It is natural for the spine to curve forward and backward to a certain degree. This is what gives the side-view of the spine its “S”-like shape. But sometimes the spine twists and develops curves in the wrong direction — sideways. When the spine twists and develops an “S”-shaped curve that goes from side to side, the condition is known as scoliosis.
A scoliosis curve can occur in the thoracic spine, the lumbar spine, or both areas at the same time. When the vertebrae in the mid and low back curve to the side, the normal appearance and condition of the spine and its muscles changes. The severity of the scoliosis is measured in degrees by comparing the curves to “normal” angles. Curves can range in size from as little as 10 degrees to severe cases of more than 100 degrees. The amount of curve in the spine helps your doctor decide what treatment to suggest. Conservative (nonsurgical) treatment is usually suggested for curves of less than 40 degrees, while curves over this amount may require surgery.
Scoliosis is most commonly seen in adolescents and adults. Adults can also develop scoliosis as a result of degeneration.
Most cases of scoliosis are first discovered and treated in childhood or adolescence-particularly during puberty when the curvature becomes more noticeable. When an adolescent has scoliosis with no known cause, doctors call the condition adolescent idiopathic scoliosis. This form of scoliosis can affect a child who is healthy and not having nerve, muscle, or other spine problems. It is the most common form of spinal deformity doctors see, affecting about three percent of the general population.
Scoliosis that occurs (or is discovered) after puberty is called “adult scoliosis.” Adult scoliosis can be the result of untreated or unrecognized childhood scoliosis, or it can arise during adulthood. The causes of adult scoliosis are usually different from the childhood types.
Degenerative adult scoliosis occurs when the combination of age and deterioration of the spine leads to the development of a scoliosis curve in the spine. Degenerative scoliosis usually starts after the age of 40. In older patients, particularly women, it is also often related to osteoporosis. The osteoporosis weakens the bone, making it more likely to deteriorate. The combination of these changes causes the spine to lose its ability to maintain a normal shape. The spine begins to “sag” and as the condition progresses, a scoliotic curve can slowly develop.
Scoliosis is often painless. People with scoliosis commonly see a spine specialist because they notice a problem with the way their back looks. If you have scoliosis, you may notice some of the following things about your body.
- One shoulder or hip may be higher than the other
- One shoulder blade may be higher and stick out farther than the other
- These deformities are more noticeable when bending over
- A “rib hump” may occur, which is a hump on your back that sticks up when you bend forward. This occurs because the ribs on one side angle more than on the other side
- One arm hangs longer than the other because of a tilt in the upper body
- The waist may appear asymmetrical
Back pain can eventually develop as the condition progresses. The deformity may cause pressure on your nerves and possibly even on your spinal cord. This can lead to weakness, numbness, and pain in your lower extremities. In severe cases, pressure on the spinal cord may cause loss of coordination in the muscles of your legs, making it difficult to walk normally. If your chest is deformed due to the scoliosis, your lungs and heart may be affected. This can cause breathing problems, fatigue, and even heart failure. Fortunately these severe symptoms are rare.
Usually after the exam, X-rays will be ordered that allow your doctor to see the structure of the spine and measure the curve. You will be asked to hold very still in certain positions. Doctors use the Cobb technique to measure curves in the spine. Lines are drawn on the X-ray to form an angle. The doctor measures the angle formed by the line and assigns the number of degrees to the size of the curve.
The treatment for degenerative scoliosis is usually conservative. Treatment commonly includes medication, exercise, and bracing to support the spine.
Surgery may be recommended in some cases of scoliosis, especially if you have nerve problems that are becoming steadily worse, uncontrollable pain, or spinal stenosis. If the nerve roots are being irritated or pinched because of the scoliosis, surgery may be necessary to remove the pressure. Surgical treatments can include a decompressive laminectomy to free up or “decompress” the nerves, the surgeon must remove a section of bone from the back of the spine (lamina). Your procedure might also include fusion. Patients with spinal instability who need surgery for spinal stenosis will likely also need lumbar fusion.