Scoliosis is the most common malformation of the spine, affecting between two and three percent of people in the U.S. by age 16. Instead of continuing to extend vertically as a person grows, the spine begins to curve laterally in one of two ways, either as a C-shape with one curve or in an S-shape with two curves. Overall, approximately six million people of all ages are affected by scoliosis in the U.S.
There are a few main causes of scoliosis.
This type of scoliosis occurs as a result of a birth defect in the bone or the spine and is usually diagnosed at a young age.
Muscles or nerves that are not functioning correctly as a result of conditions such as spina bifida or cerebral palsy can cause neuromuscular scoliosis. The spine will begin to curve as the initial disease intensifies or becomes more serious.
Degenerative scoliosis usually develops as a result of some traumatic injury to the back, including a major illness, back surgery for another condition, or osteoporosis. Older people who are diagnosed with scoliosis usually have this type due to a traceable event or cause.
Unfortunately, the most common cause of scoliosis can also be the most frustrating one. Idiopathic scoliosis has no evident cause. Eighty-five percent of scoliosis cases are idiopathic in nature, but there is some evidence that it can be genetic.
Scoliosis is grouped into categories based on the age at which a person is diagnosed. Those categories are:
- Infantile scoliosis: From birth to age three, generally congenital scoliosis.
- Juvenile scoliosis: From three to nine years old, can be any type.
- Adolescent scoliosis: During the tween and teen years from age ten to 18.
- Adult scoliosis: Any diagnosis after age 18, usually degenerative scoliosis. Adult scoliosis is far less common than all other types.
The initial diagnosis of scoliosis is usually made during routine screenings at school. The majority of public schools offer free annual screenings for kids. A visual diagnosis can often be made by simply having children bend over to touch their toes. In some cases, the curve of the spine will be visible through a t-shirt in this posture. Other signs may be a prominent scapula (shoulder blade), one shoulder visibly higher than the other, or a noticeable tilt to one side. The initial stages of scoliosis are not usually painful, but left untreated, the condition can cause not only pain but also difficulty moving, damage to the heart and lungs, and back problems.
Because the majority of scoliosis is idiopathic, it can be difficult to pinpoint risk factors, but there are a few.
- Sex: Girls have a higher likelihood of developing scoliosis than do boys, but the reasons for this are not known.
- Age: Scoliosis generally appears most frequently in ages nine to 15, which is why diagnostic screenings begin around 3rd
- Genetics: There is some indication that a family history of scoliosis makes a person more susceptible.
If scoliosis is suspected, then an X-ray of the spine is generally recommended to confirm a diagnosis and to measure a curve if it is present. Curves are measured in degrees. Curves that are slight (under 25 degrees) and diagnosed in younger children are usually only monitored visually and through X-rays every six months to see if the curve will straighten itself as the child grows.
Curves between 25 and 40 degrees may be treated with a brace. These braces can be made of hard plastic or soft material and may be worn for up to 23 hours a day depending on the severity of the curve. Braces are custom-made to correct the curve that is unique to each patient. Although adolescence can be a difficult time to have to wear something that draws attention to the body, braces are highly successful in correcting curves and can usually be discontinued after the spine stops growing.
If the curves are more severe or are in an S-shape, they will generally worsen over time and may require treatment. For children who have at least two years of skeletal development remaining, a brace is often all the treatment that is necessary. More severe curves at any age (those measuring 40 degrees or more) may require surgery to correct. Spinal fusion is the most common surgery for severe scoliosis. Hooks, rods, screws, and wires are placed into the spine to straighten it, with pieces of bone grafted over the top. The bones will grow together to keep the spine straight. This is a major back surgery that takes several hours and has a long recovery time.
For adults, osteoporosis or a diagnosis of scoliosis in adolescence are the most prominent risk factors for developing scoliosis later in life. Mayo Clinic orthopedic surgeon Paul Huddleston, M.D. believes that screening and prevention are key as Baby Boomers age (especially women):
“You can ask the question: Is my bone health what it should be or what I expect it to be? That involves seeing your health care provider, getting screened, and then taking action to prevent softening of the bone. Because once the bones start to break with the osteoporosis, you can’t undo that fracture, and you’ve really lost that opportunity to stay in that good space.”
Recent research on yoga for scoliosis has yielded promising results, and there is anecdotal evidence that chiropractic can help with acute incidence of pain, but the best treatment recommendations remain the same: early screening, a diet filled with calcium and vitamin D for strong, healthy bones, and lots of weight-bearing activity through all stages of life.
Have you or someone you love been diagnosed with scoliosis? What was your treatment plan?
Image by Paul Hudson via Flickr