Scoliosis

What is it?

Scoliosis is an abnormal side-to-side curvature of the spine, that measures 10 degrees or more. Scoliosis is usually described in two ways: by the age at which a person is first affected, and the underlying cause of the curvature. Types of scoliosis in relation to the age are: infantile (birth to age 3, juvenile (ages 4-10), adolescent (ages 11-18), adult (older than 18). Types of scoliosis in relation to the cause are: idiopathic (“for a cause that is not known.”), degenerative (“due to wear-and-tear.”), congenital (“present at birth.”), functional (when a structurally normal spine appears curved due to an underlying conditions), structural (caused by disease, injury, or infection)

Symptoms

Scoliosis has many possible causes, and its symptoms can vary by cause.

  • Congenital scoliosis, which is present at birth, can produce weakness, numbness, or clumsiness if it affects the spinal cord.
  • Idiopathic scoliosis, which develops without known cause, usually doesn’t have symptoms except noticeable postural changes.
  • Degenerative scoliosis, which results from wear and tear on the discs and joints of the spine, is likely to cause symptoms, which may include back pain that is getting worse with sitting or standing, and numbness and weakness in one or both legs.

Common to all types of scoliosis is:

  • Head off-center with the rest of the body
  • The difference in shoulder height, and the difference in hip height or position
  • The difference in the way the arms hang beside the body when standing straight
  • When bending forward, the difference in height between the sides of the back

Diagnosis

To confirm a diagnosis of scoliosis, and to measure the degree of spinal curvature, the doctor may order X-rays, magnetic resonance (MR) imaging, and computed tomography (CT) scan.

Treatment

Different types of scoliosis have different therapeutic approaches:

Adolescent idiopathic scoliosis: Nonoperative treatment, including physical therapy, and strengthening and stretching exercises, may be an option for some patients. If the curvature measures 50 degrees or more on an X-ray and bracing is not successful, surgery is then considered to correct the spinal deformity.

Degenerative scoliosis: Nonsurgical therapies for degenerative scoliosis include physical therapy, anti-inflammatory medications, steroids, and injections. Spine surgery may be recommended when the spinal curve is greater than 50 degrees and the patient has nerve damage to their legs or is experiencing bowel or bladder symptoms.

Congenital scoliosis: Infants with congenital scoliosis require surgery if the curvature is progressing. The decision to have surgery for congenital scoliosis depends less on the size of the curve than on its cause and expectation of progression.