Understanding Scoliosis
Scoliosis is a somewhat rare spinal condition that’s most often diagnosed during adolescence.
Scoliosis is a condition in which the spine curves sideways in a C or S shape. Some curvature in the spine is normal — even necessary. Spinal curves help us maintain healthy alignment and balance in our back, shoulders, and pelvis. However, when abnormal or exaggerated spinal curves develop, it is called scoliosis.
Scoliosis is somewhat rare, affecting only:
2-3%
of the general population1.
Many conditions can cause or be associated with scoliosis, including cerebral palsy, spina bifida, muscular dystrophy, spinal muscular atrophy, and tumours. However, over 80% of cases are idiopathic — meaning there is no known cause — and are often diagnosed in otherwise healthy people1.
There are four main types of scoliosis:
Idiopathic Scoliosis means there is no known cause to explain why the spine develops
a curve. It is the most common type of scoliosis, representing 80% of cases.¹
Congenital Scoliosis (present at birth) is caused by malformation of the spine during prenatal development. The spinal column develops during the third to sixth week in utero at the same time as several other major organ systems.
NMS (Neuromuscular scoliosis) occurs in children with a neuromuscular disorder that impairs their ability to control the muscles that support their spine. Conditions associated with NMS include cerebral palsy, spina bifida, muscular dystrophies, and spinal cord injuries.
Early onset scoliosis (EOS) is diagnosed in patients younger than 10 years old.¹ Some EOS cases are idiopathic, which is called idiopathic early onset scoliosis.
Degenerative Scoliosis
Degenerative (de novo scoliosis) is another type of scoliosis diagnosed in adult patients who have no previous history of scoliosis.
Curvature of the spine in this case is caused by degeneration where the discs and facets loose the ability to maintain the normal shape of the spine so the spine begins to curve. There are many contributing factors to the pain of degenerative scoliosis.
Spinal stenosis is a condition that causes pain by pinching the nerve roots in the spine, and it often accompanies scoliosis.
Degenerative Disc Disease (DDD), which is when the disc space loses its normal height, also causes pain. Arthritis can also attack the joints of the spine, like the facet joints, to trigger back pain.
Treatment options
Depending on the severity of a person's scoliosis, a doctor may recommend observation, bracing, or surgery.
If the spinal curve is mild (less than 25 degrees) and has low risk for progression, scoliosis may not require active treatment. The doctor will monitor the curve through regular check-ups to watch for progression.2
Observation is also an appropriate treatment if a child is diagnosed with moderate scoliosis (25-to 40-degree curve) and has finished growing (typically age 17 for boys and age 15 for girls). At this point, a moderate curve is considered unlikely to progress or cause problems in adulthood2. Doctors often recommend follow-up x-rays every five years to confirm that the curve stays stable.
Bracing is an option for patients with mild to moderate spinal curves who are still growing. A back brace is a device customised to conform to a patient's body that keeps the spine in a straight, secure position. The goal of bracing is to keep the curve from progressing. Wearing a brace won’t correct the curve, but it may prevent the curve from getting worse as a person grows. Typically, a brace will be worn until a doctor has determined that a patient has finished growing.2
Corrective Surgery
Severe scoliosis curves greater than 40 degrees may require corrective surgery. Spinal fusion realigns the curved vertebrae and fuses them together.2
The two primary aims of scoliosis surgery are:
- To stop a curve from progressing
- To reduce rib prominence and to diminish spinal deformity
A surgeon may use one of two primary approaches: the posterior approach or the anterior approach. In some cases, a surgeon may use a combination of the two.
Anterior approach
The anterior approach means a surgeon will access the spinal column from the side of the chest wall, rather than through the back. Certain types of scoliosis curves are especially amenable to the anterior approach2.
Posterior approach
In a posterior approach operation, a surgeon accesses the spine through the patient’s back. The posterior approach is the most traditional approach to spinal surgery. Most scoliosis surgeries are performed this way2.
Introducing Josephine!
She has her own storybook to explain scoliosis to kids.
Print a discussion guide with important questions for your next doctor appointment.
Print a discussion guide with important questions for your next doctor appointment.
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1 Fadzan, M; Bettany-Saltikov, J. Etiological theories of adolescent idiopathic scoliosis: past and present. 2017. Open Ortho journal. 11 pg 1466-1489
2 Wiggins G.C. et al. Pediatric spinal deformities. 2003. Neurosurg Focus 14 (1) Article 3.