Scoliosis is an unnatural curvature of the spine. The normal shape of the spine includes a top-of-the-shoulder curve and a lower back curve. If your spine is curved from side to side or in an “S” or “C” shape, you probably have scoliosis.
According to the Scoliosis Research Society, more than 80 percent of scoliosis cases have no identifiable cause (SRS). The condition is often diagnosed during the first seven years of a child’s life.
Common causes (when they can be pinpointed) are birth defects, neurological abnormalities, and genetic conditions.
Common Types of Scoliosis
Types Based on Cause
The largest category of scoliosis is idiopathic scoliosis, which has no definite cause. Idiopathic scoliosis is broken down by age group:
- infant (0 to 3 years)
- juvenile (4 to 10 years)
- adolescent (11 to 18 years)
- adult (18+ years)
There are a number of different types of scoliosis among the estimated 20 percent of cases in which a cause can be identified, including:
- congenital (spinal deformities that appear at birth)
- neurological (when brain abnormalities affect nerves and muscles in the spine)
Types Based on Permanence
Scoliosis can also be broken into two other categories: structural or nonstructural. Structural scoliosis is when the spine’s curve is fixed and was caused by a disease, injury, or birth defect.
Nonstructural scoliosis is when the curve is temporary and can be fixed.
What are the types and causes of scoliosis?
Non-structural scoliosis (functional or postural scoliosis)
In this type, the back (spine) is structurally normal, but looks curved because of another condition such as differing leg length or muscle spasm in the back muscles.
The curve is usually mild and it changes or goes away when the person bends sideways or forwards.
In these cases, the curve is fixed and doesn’t go away when the person changes position. There are different types:
Idiopathic. This means the cause is not known. More than 8 in 10 cases of scoliosis are idiopathic.
Neuromuscular. This means the curve is caused by a condition which affects muscles or nerves of the back. For example, it may occur in some cases of muscular dystrophy, polio, cerebral palsy, or neurofibromatosis.
Each of these conditions has other symptoms and problems in addition to a scoliosis. Around one 1 in 10 cases of scoliosis are neuromuscular.
Osteopathic. This means as a result of a bone abnormality.
Congenital. This means the spine does not form properly when a baby develops in the womb. This is a cause in around 1 in 10 cases.
The rest of this leaflet is about the common type – idiopathic scoliosis.
Who gets idiopathic scoliosis?
Idiopathic scoliosis can develop at any stage in childhood. It is not known how or why it develops. It is not due to poor posture and you cannot prevent it.
It most commonly develops during the growth spurt of puberty and early adolescence. This is usually between the ages of 10-12 for girls and 11-16 for boys. About 1 in 40 children have some degree of scoliosis.
Mild scoliosis affects about the same number of boys and girls. However, moderate or severe scoliosis is more common in girls.
Idiopathic scoliosis is not a straightforward hereditary condition. However, in about 1 in 4 people with scoliosis there are one or more other family members with the same condition.
Recognizing the Signs of Scoliosis
Scoliosis is a physical condition that can cause severe spinal curving. Since there are varying degrees of scoliosis, symptoms may vary. Common symptoms associated with scoliosis include:
- one shoulder blade that is higher than the other
- one shoulder blade that sticks out more than another
- uneven hips
- a rotating spine
- spinal twist
- problems breathing because of reduction of chest area for the lungs to expand
- back pain
How Is Scoliosis Diagnosed?
Since scoliosis is a spinal shape issue, a physical examination is the first step. Your doctor will observe your back while you stand with your arms at your sides.
He or she will be looking for spine curvature and whether or not your shoulders and waist area are symmetrical (in line).
Next, your doctor will ask you to bend forward and observe your back from this angle. This time he or she will look for curvature in your upper and lower back.
In addition, some form of imaging test will be used to get a closer look at your skeleton. Tests may include:
- X-ray: uses radiation to create a picture of the spine
- MRI: uses radio and magnetic waves to get a detailed picture of bones and tissue surrounding them
- CT scan: X-rays taken at a variety of angles to get a 3D picture of the skeleton
- Bone scan: a solution that is radioactive is injected into your blood. It will be concentrated in area of increased circulation, making spinal abnormalities easier for your doctor to see.
Treatment Options for Scoliosis
The type of treatment depends on numerous factors, but the degree of spine curvature is a major factor.
Your doctor will also take into consideration your age, whether you are likely to continue growing, the amount and type of curvature, and the type of the scoliosis.
The primary treatment options are bracing and surgery.
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, you will like have to use a brace if:
- you are still growing and the curvature is more than 25 to 30 degrees
- you are still growing and the curvature is between 20 and 29 degrees, but the curvature is getting worse
- the curvature is between 20 and 29 degrees and you have at least two more years to grow; also, if you are a girl and you have not begun menstruation (NIAMS)
The braces will not straighten the spine, but can prevent the curvature from increasing. This method of treatment is more effective for cases that are detected early.
The braces will usually be worn 24 hours a day for maximum effectiveness. However, children will be able to remove the braces to participate in normal exercise and sports activities.
A doctor will usually recommend that braces be worn until a child reaches adolescence and is no longer growing.
There are two main types of braces:
- Underarm: made of plastic and fits close to the body. The brace is virtually invisible. This is used to treat lower spine curves, as it fits around the lower portion of the body.
- Milwaukee: this brace starts at the neck, and covers the entire torso, with the exception of the legs and arms.
This brace is for curves that the underarm brace cannot address.
Surgery is usually reserved for people with severe curves—those greater than 45 or 50 degrees. However, you can always request this option if you feel that the curvature is interrupting your daily life or causing you discomfort.
Spinal fusion is the standard scoliosis surgery. The doctor will fuse your vertebrae (spinal bones) together using a material similar to bone, called bone graft, and rods and screws.
The rods keep the spine in a straight position and the screws hold it in place. This will result in the bone graft and the vertebrae eventually fusing into a single bone.
Children’s rods can be adjusted as they grow. There are some risks inherent in spinal fusion surgery including:
- excessive bleeding
- failure to heal
- nerve damage
Long-Term Outlook for Scoliosis
The long-term outlook for scoliosis depends on how severe the curvature is. For mild to moderate cases, the condition will not interfere with everyday functions.
However, individuals with severe forms of scoliosis may have some physical limitations.
Growing up with scoliosis can be difficult. It is important for your child to have a support group and for you to join a parental support group as well.
This will give you and your child shoulders to lean on and sounding boards for advice about dealing with the condition on a daily basis.
There is no reliable evidence that other techniques, such as osteopathy, chiropractic, physiotherapy, reflexology, acupuncture, neuro stimulation, and so on, can make any difference to a scoliosis.
However, these complementary techniques can sometimes be useful to improve backache or pain in some people with scoliosis.