, 2014.
  • "Scoliosis." The Nemours Foundation, 2013. http://kidshealth.org/kid/health_problems/bone/scolio.html#. Accessed Sept. 3, 2014.
  • "What Are the Treatment Options for Scoliosis?" American Academy of Orthopaedic Surgeons, 2011. http://orthoinfo.aaos.org/topic.cfm?topic=A00636. Accessed Sept. 3, 2014.