Scoliosis: types, causes, symptoms and treatment.

Scoliosis is a medical condition that presents as an abnormal, sideways curvature of the spine. The spine, which usually appears as a square pillar, becomes distorted into an "S" or a "C" shape, a deviation from its typical vertical alignment. This condition, contrary to a common misconception, is not a result of poor posture or carrying heavy loads. Instead, it is often linked to genetic factors, congenital spinal malformations, or neuromuscular conditions.

Defining the Curve: What is Scoliosis?

The degree of this spinal curve can vary significantly from one individual to another. In some cases, the curvature might be so slight that it's barely noticeable, while in others, it could be severe enough to cause visible physical deformities and impact routine functions. Scoliosis is officially diagnosed when the curve measures 10 degrees or more, a measure determined by a widely accepted technique known as the Cobb Angle.

The Cobb Angle, named after American orthopedic surgeon John Robert Cobb, is a standard method used worldwide to measure spinal curves' severity. It involves drawing lines parallel to the top of the uppermost tilted vertebra and the bottom of the lowermost tilted vertebra in the curve on an X-ray image.

Perpendicular lines are drawn from these, forming an angle at the intersection, the Cobb Angle. The larger the Cobb Angle, the more severe the scoliosis.

It's important to note that while a Cobb Angle of 10 degrees or more indicates scoliosis, the condition's management vastly depends on the severity of the curvature. For instance, a curve between 10-20 degrees is usually considered mild and often doesn't require treatment but regular monitoring for changes.

However, a curve greater than 20 degrees may necessitate more proactive treatment, such as bracing. When the Cobb Angle reaches 40-50 degrees or more, surgical intervention might be considered, as curves of this magnitude can potentially impact lung function and overall health.

According to the American Association of Neurological Surgeons, scoliosis affects approximately 2-3% of the population, equating to about six to nine million people in the United States. It can occur at any age but is most commonly identified during adolescence, between the ages of 10 and 15. Girls are more likely to be affected than boys.

 

Scoliosis types and complexities 

Scoliosis is as unique as the individuals it affects, with each case presenting distinct characteristics. One of the key factors that differentiates one case from another is the site of the curve along the spine. Understanding these types is critical in assessing the condition and planning appropriate treatments.

1. Thoracic Scoliosis: The most common form of scoliosis, thoracic scoliosis, occurs when the curve is located in the thoracic spine, which comprises the middle and upper parts of the spinal column. This area houses the rib cage, so a curve here can lead to a noticeable rib hump on one side of the back when the person bends forward. Thoracic scoliosis can also affect the body's ability to house and protect the lungs, potentially impacting respiratory function in severe cases.
2. Lumbar Scoliosis: In lumbar scoliosis, the curve is situated in the lumbar region or the lower part of the spine. This area carries the most body weight, and a curve here can lead to imbalances that manifest as one hip being higher than the other. Lumbar scoliosis is often less visible when clothed than thoracic scoliosis, as it doesn't involve the rib cage. However, it can still lead to significant discomfort and back pain, particularly in adulthood.
3. Thoracolumbar Scoliosis: In some cases, the curvature spans both the lower part of the thoracic spine and the upper part of the lumbar spine. This is known as thoracolumbar scoliosis. The presence of the curve across these two regions can lead to both a rib hump and hip imbalance, combining potential complications of both thoracic and lumbar scoliosis.
4. Combined or Double Curve Scoliosis: In more complex cases, an individual may present with two distinct curves in the spine, often forming an "S" shape. This is referred to as combined or double-curve scoliosis. The most common form of double-curve scoliosis involves one curve in the thoracic region and another in the lumbar region. While one curve is usually more severe, both must be monitored and potentially treated to ensure balanced alignment.

Each type of scoliosis presents unique challenges and considerations, necessitating a personalized approach to management and treatment. For instance, thoracic scoliosis may require close monitoring for potential respiratory impact, while lumbar scoliosis might necessitate strategies for managing discomfort or pain. In all cases, early detection and intervention can significantly improve the prognosis and quality of life for individuals living with scoliosis.

 

Different scoliosis types based on causes: 

1. Idiopathic Scoliosis: The most prevalent type, idiopathic scoliosis, accounts for about 80% of all cases. The term 'idiopathic' means without a known cause, and despite ongoing research, the exact cause of this form of scoliosis remains elusive. However, it is believed to have a genetic component, as it often runs in families. Idiopathic scoliosis typically presents during adolescence but can also appear in infancy or early childhood.

