The Curve You Shouldn’t Ignore: Understanding Scoliosis.
National Scoliosis Awareness Month takes place yearly in June with the goal of highlighting the growing need for public education, early detection, and awareness about scoliosis and its prevalence within the community.
What is scoliosis?
Scoliosis is an abnormal lateral (sideways) curve of the spine, normally forming an S or C shape when viewed from behind. Because the ribs are attached to the spine, the rotation of the spine causes the ribs to lift up; this results in a noticeable rib hump. When combined with spinal rotation, a curve greater than 10 degrees is in definition for clinical diagnosis.
Scoliosis is the most common spinal disorder to occur in children and adolescents but can occur in adults, in particular from degenerated discs as the spine ages. Crucially, scoliosis is not the result of poor posture, and it is not brought about by carrying heavy bags. The majority of patients have little or no back pain, and particularly at the earlier stages, it is quite pain-free.
Causes & Types of Scoliosis:
For the vast majority, about 80%, the cause is not identified, it is termed Idiopathic Scoliosis, and the primary types are:
- Infantile Idiopathic Scoliosis (0-3 years): Very rarely, the condition can be self-correcting and has to be monitored. It has been linked to plagiocephaly (flattening of the head)
- Juvenile Idiopathic Scoliosis (4-10 years): 20% of childhood scoliosis; without treatment, the progression can lead to serious cardiopulmonary complications. Curves over 30 degrees have a high probability of progression; in fact 95% will require surgical treatment
- Adolescent Idiopathic Scoliosis (11-18 years):This constitutes 90% of childhood cases of idiopathic scoliosis and can typically occur during a growth spurt. Girls are far more likely to have their curves progress to requiring treatment.
- Adult (Degenerative) Scoliosis: This condition is the result of degeneration in spinal discs, it occurs with age, in 8% over 25 and as high as 68% over 60 years old and may result in nerve compression, and is more painful and disabling than that which occurs in childhood.
Non-idiopathic scoliosis occurs as a result of neuromuscular disorders like Cerebral Palsy and Muscular Dystrophy, and connective tissue disorders like Marfan syndrome. Congenital scoliosis, also non-idiopathic, occurs as a result of bony malformations within the spinal canal.
Signs & Symptoms
Mild scoliosis is often undetectable without an x-ray; however, the following may be noticeable indicators of the condition:
- Uneven shoulders, one sits higher than the other
- A shoulder blade that sticks out more than the other side
- One hip is higher than the other side
- A difference in waist/hip level, on one side it is higher than the other
- One side of the chest and ribcage protrudes more than the other (rib hump)
- Clothes look a different length on either side
- A noticeable S-shaped curve to the spine
- In severe cases reduced lung capacity, difficulties breathing
- thoracic/lumbar back pain (more common in the adult form of this condition).
A simple test known as the Adams Forward Bend Test involves the patient standing with their hands hanging and bending from the waist down with their arms relaxed. The resulting curve may show one shoulder blade appearing higher than the other, and there may be an asymmetry on the back, and one side will seem higher than the other, and you can sometimes see a protruding rib cage.
Diagnosis and Measurement
To form a formal diagnosis, a physical examination and imaging of the spine are required. Key assessment measures for a condition include the following:
The Cobb Angle: Measured from an x-ray when stood upright this gives an indication of the degree of curvature to the spine. With a Cobb angle of 10 degrees and above a diagnosis can be confirmed. From 20-40 degrees treatment options are usually braced up until Risser 4. Anything above 40 degrees and below 50 degrees usually warrant surgery depending on the Risser stage and curve progression.
Risser Sign: The Risser sign gives an indication of the skeletal maturity of the patient. A Risser score can vary from 0 to 5, where 0 indicates an immature patient with rapidly developing bones who will progress, to 5 being a skeletal mature patient who will likely see little or no progression. A patient at Risser 0 with a curve of 25 degrees will see a greater amount of progression than that which occurs in a Risser 4 aged patient, which at 25 degrees will remain as such, assuming little growth is anticipated.
Treatment
The course of treatment prescribed is based on age, skeletal maturity, the degree of curvature, and its rate of progression. These may include the following:
- Observation: If the curve is under 20-25, a patient is typicallyobserved, requiringa number of x-rays taken over several months to monitor its progress. If no further curvature occurs, nothing further needs to be done.
- Bracing:If a curve is between 25 and 40 degrees in a young patient, it is likely that they will require a brace to prevent it from developing any further. Braces do not correct the existing curvature; they are designed to halt its further progression, the two most common forms being the Boston and now more modern Cheneau braces. The efficacy of the brace iswholly dependent on how many hours per day it is worn for.
- Physiotherapy & Exercise-Based Treatments: Scoliosis-specific physiotherapy, particularly the Schroth method, is increasingly being seen as a successful non-surgical treatment. The Schroth Method involves exercises specifically tailored to de-rotate, elongate, and stabilize the spine. Its benefit lies in an improvement of posture and breathing, leading to improved lung capacity and overall quality of life. SEAS and Lyon physiotherapy, which can be combined with bracing, are other alternative treatment options.
- Surgery:If the curve is over 40-50 degrees or if a patient is developing scoliosis and it is known to progress above that amount, surgical intervention may berequired. Spinal fusion is the most common treatment, which entails joining vertebrae together using rods, screws, bone grafts, etc. Growth-sparing techniques such as growing rods can be utilized in young children in order to prevent future impairment of lung function.
Why a Second Opinion Matters in Scoliosis: Every case is different, and not two scoliosis cases are the same. The decision to opt for observation, bracing, physiotherapy, or surgery often comes down to expert medical opinion, but not all doctors have the same views on how a condition should be managed.
Consider seeking a second opinion in cases of
- Your child is being recommended for a spinal fusion operation.
- You’re being told surgery is required when your curve measures less than 50 degrees.
- You’re unsure whether bracing is the best course of action for the shape of the curve.
- You want to rule out other options before the drastic measures of spinal surgery.
- You don’t fully understand why the treatment recommendation is being made.
- You’re an adult suffering from degenerated scoliosis and are to be subjected to surgical procedures.
- You’ve been told to “wait and see” but aren’t sure if that’s the right decision.
Take Control of Your Scoliosis Journey
For More Information About Scoliosis:
This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider regarding any medical condition or concerns.
