What is scoliosis?
Scoliosis is an abnormal side-to-side curvature of the spine away from the midline. This usually causes one shoulder to appear higher than the other or makes the pelvis appear to tilt. In addition to the side-to-side curving, there may also be some rotation of the spine. This rotation, when present, may make your waist or shoulders look uneven. A variation of scoliosis, called kyphoscoliosis, may also involve abnormal front-to-back curvature.
The spinal column refers to the column created by your vertebrae. It consists of 24 articulating vertebrae that run from the top and back of your neck down your back and are separated by cushiony intervertebral discs. This is followed by nine fused vertebrae in the sacrum and coccyx at the base of your spine.
Scoliosis usually develops during childhood and may easily be overlooked. When the condition is discovered in an adult, it may actually be the progression of undetected childhood scoliosis. However, both scoliosis and kyphosis can develop in adulthood, usually in response to degenerative disc disease, osteoporosis (thinning and weakening of the bones), or spondylosis (spinal degeneration).
Scoliosis is not life threatening and often does not progress. It is important to treat any related pain (usually in adults only) to prevent debilitation. Although scoliosis in a child should be monitored regularly as the child grows, often it needs no intervention at all. In some cases, treatment can prevent further progression, so it is important to monitor spinal changes regularly.
Scoliosis is usually a mild condition and sometimes requires no treatment. In rare cases of severe curvature that is left untreated, the rib cage may be compromised and press in on the heart or lungs, making it difficult for them to function. Seek prompt medical care if you experience worsening of your back pain or if you notice uneven shoulders or waist or elevated hips.
What are the symptoms of scoliosis?
Symptoms of scoliosis do not usually appear in childhood unless the condition is advanced and begins to cause discomfort in the back. Instead, outward signs may be noticed by a parent or physician and are reflected as subtle aberrations in “posture.”
Common signs of scoliosis
Scoliosis occurs frequently without symptoms. Pain or discomfort in older adults is often related to degenerative spine disorder, a natural degeneration of the spine that comes with aging. In children, visible signs of scoliosis may include:
- Elevated hips
- Fatigue after sitting for a long period (occasional)
- Head not centered over the child’s body
- Leaning to the side
- Prominent or uneven shoulder blades
- Ribs higher on one side
- Uneven shoulders or hips
- Uneven waistline
Symptoms that might indicate a serious condition
In rare cases, complications from severe scoliosis can lead to a serious condition that should be immediately evaluated in an emergency setting. Seek prompt medical care if you, or someone you are with, have any of these symptoms including:
- Uneven shoulders, waist or hips
- Worsening back pain
What causes scoliosis?
Most cases of scoliosis are congenital, that is, they are present at birth, and are caused by problems in vertebral development or in ribs that are fused together early in life. Scoliosis can also be caused by neuromuscular problems related to diseases like cerebral palsy, muscular dystrophy, or spina bifida (birth defect resulting in incomplete formation of the backbone and spinal canal). Certain hereditary conditions such as neurofibromatosis, Marfan syndrome, and Ehlers-Danlos syndrome may also have an associated scoliosis. Idiopathic scoliosis (scoliosis of unknown origin) may develop in adolescence. It is important to remember that scoliosis is not merely a result of poor posture.
Several risk factors increase the risk of developing scoliosis. Not all people with risk factors will get scoliosis. Risk factors for scoliosis include:
- Cerebral palsy
- Degenerative disc disease
- Female sex
- Muscular dystrophy
- Osteoporosis (thinning and weakening of the bones)
- Polio
- Spina bifida (birth defect resulting in incomplete formation of the backbone and spinal canal)
- Spondylosis (spinal degeneration)
How is scoliosis treated?
In many cases, scoliosis does not require treatment. For example, some cases of childhood and adolescent idiopathic scoliosis are monitored roughly every six months with no treatment necessary. If curves worsen, a scoliosis brace may be used to help slow progression. Back braces do not reverse scoliosis curvature but apply pressure to help straighten the spine and prevent further curvature from developing. Bracing is only helpful in select cases. Your physician will be able to determine whether a scoliosis brace can help you.
Surgery is not always appropriate and is usually reserved for severe curvatures. Although surgery cannot completely straighten the curvature, it can improve it and stop or slow progression by fusing the affected bones together.
Complementary treatments
Some complementary treatments may help some people to better deal with scoliosis. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for full medical care.
Complementary treatments may include:
- Acupuncture
- Massage therapy
- Yoga
Complications of untreated or poorly controlled scoliosis can be serious. You can help minimize your risk, or your child’s risk, of serious complications by following the treatment plan you and your health care professional design specifically for you or your child. Complications of scoliosis include:
- Adverse effects of treatment
- Heart problems (with severe curvatures)
- Lower back pain and arthritis in adulthood
- Respiratory problems (with severe curvatures)
- Self-esteem issues for children or adolescents, particularly when wearing a brace
- Spinal cord or nerve damage in severe or untreated cases
- Spine infection after surgery
