Scoliosis Overview
What is scoliosis?
Scoliosis is the abnormal curvature of the spine. In children and adolescents, it is more often seen in the thoracic area (between the base of the neck and the bottom of the ribs). Teenage females are more commonly affected. The cause is not known. In older adults, scoliosis is more common in the lumbar area and is associated with significant degeneration of the discs and the vertebrae. Women are more affected than men.
This condition is defined by the degree of curvature in the spine, or the Cobb angle:
- No scoliosis: Curvature <10 degrees
- Mild scoliosis: curvature10-24 degrees
- Moderate scoliosis: curvature25-39 degrees
- Severe scoliosis: curvature >40 degrees
Who gets it and when?
Scoliosis is usually diagnosed in adolescence, but it can worsen with time. Both women and men experience it, but cases in women are more likely to require more advanced interventions.
Rarely, some individuals are born with an abnormal curvature of the spine, known as congenital scoliosis. Others are diagnosed as adults or experience a worsening case of scoliosis that was under control during childhood.
What causes scoliosis
What are the causes and risk factors of scoliosis?
The cause of most cases of scoliosis is unknown, though family history seems to increase risk. It is more prevalent in people with conditions such as spina bifida, cerebral palsy and muscular dystrophy.
Scoliosis pain symptoms
What are the signs and symptoms of scoliosis?
Scoliosis causes multiple symptoms that can include:
- Back pain
- Visual asymmetry from the back
- Uneven shoulders, hips, waist, ribs or legs
- Difficulty standing straight; regularly leaning to one side
- Head not centered above the pelvis
- Core weakness
- Decreased height
- Leg pain, tingling, numbness or weakness
- In severe cases, difficulty breathing (due to compression from the rib cage)
Scoliosis Diagnosis
How is scoliosis diagnosed?
After an initial visual screening that indicates scoliosis, often during a sports physical, pediatric wellness visits or school nurse office visit, a health care provider will evaluate the patient’s medical history and conduct a physical exam. Simple x-rays can be used to measure the size of the spine’s curvature. Diagnostic imaging may include an X-ray or MRI.
Scoliosis Treatment
How is scoliosis treated?
In general, most patients do not require surgery for scoliosis. A “watch and wait” approach is common, especially if the curve is less than 20 degrees.
Medical
An external brace can be used intermittently if the spinal curvature is between 20 and 50 degrees, but only for a short term so as not to weaken the muscles in the spine and core. This treatment can also be used for individuals with more severe curvature who are unable to tolerate surgery. Medications, such as NSAIDs and corticosteroids (like oral prednisone), may also be used to alleviate symptoms.
Physical Therapy
Physical therapy for scoliosis is aimed at supporting posture and core muscle strength. It’s important for people with scoliosis to maintain an appropriate weight and modify their daily activities if needed.
Non-Surgical Procedures
Epidural steroid injections can be helpful in older patients with lumbar scoliosis but are not recommended in younger patients with idiopathic scoliosis.
Surgical
If the curvature of the spine is greater than 50 degrees and you have decreased daily functions or an inability to perform activities of daily living, surgery will be considered. One common surgical treatment for adults in this group is a posterior spinal fusion, in which vertebrae are connected by accessing the spine from the back of the body, though some patients may require an anterior approach (from the front of the body) or a combination of the two. Other surgical treatments include osteotomies, in which stiff segments of facet joints are released, and spinal decompression surgeries.
