Scoliosis: Types, Causes, Symptoms, Diagnosis, Prevention, and Treatment

Even though scoliosis appears to be a bone condition, it’s actually a neuro-muscular condition that is influenced by a number of different factors.

The curve, three-dimensional change in the spine’s alignment, is only a symptom of this multi-factorial condition. That’s the major reason why scoliosis has challenged a lot of researchers and health care professionals for centuries. Let’s see what they have already found about this condition and how we can treat and prevent it.

What’s scoliosis?

The abnormal curvature of the spine is called scoliosis. The normal, healthy shape of the spine has a curve at the lower back and a curve at the top of the shoulder. When the spine is in a “C” or “S” shape or is curved from side to side, it’s an alarming sign of scoliosis. Scoliosis tends to affect kids from 10 to 14 years old. The curve may occur at a different point of the spine and may not or may tilt the pelvis.

In most cases, scoliosis is a progressive condition so it’s important to treat it timely to avoid complications in the future. Sometimes, scoliosis doesn’t show any symptoms and thus is left untreated.

What are the main types of scoliosis?

There are 4 main types of scoliosis that mostly children tend to develop, and they are:

• Perhaps, the most mysterious type of scoliosis, idiopathic appears from nowhere. Some researchers believe that it has a genetic component and can be inherited.
• This type of scoliosis mostly affects people born with a bone abnormality. It develops in the uterus and is generally recognized and diagnosed during a child’s infancy. Affecting 1 in 10,000 children, congenital scoliosis is a rare condition, yet hard to treat. Children with congenital scoliosis require a specific corrective surgery.
• Often caused by general wear and tear and premature aging, degenerative scoliosis spurs from the thinning of the bones. A serious trauma or injury can also be a cause of this condition. Degenerative scoliosis is more likely to affect adults later in life.
• This form of scoliosis is resulted from reduced nerve or muscle function and is typically seen in people with spina bifida, cerebral palsy, or other conditions, which are accompanied by paralysis. Additionally, neuromuscular scoliosis is often referred to as another form of myopathic scoliosis.

The severity of any form of scoliosis greatly depends upon the direction, location and shape of the intrusive curve. The lateral arcs are usually called “C-shaped” or “S-shaped” curve, as it resemble the deviation of the letter. There are 5 specific curvatures that indicate the severity of scoliosis:

• Surfaced in the lower back (lumbar) region of the spine, levoscoliosis is a curve to the left. It’s vital to diagnose it as soon as possible because levoscoliosis may be a sign of a spinal cord tumor. Levoscoliosis occurs in the thoracic spine.
• This one is the most frequent kind of spinal curve. It occurs when the spine tends to bend toward the right and develop in the middle back (thoracic) area of the spine. Dextroscoliosis may be accompanied by another curve that moves in the opposite direction in the lower area of the spine, forming a “S”-shape curve or be isolated, creating a “C”-shape curve.
• Thoracolumbar scoliosis. This one involves the vertebrae in the upper lumbar spine and the lower thoracic spine.
• Lumbar scoliosis. This curve usually occurs in the lumbar (lower) area of the spine.
• Thoracic scoliosis. This one develops in the thoracic (middle) area of the spine.

What are the major causes of scoliosis?

It’s not easy to determine the cause of certain form of scoliosis, but the major triggers are:

• Spinal infections;
• Sudden spinal accident, trauma, or injury;
• Bone degeneration;
• Aging;
• Growth or tumor;
• Osteoporosis;
• Muscular dystrophy, which is a group of the genetic disorders that lead to muscle weakness;
• Cerebral palsy, which is a group of the nervous system disorders that can affect vision, movement, thinking, hearing, and learning abilities;
• Possible genetic predisposition or congenital abnormality;
• Birth defects that can affect a baby’s spinal bones, like spina bifida.

Females are more likely to develop a more severe type of scoliosis than males. Children with a family history of any form of scoliosis have a higher risk of developing the condition.

What are the major symptoms of scoliosis?

Since scoliosis can develop gradually and you may not experience any mild or severe pain, you may have trouble spotting it without a doctor’s help. But, identifying the following symptoms promptly will boost your chance of receiving an effective treatment and preventing any complications that can happen later in life:

• The body start tilting to one side;
• Leg length discrepancies: one leg may be shorter than the other one;
• Difficulties with breathing due to a lowered area in the chest for the lungs to expand;
• Sharp or dull back pain;
• Visually uneven waist;
• One hip may appear more prominent or higher than the other one;
• One shoulder blade may protrude more than the other one;
• One shoulder may be higher than the other one;
• The spine seems to be curved when you view from the back;
• Rib cages appear at different heights;
• Head isn’t centered right above the pelvis;
• The texture or appearance of the skin overlying the spine unexpectedly changes (color abnormalities, hairy patches, dimples, etc.)

How is scoliosis diagnosed?

Scoliosis is usually diagnosed through a physical examination, spinal radiograph, an x-ray, MRI or CT scan. A doctor uses the Cobb Method to measure the curve and set a diagnosis in terms of severity or complexity by the number of degrees. The scoliosis is confirmed based on a coronal curvature, which is measured on a posterior-anterior radiograph of bigger than 10 degrees. Generally, a curve bigger than 25 to 30 degrees is considered significant. Curves over 45 to 50 degrees are diagnosed as severe and they require immediate and prolonged treatment.

