Scoliosis is the lateral or sideways curvature of the spine. There are two broad categories of scoliosis: adolescent and adult. The cause of adolescent scoliosis is unknown. It usually involves the thoracic spine, which is the part of the spine that connects to the rib cage. Adult scoliosis is due to degeneration of the spine. It comes in many forms and varies greatly in terms of symptoms. It may be asymptomatic or cause pain and/or neurological dysfunction.
Surgery is reserved for patients with severe symptoms. Some adult scoliosis can be treated with minimally invasive spine surgery while others require traditional open surgery. Scoliosis is typically diagnosed early on and initially treated conservatively with bracing and physical therapy. When this fails and the curve progresses beyond 25-30 degrees, surgery is typically recommended.
Scoliosis is described based on the age when the person is diagnosed and the cause of the curvature. Some common types of scoliosis include:
- Idiopathic – This is the most common type in infants, juveniles and adolescents. For this type of scoliosis, the cause is unknown.
- Degenerative – This is the most common type of scoliosis in adults. The cause of this scoliosis is asymmetric, general wear and tear on the spinal discs and joints.
- Congenital – This is the type of scoliosis that is present at birth.
- Nonstructural (functional) – This is when a normal spine appears abnormal due to an underlying condition. These conditions can be positional, difference in leg length, an inflammatory condition, or another condition. This type of scoliosis is usually temporary.
- Other – Some other causes of scoliosis include disease, injury, infection, or tumors
Common Symptoms of Scoliosis
Scoliosis symptoms vary based on the cause.
- Congenital – weakness, numbness, or clumsiness (although rare)
- Idiopathic – noticeable postural changes
- Degenerative – back pain, electric shock-like pain, numbness, or weakness in the legs
Diagnosis of Scoliosis
Indications that scoliosis is present include:
- Difference in shoulder height
- Head off-center with the rest of the body
- Dissimilarity in hip height/position
- Difference in shoulder blade height/position
- Dissimilarity in the way the arms hang beside the body when standing straight
- Difference in height between the sides of the back, when bending forward
Certain image tests are used to determine the degree of the spinal curvature. These tests include:
- X-ray – Imaging from X-rays can be used to see bone and spine and typically include the entire spine.
- MRI scan – shows soft tissue relationships and is the best study to visualize the nerves.
- CT scan – uses x-ray images and a computer to produce detailed pictures of the spine and surrounding structures
Treatment Options for Scoliosis
Just as symptoms vary depending on the type of scoliosis, treatment options vary as well.
- Idiopathic scoliosis – Nonoperative treatment includes physical therapy, stretching and strengthening exercises. Sometimes depending on the degree of the curve, a brace may have to be worn. If the curve is significant, surgery is considered to correct the spinal deformity.
- Degenerative scoliosis – If spinal stenosis has resulted due to scoliosis, surgery may be required to fix the deformity.
- Congenital scoliosis–If the curve of the spine is progressing, surgery must be performed.