Scoliosis

Spinal deformity conditions can affect anyone in any phase of life, and the Advanced Spine Institute of Greater Boston can help you navigate treatment.

Scoliosis, an extreme or abnormal side-to-side curve of the spine, is the most common spinal deformity. Scoliosis can develop in the thoracic (mid-back) and lumbar (low back) spine. Progressive scoliosis may cause the spine to start to rotate, pulling the ribs and further distorting the shape of the spine, creating a rib hump on the back and causing one side of the body to be taller than the other. When scoliosis is caused by muscle problems and does not involve spinal rotation, it is almost always reversible.

Types of Scoliosis

There are several types of scoliosis, some with a known cause, others without. When the cause of the disorder is unknown, it is termed idiopathic scoliosis. There are 3 types of idiopathic scoliosis:

  • Congenital (at birth) and infantile: occurs in children three years old or younger
  • Juvenile: patients are 4 to 10 years old
  • Adolescent: patients are 10 to 18 years old

Known Causes of Scoliosis

The causes of scoliosis fall into one of three categories: functional, neuromuscular, or degenerative.

Functional scoliosis is also termed nonstructural scoliosis because poor posture, a short leg, and/or the back muscles cause the spine to curve abnormally. This type of scoliosis is almost always reversible.

Neuromuscular scoliosis can be caused by cerebral palsy, Marfan’s disease, muscular dystrophy, muscle atrophy, polio, spina bifida, or spinal cord injury. Abnormal spinal curvature may worsen during growth spurts and lead to weak trunk muscles making it difficult to sit upright, stand, or walk.

Degenerative scoliosis affects adults and develops secondary to a spinal condition such as bone spurs, degenerative disc disease, osteoarthritis, osteoporosis, spinal fracture, or weakening of soft tissues such as the spine’s ligaments.

Curve Types

A component of a scoliotic curve is called a compensatory curve or counter curve. This means to compensate for the major curve, a curve develops above or below the major curve. The compensatory curve is usually less severe than the major curve. This is how the body tries to deal with maintaining balance. For example, if the major curve is to the left, the compensatory curve is to the right.

Scoliotic Curve vs. Normal Curve

The 4 types of curve patterns are:

  • Right thoracic: the major curve is to the right in the mid-back and the compensatory curve may develop in the low back (lumbar spine).
  • Left lumbar: the major curve is to the left in the low back. A compensatory curve may develop in the thoracic spine in the opposite direction (right).
  • Right thoraco-lumbar: the major curve is to the left in the mid and low back (thoraco-lumbar). The spine resembles the letter “C”.
  • Right thoracic and left lumbar: this is a double curve and the spine resembles the letter “S.” The right mid-back curve is about the same size as the left low back curve.

Symptoms and Diagnosis

Because scoliosis is a complex disorder that can be progressive, early diagnosis and treatment by a scoliosis specialist is important to prevent or treat deformity.

Scoliosis can cause:

  • One shoulder or hip to be higher than the other
  • One leg longer than the other
  • The head to appear as if it is not centered over the body
  • Hemlines and trousers to hang unevenly
  • Shoulder blade / rib cage prominence when bending forward at the waist
  • Visible curvature of the spine
  • Back pain (severe scoliosis)
  • Shortness of breath (severe scoliosis)

Depending on the patient’s age, diagnosis often includes:

  • Medical and family history (i.e. family members who have/had scoliosis)
  • Physical and neurological examination
  • X-rays such as full body, side and back to front views*
  • Magnetic resonance imaging (MRI)*
  • Bone scan
  • Adam’s Forward Bending test to identify the curve(s)
  • Plumb Line test to see if the spine is straight or curves
  • Scoliometer to measure the size of the rib hump

*X-rays are essential and help the specialist to measure the size of the curve(s). Curves measuring greater than 25-30 degrees are considered significant. Curves greater than 45-50 degrees are considered severe. Depending on the severity of the scoliosis and symptoms, an MRI may be needed.

Treatment

The type of treatment is dependent on many factors, such as the patient’s age (i.e. skeletal maturity, when the patient stops growing), severity of the curve(s), curve progression, and symptoms. Basically, treatment falls into 3 categories:

Observation: The curve is observed and diagnostic imaging tests (i.e. x-rays) are performed every 6 months until the patient reaches skeletal maturity. Adult scoliosis may also be monitored for progression.

Bracing: Bracing can help prevent curve progression in patients who are still growing and have not reached skeletal maturity (adulthood). Bracing is not appropriate treatment to correct adult scoliosis.

Surgery: Progressive or severe scoliosis is treated using spinal instrumentation (i.e. rods, screws) and fusion (bone graft) to help realign and stabilize the spine.

Final Note on Scoliosis

Scoliosis is a potentially serious condition that may occur at any age, including in very young children. There are numerous ways to treat scoliosis, but not all patients are candidates for all treatment options. Your care providers at the Advanced Spine Institute of Greater Boston can help you navigate the path of treatment. Early diagnosis and treatment by an expert in scoliosis will yield the best outcomes.