Scoliosis

A normal spine, when viewed from behind, appears straight. However, a spine affected by scoliosis shows evidence of a lateral, or sideways, curvature, and a rotation of the back bones (vertebrae), giving the appearance that the person is leaning to one side. Scoliosis is defined as a curvature of the spine measuring 10 degrees or greater on x-ray.

Scoliosis is a type of spinal deformity and should not be confused with poor posture.

Four common types of curve patterns seen in scoliosis include the following:

• Thoracic – 90 percent of the curves occur on the right side.
• Lumbar – 70 percent of the curves occur on the left side.
• Thoracolumbar – 80 percent of the curves occur on the right side.
• Double major – curves that occur on the right and left side.

Causes

In most (80 to 85 percent) cases, the cause of scoliosis is unknown – a condition called idiopathic scoliosis. In other cases, scoliosis may develop as a result of degeneration of the spinal disks or as a hereditary condition that tends to run in families.

The abnormal curves of the spine are classified according to their cause, including the following:

• Nonstructural scoliosis (also called functional scoliosis)In this condition, a structurally normal spine appears curved due to one or more underlying conditions (i.e., difference in leg length, an inflammatory condition, etc.). This type of scoliosis is generally temporary and is often relieved when the underlying condition is treated.
• Structural scoliosisThe possible causes of structural scoliosis are numerous, including the following:
  

  Of unknown origin (idiopathic structural scoliosis)

  Disease (i.e., neuromuscular, metabolic, connective tissue, or rheumatoid disease)

  Congenital malformation of one or more vertebrae

  Injury

  Infection

  Abnormal growth or tumor

Symptoms

The following are the most common symptoms of scoliosis. However, each individual may experience symptoms differently. Symptoms may include:

• Difference in shoulder height
• The head is not centered with the rest of the body
• Difference in hip height or position
• Difference in shoulder blade height or position
• When standing straight, difference in the way the arms hang beside the body
• When bending forward, the sides of the back appear different in height

Back pain, leg pain, and changes in bowel and bladder habits are not commonly associated withidiopathic scoliosis. A person experiencing these types of symptoms requires further medical evaluation by a physician.

The symptoms of scoliosis may resemble other spinal conditions or deformities, or may be a result of an injury or infection. Always consult your physician for a diagnosis.

Diagnosis

In addition to a complete medical history and physical examination, x-rays (a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film) are the primary diagnostic tool for scoliosis. In establishing a diagnosis of scoliosis, the physician measures the degree of spinal curvature on the x-ray.

The following other diagnostic procedures may be performed for non-idiopathic curvatures, atypical curve patterns, or congenital scoliosis:

Magnetic resonance imaging (MRI) – a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

Computed tomography scan (CT or CAT scan) – a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

Early detection of scoliosis is most important for successful treatment.

Treatment

Specific treatment of scoliosis will be determined by your physician based on:

• Your age, overall health, and medical history
• Extent of the condition
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the condition
• Your opinion or preference

The goal of treatment is to stop the progression of the curve and prevent deformity. Treatment may include:

• Physical therapy
• Instruction in stretching and strengthening exercises to address muscle imbalances.
• Observation and repeated examinations may be necessary to determine if the spine is continuing to curve.
• Bracing may be used when the curve measures between 25 to 40 degrees on an x-ray, but skeletal growth remains. The type of brace and the amount of time spent in the brace will depend on the severity of the condition. When scoliosis is diagnosed at birth or in early childhood, treatment with braces or a body jacket may be required to prevent progression – and careful monitoring is important to discern whether surgery becomes advisable.
• Surgery
• Surgery may be recommended when the curve measures 50 degrees or more on an x-ray and bracing is not successful in slowing down the progression of the curve.

According to the Scoliosis Research Society, there is no scientific evidence to show that other methods for treating scoliosis (i.e., manipulation, electrical stimulation, and corrective exercise) prevent the progression of the disease.