The Adam’s Forward Bend Test is another standard exam used to diagnose scoliosis, particularly in children. During this test, a child leans forward with their feet together and tries and bends at least 90 degrees at the waist. This allows a doctor to detect any abnormal spinal curvatures or any asymmetry of the trunk. Since it’s a simple and basic screening test that allows a doctor to determine the potential scoliosis problems, it doesn’t help to find out accurately the form or severity of scoliosis. A number of radiographic tests might be required in order to set an accurate diagnosis.

The imaging or radiographic tests that your doctor is more likely to ask you to take include:

• Magnetic resonance imaging (MRI). This test will show three-dimensional images of the body structures, including the spinal cord and the nerve roots with the surrounding areas. It can also show any deformities, degeneration, and enlargement. MRI uses computer technology and powerful magnets;
• Bone scan. It will help your doctor to detect a radioactive solution injected into the blood that concentrates in the areas of an enhanced circulation, showing any spinal abnormalities or issues.
• X-ray. This is a widely-used application of a radiation to create a picture or film of almost any area of the bod. X-ray shows the outline of the joints and the structure of the vertebrae. X-ray of the spine is required to identify the potential causes of the back pain, such as deformities, fractures, infections, etc.
• CT or CAT scan (computed tomography scan). This is a diagnostic picture made after a computer reads your X-ray image. CT scan will show the size and shape of your spinal canal, the structures around it and its contents. CT scan is often needed to visualize the bone structures.

How to prevent scoliosis

Unfortunately, you can’t prevent scoliosis. Proper treatment can only stop the curve from getting worse. The spinal curves of kids and teens with a mild form of scoliosis must regularly be checked by a doctor to monitor if the curve is worsening or improving.

Even though many curves – especially those of children – don’t reach the point where a special medical treatment or surgery is required, it’s important to stop the curve from worsening or growing. Adults with scoliosis are more likely to experience mild to severe back pain. Painkillers and ointment can be used to relieve the pain, but it’s vital to maintain good health and exercise on a regular basis.

Additionally, you should keep your weight in check. Overweight people with scoliosis tend to have a more severe back pain than slimmer individuals. Also, check your posture and protect your back from injuries – especially if you work out hard in the gym. Don’t wear high-heeled shoes on a daily basis, as they put your lower back and hips into poor alignment and cause a lot of stress on the lower back.

How to treat scoliosis

When there’s a confirmed diagnosis of any form of scoliosis, there are a few important factors to consider in order to determine the necessary treatment options, such as:

• The extent and degree of a curvature. A doctor checks how severe the curve is and how it affects your lifestyle.
• Spinal maturity. A doctor checks if your spine still changing and growing.
• Any possibility of the curve progression. If you had a large curve prior to your adolescent growth spurt, you’re more likely to have a curve progression.
• Location of the curve. Unlike the curves in other areas of the spine, thoracic curves are more likely to grow and progress.

When a doctor determines your form of scoliosis and its progression, they can suggest you three main treatment options, such as:

• The patient, especially a child, is required to visit a doctor every 4 to 6 month in order to observe the progress of the curve. Further, adults with scoliosis might be asked to do X-rays once in 5 years, if there’s no unexpected growth of the curve. If the symptoms get progressively worse, a doctor might consider the third treatment option.
• This treatment is available only for children who haven’t reached a skeletal maturity. Bracing is recommended for patients whose curve is between 25 to 40 degrees and it’s quickly progressing. There are numerous brace designs and the modern ones are a bit more effective. For the better results, the brace must be checked on a regular basis to ensure a proper fit and might need to be used 16 to 23 hours daily until the growth of the curve stops. But keep in mind that a few examinations are required since bracing isn’t for everyone.
• This is a drastic treatment that doctors turn to when they should reduce the spinal deformity or/and prevent the curve from progressing. Surgery is recommended only when there are warning signs of fast progression or when the spinal curve is bigger than 40 degrees. If a surgery is done in childhood, a revision surgery may be required in adulthood, depending on the particular case. Adults with spinal stenosis and degenerative scoliosis may need a decompression surgery with a surgical approach from both the front and back and a spinal fusion. When the spinal curve is getting bigger than 50 degrees and you have a serious nerve damage to your legs or/and are experiencing the bladder or bowel symptoms, surgery may also be required. Since there are a lot of risks and complications, many tests and examinations are needed before surgery. Some of the risks are nerve damage, pain, infection, failure to heal, and excessive bleeding.

When you live a healthy life and take care of your back, it’s possible to live a pain-free life with scoliosis.

Some adults don’t experience any symptoms of scoliosis unless they put a lot of pressure on their back or sleep in the wrong position.

The key is to practice a good posture and be careful with exercise. Also, if you have a sedentary job, try to take short breaks and do a few stretches. Healthy eating with enough calcium is recommended as well. If your scoliosis prevents you from living an active life, be sure to consult your doctor.

References:

https://www.healthline.com/symptom/scoliosis

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2532872/