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What is scoliosis?
Scoliosis can affect the body by causing pulmonary and respiratory problems if the organs become compressed due to the curvature. Nerves coming from the spinal cord can also be affected with worsening scoliosis.
Everyone has some curvature of the spine. In the sagittal plane — the plane that divides your left and right sides — the spine has natural curves that support movement and stresses. Scoliosis is often identified with curves of the spine that occur to the left or right; however, the condition can also cause the spine to curve to the front or back.
Scoliosis is a spinal condition that affects 2% to 3% of the world's population. In the U. S., between 6 and 9 million people have scoliosis.
The condition usually develops in young people between the ages of 10 and 15 years, but it can show up in people even younger. Females are more apt to develop scoliosis to the point that needs treatment, but both males and females develop scoliosis at about the same rate.
There are treatments for scoliosis. However, doctors will sometimes leave it alone if it doesn't appear that the condition will worsen or change. If you have or think you might have scoliosis, it's good to know the signs, causes, and treatments to help you understand the steps doctors might take to treat it.
Symptoms of scoliosis
Several symptoms are present if you have scoliosis. These can include:
- Uneven shoulders
- Head might not be centered or is tilted
- Tilted hips
- Upper body might tilt
These symptoms may also be paired with moderate to severe back pain.
Types of scoliosis
Three general types of scoliosis exist:
- Idiopathic scoliosis
- Congenital scoliosis
- Neuromuscular scoliosis
Other types of scoliosis might be referred to as:
- Nonstructural scoliosis
- Degenerative scoliosis
Idiopathic scoliosis is the most common type of scoliosis. As you grow, the spine begins to curve in one or more areas, and it’s difficult for doctors to determine its cause. The condition can also affect adults.
Congenital scoliosis is an abnormal curve in the spine that occurs at birth. Nervous system disorders and conditions can cause scoliosis, which is how neuromuscular scoliosis forms.
Nonstructural scoliosis is a curvature of the spine induced by a temporary influence or one outside of the spinal cord. For example, different leg lengths may cause a person to tilt their hips to compensate. It can also be brought on by intense muscle spasms that cause the spine to tilt.
Degenerative scoliosis usually occurs in adults with spinal cord injuries and degenerative problems.
Causes of scoliosis
The most common form of scoliosis, idiopathic scoliosis, does not yet have an identified cause. However, significant resources are devoted to finding it. The condition usually occurs in teenagers between the ages of 10 and 18.
Congenital scoliosis occurs when the spinal cord does not properly develop within the first six weeks of a baby's development. Nonstructural scoliosis is a curvature of the spine caused by conditions that are not related to an abnormal structure of the spinal cord.
Neuromuscular scoliosis is caused by medical conditions, like cerebral palsy, that affect the nervous and muscular systems and their ability to control muscles that stabilize the spine. If these muscles do not support the spine, it grows toward the direction the muscles are weakest in.
When to see the doctor for scoliosis
If you have neuromuscular or congenital scoliosis, you've likely been seeing the doctor since you were born. If your condition begins to worsen, see your doctor right away. Scoliosis that gets worse can cause pulmonary and respiratory problems if the organs become compressed due to the curvature. The nerves coming from the spinal cord can also be affected with worsening scoliosis. Visiting your doctor is essential so they can treat you and prevent more severe symptoms.
If you begin to develop scoliosis at any age, see your doctor. It is often related to several other conditions. If you're between 10 and 18, you might have idiopathic scoliosis that needs to be treated. Adults could have spinal conditions or other problems that make it essential to see a doctor.
Diagnosing scoliosis
Usually, the doctor has you perform the Adam's Forward Bend Test, where you bend forward, and they observe your spine. Any abnormal curvatures are easy to spot using this test. If there is any curvature to note, the doctor may send you to get X-rays, a computed tomography (CT) scan, or magnetic resonance imaging (MRI) scan. These tests let them see the vertebra's position and attitudes, the discs, and diagnose any conditions.
Doctors will observe children with scoliosis with periodic imaging to see if there have been any changes in their conditions. Adults—whose skeletal structures have matured and stopped growing—can develop scoliosis as their bodies age. Doctors will use the same tests to determine the cause of adult-onset scoliosis, which might occur if:
- Childhood scoliosis was untreated
- Surgically treated childhood scoliosis further develops
- There are degenerative changes in the spine
Treatments for scoliosis
Treatment for scoliosis is limited to observation, bracing, and corrective surgery. Doctors will likely observe children with scoliosis periodically to ensure the condition is not worsening and causing other health problems.
If their curve ranges between 25 and 40 degrees, the doctor may prescribe a brace for them to wear to prevent further curvature as they grow. If their curve is more than 40 degrees or progresses to that degree, they might advise corrective surgery.
Adults who received treatment when they were children may get a recommendation for revision surgery if their condition worsens as they age. If adults develop scoliosis, doctors might prescribe observation, bracing, physical therapy, and pain relievers as initial treatments.
If non-operative treatments have not helped the condition, doctors might opt to conduct a surgical treatment to realign the spine. Current surgical treatments are:
- Micro-decompression
- Surgical stabilization
- Fusion
- Osteotomy
- Vertebral column reconstruction
Two methods use hardware to align and fuse vertebrae—spinal fusion and surgical stabilization. In micro-decompression, doctors remove portions of the vertebrae that are compressing nerves. Doctors can perform an osteotomy, where they cut and realign parts of the spine.
The last option doctors have is removing sections of the vertebrae and realigning the spine. This option is called a vertebral column reconstruction.