Scoliosis

When looking at the spine from the front or back, it should appear straight up and down. While looking from the side, there should be a slight curve forwards in two places: the neck and the low back. This is the normal shape of the spine. Scoliosis is an abnormal curvature of the spine from side to side, and is often accompanied by a rotational or twisting component. The curvature can be a C-shape or an S-shape. Furthermore, the curvature is described by the direction it points and its rotational component. For example, a dextrorotary lumbar scoliosis indicates a curvature to the right with rotation in the lumbar spine.

Signs and Symptoms

It is typically a parent, teacher, coach, or even class mate that first notices the signs of asymmetry. It may be noted that one shoulder appears lower than the other or protrude further than the other. The back may appear to twist or lean. The head may appear to be displaced to one side. One hip may appear to be cocked forward or to the side. The rib cage may appear to stick out on one side. One leg may appear to be longer. These general asymmetries are usually the first signs. In addition, the person may have symptoms and complain of pain or spasm in the back, neck, shoulders, or hips. Note that some scoliosis patients do not have spine pain or rib pain at all, but only visual asymmetries.

Causes of Scoliosis

Nobody knows exactly what causes scoliosis in the wide majority of cases. Hence, most are idiopathic in nature. If the abnormal curvature is due to some other process, then it is termed a secondary scoliosis. Most cases of secondary scoliosis are due to pathology of the nerves, muscles, connective tissue, or some irregularity in the vertebral bones or discs. Other pathologies like tumors or infections or degenerative changes that warp the shape of the vertebra or cause a person to lean away from the side of pain can also result in curvature. If spinal deviation is due to a permanent and fixed abnormality in the shape of the vertebra, such as a wedged vertebra, this is termed a structural scoliosis.

On the other hand, if the curvature is not permanent and the spine can actually straighten with certain positions, then it is a functional scoliosis. This type can be due to a short leg or muscle imbalance. Adam’s Test is a simple way one can determine the difference between a structural and functional scoliosis. Names are also given depending on when the condition begins. If a person is born with an abnormality such as a misshapen vertebra, then the term congenital is used. If it is discovered from birth to 3 years old, we use the term infantile. From 3-10 years old the term juvenile is used, from 10-18 we use the term adolescent, and in adults we logically use the term adult onset scoliosis.

Risk Factors

Most scoliosis develops between the ages of 10-20 and females are often more affected than males. There is a genetic component as the risk of developing a scoliosis is higher in those individuals who have one parent with scoliosis and much higher in those with two parents. But, as with almost all diseases, environmental factors play a role as well. The earlier the onset of scoliosis, the worse the prognosis. Scoliosis tends to worsen over time and the curvature is at risk of increasing as the spine grows.

Treatment of Scoliosis

Without a doubt, the priority in treating scoliosis, first and foremost, is to stop it’s progression. Curvature needs to be assessed and monitored over time. A side to side curvature in the spine has to be over 10 degrees before it is considered a true scoliosis. This is because almost everybody has some amount of curvature in the thoracic spine to accommodate the space for the heart. If the curvature is over 10 degrees and the patient is not yet skeletally mature, then the curvature needs to be monitored. Guidelines indicate X-ray should be taken at least every 6 months to measure any progression.

Treatment is aimed to straighten and symmetrically balance the spine. Scoliosis can be treated with manipulation, massage, stretches and exercises. For the same reason, decompression and traction are also an excellent therapy options. Scoliosis can be due to a problem with anatomical or functional leg length discrepancy thereby causing the pelvis and spine to tilt. Shoe orthotics or lifts would therefore be used in order to correct the asymmetry. If the problem is due to abnormal biomechanics then targeted rehab to correct the dysfunction should be employed. Braces can be used in more severe curves, though the clinical efficacy of using braces is questionable. If the curve becomes very severe measuring 50 degrees or more, a surgical consult is warranted because at this stage the heart and lungs can begin to be affected.

Prognosis

Generally, the prognosis of scoliosis depends on the likelihood of progression. Larger curves carry a higher risk of progression than smaller curves. Thoracic curves carry a higher risk of progression than lumbar or thoracolumbar curves. Double curves carry a higher risk of progression than single curves. In addition, patients not having yet reached skeletal maturity have a higher likelihood of progression. If you think you have scoliosis, please visit our Tulsa Chiropractor today.