The term scoliosis is used to describe a curved spine. It is not the same thing as having bad posture, nor is it a disease. Most often a curve develops in the thoracic spine, the mid to upper level of the back. It may develop in the lumbar (lower spine) as well. As the spine is twisted, the curve may form on the left or right side in a C-shape and sometimes twist in both directions forcing the spine into an 'S-shape. Scoliosis can occur in any age group.
In some cases a child may develop a curve which improves or resolves as the child grows into adulthood. Left untreated, a curve may continue to worsen causing serious deformity of the spine, pain, and disability.
Causes and Types of ScoliosisScoliosis may be caused by developmental, congenital, or degenerative disorders. There are four major categories for types of scoliosis:
Congenital Scoliosis
This is a problem that begins prior to birth, often with the development of the vertebrae. Some vertebrae may not be present or be poorly formed, incomplete, or fused together.
Neuromuscular Scoliosis
Many neurological and neuromuscular disorders are also linked to the development of scoliosis. These include:
- Cerebral Palsy
- Muscular Dystrophy
- Spina Bifida
- Paralysis
- Spinal Cord Tumors
- Arnold Chiari Malformation
- Syringomyelia
Degenerative Scoliosis
This is the type usually seen in adults. It develops as a result of deterioration of the spine from other conditions such as arthritis or osteoporosis.
Idiopathic Scoliosis
Idiopathic means the cause for the curvature of the spine is not known. About 80% of the time the cause for scoliosis is unknown. There are three categories of idiopathic scoliosis:
- Infantile - This includes infants from one to three years of age and is seen most often in boys
- Juvenile - scoliosis in children from 3 to 9 years old.
- Adolescent - This is the most common form of scoliosis among children from 10-18 years old and is more frequent in girls.
When a child or adult develops scoliosis the physician may also order an MRI to determine if either syringomyelia (SM) or Arnold Chiari Malformation (CM) are also present. Both of these rare spinal cord disorders are associated with scoliosis.
Diagnosis
Physicians usually identify scoliosis by x-ray and physical exam. When a patient bends over, a curvature of the spine is often visible to a trained observer. An x-ray can show the size and type of a curve in the spine.
Symptoms of Scoliosis
Some people with scoliosis have no symptoms while others suffer many. Symptoms may develop slowly. The following symptoms are typical in scoliosis:
- Body twisted to one side when walking or bending over
- One shoulder or hip is higher than the other
- Chronic back pain
Treatment
In the United States, treatment for scoliosis has historically focused on three approaches:
Observation - monitoring to see if the spine deformity stops on its own
Bracing - Bracing without physical therapy to try and halt the progression
Surgery - Fusing the spine or inserting a rod to keep it straight, when the curvature becomes disabling.
According to the Scoliosis Research Society and the National Institute of Arthritis and Musculoskeletal Disorders and Skin Diseases (NIAMS), these are the only effective treatments for scoliosis.
This approach to treating scoliosis may direct many patients away from other effective treatments for scoliosis. After decades of success in Europe, physical therapy and exercise programs such as the Schroth method, are becoming more widely available in the United States.
Newer types of bracing, notably the SpineCor bracing developed in Canada, are giving patients relief from their pain while also improving their spine health.
Physical therapists and rehabilitation specialists have a role alongside the physician and patient in deciding how to best manage scoliosis. Today, patients and their families have more options for successful treatment of scoliosis than in the past.
Sources
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Neuwirth, MD, and Kevin Osborn; The Scoliosis Sourcebook; Contemporary Books, 2001
Schommer, Nancy; Stopping Scoliosis: The Whole Family Guide to Diagnosis and Treatment, 2nd edition; pub. Avery; 2002
Resources
Spinal Dynamics of Wisconsin - One of the centers in the United States using the Schroth method for treating scoliosis
Related Links
Chiari Malformation - An Overview
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