2. Congenital Scoliosis: Congenital scoliosis is present at birth and is caused by a malformation of one or more vertebrae during the development of the fetus. It may result in more significant physical deformities and, due to its early onset, can substantially impact the individual's quality of life. This condition is relatively rare, occurring in approximately 1 in 10,000 newborns.

3. Neuromuscular Scoliosis: Neuromuscular scoliosis results from medical conditions that affect the nerves and muscles of the body. Conditions such as cerebral palsy, spina bifida, or muscular dystrophy can lead to muscle weakness or imbalances that cause the spine to curve. The prevalence of neuromuscular scoliosis varies widely depending on the associated condition, but it is common in children with certain neuromuscular disorders.

4. Degenerative Scoliosis: Also known as adult onset scoliosis, degenerative scoliosis arises due to the natural aging process. As we age, our joints and discs in the spine can wear out or degenerate, leading to a loss of the normal spinal alignment. This condition is relatively common in adults over the age of 50 and can be exacerbated by osteoporosis, a condition that weakens the bones. While it typically progresses slowly, degenerative scoliosis can result in significant back pain and reduced quality of life if left untreated.

 

Symptoms of Scoliosis

Despite the different causes, the various forms of scoliosis often present similar symptoms. The condition can sometimes be difficult to detect, particularly in its early stages when the curve is mild. However, certain physical signs may indicate the presence of a spinal curve:

1. Uneven shoulders: One shoulder may appear higher than the other.
2. Asymmetric waist: One side of the waist may appear higher or more prominent.
3. Hip imbalance: One hip may be higher or more prominent than the other.
4. Prominent shoulder blade: One shoulder blade may stick out more than the other.
5. Leaning to one side: The individual may lean to one side, particularly noticeable when standing up straight.

It's important to note that these physical signs do not always indicate scoliosis, and they can also occur in other spinal conditions. Moreover, scoliosis does not typically cause pain in children or teenagers. If back pain is present in a young individual along with these signs, it is important to seek medical attention. In adults, particularly those with degenerative scoliosis, back pain is a common symptom.

 

Treatment of scoliosis 

Once scoliosis is suspected or diagnosed, the course of treatment will depend on several factors, such as the severity of the curve, the patient's age, and the potential for the curve to progress. The following are some of the standard treatment strategies:

1. Observation: In cases where the curve is less than 25 degrees, the standard approach is often "watchful waiting." This involves regular check-ups to monitor the curve for any changes. Given the slow progression of most mild scoliosis cases, immediate intervention is often unnecessary, and this strategy allows for early action if the curve worsens.
2. Bracing: Bracing is often recommended if the curve measures between 25 and 45 degrees in children who are still growing. According to a 2013 study published in the New England Journal of Medicine, bracing significantly decreased the progression of high-risk curves to the threshold for surgery. The purpose of the brace is not to correct the curve but to prevent further progression.
3. Physical Therapy: Physical therapy, specifically tailored exercises for scoliosis, can be valuable in managing the condition. These exercises, often part of a physiotherapeutic scoliosis-specific exercise (PSSE) program, can help reduce pain, improve posture, and enhance physical function. These exercises can help improve strength and flexibility, improving the overall quality of life for adults with scoliosis.
4. Surgery: Surgery might be recommended in severe cases where the curve is above 45 degrees or continues to progress despite bracing. The most common surgical procedure is spinal fusion, which connects two or more vertebrae so they can't move independently, reducing the curve and preventing further progression. A 2018 study in The Spine Journal found that surgical intervention could significantly improve the quality of life for individuals with severe scoliosis. However, as with any major surgery, spinal fusion has potential risks and complications, which should be thoroughly discussed with the healthcare provider.

 
Beyond these standard treatments, emerging technologies and therapies such as non-fusion surgeries and genetic testing offer additional potential pathways for scoliosis treatment in the future.
 
It's essential to remember that each case of scoliosis is unique, and treatment should always be individualized based on the specific needs and circumstances of the patient. Regular communication with healthcare providers, ongoing education about the condition, and proactive management can help individuals with scoliosis lead healthy, active lives.