Understanding Scoliosis

Scoliosis is a common condition that affects many children, adolescents, and can impact individuals right through into adulthood. Simply defined, scoliosis is a sideways curvature of the spine that measures greater than 10 degrees. It also includes an amount of spinal column rotation.

The most common diagnosis of scoliosis is Idiopathic Scoliosis – with “idiopathic” referring to the cause being unknown.

A spine with scoliosis curves will sometimes looking like a letter “C” or “S” rather than a looking like a line straight down the middle of the back.

Patients usually suffer from a rotation of the spine which would make the waist or shoulders appear uneven.

• Infantile idiopathic scoliosis is the term used to describe scoliosis found in children from 0 to 3.
• Juvenile idiopathic scoliosis is the term used to describe scoliosis found in in children from 4 to 10.
• Adolescent idiopathic scoliosis is the term used to describe scoliosis found in adolescents from 11 to 18.
• Adult idiopathic scoliosis is found in patients over 18.

To determine whether you have Scoliosis you will need to see an experienced Scoliosis Specialist/Orthopaedic Surgeon.

You will be asked to bend over for a spinal rotation assessment and the specialist will view you from the back and the side. If Scoliosis is suspected then X-rays or an EOS scan will be needed. Depending on your scoliosis measure there will be different treatment options. Learn more about your first visit.

Scoliosis is not limited to children, but can also include adults and the elderly. There are many varied presentations of Scoliosis.

In childhood for example, idiopathic scoliosis can occur in both girls and boys. As children enter adolescence, the size and requirements for treatment increases in girls some five to eight times. The progression of Scoliosis is most common during the growing years, and in some cases, severe curves may progress during adulthood.

In more than 80 percent of cases the specific cause of Scoliosis is unknown and these cases are termed “idiopathic,” meaning “of undetermined cause.” We know that there is a genetic component to the condition which explains why it is more common in some families.

What we do know is that Scoliosis is caused by conditions such as:

• congenital spinal column abnormalities- abnormally formed vertebrae present at birth – hemivertebra, failure of segmentation or formation
• neurological disorders – cerebral palsy, spina bifida
• muscular diseases – spinal muscular atrophy (SMA), muscular dystrophies
• chromosomal conditions – Down syndrome, deletions
• connective tissue disorders – Marfan’s syndrome
• a multitude of other causes such as infections or fractures involving the spine.

Common signs we see in scoliosis:

• One shoulder may appear to be higher than the other.
• One shoulder blade (scapula) may be higher or more prominent than the other.
• When the arms are hanging loosely by the side, more space may be apparent between the arm and the body on one side.
• One hip may appear to be more prominent or higher than the other.
• The head may not be exactly centred over the patient’s pelvis.
• The waist may have skin creases present on only one side of the waist.
• The waist may appear to be flattened on one side.

Scoliosis patients usually present with little and more often, no back pain. If present, this may tend to be mild and does not limit activities in most patients.

However, in some instances, patients may experience more back pain than the average. Patients reporting severe back pain should be carefully evaluated for other causes of back pain while keeping in mind their Scoliosis.

Elderly scoliosis patients presenting with greater back pain may experience additional discomfort due to arthritis or disc disease in the spine.

Some patients may suffer diminished lung function due to distortion and stiffness of the rib cage as a result of the severity of their Scoliosis. This usually only occurs in very large curvatures.

A spinal deformity is a situation whereby the spine does not demonstrate “normal curves.”

When the body is viewed from behind, a normal spine will appear as a straight line down the back. When the trunk is viewed from the side, the normal spine will demonstrate normal curves where the upper chest area has a normal roundback, or kyphosis, while in the lower spine there is a swayback, or lordosis.

When a spine with a scoliosis is viewed from behind, a lateral, or side-to-side, curvature may be apparent. This may lead to the appearance of the patient leaning to one side. Increased roundback in the chest area is called hyperkyphosis, while increased swayback is termed hyperlordosis.

There are no known preventative measures for spinal deformities if genetically driven. Once detected however, the curve can be often controlled by reducing any significant progression.

There are many misconceptions of what causes Scoliosis.

Scoliosis does not occur due to children or adolescents carrying heavy bags or books, athletic involvement, poor sleeping or standing postures. Scoliosis is not caused by a lack of calcium or minor leg length difference.

Scoliosis diagnosis is performed by physical examination of your back by a specialist physician.

Firstly, the patient is examined from behind and asked to bend forward until the spine can be viewed in a horizontal plane. In this simple test, one side of the back may appear higher than the other – due to rotation of the spinal column. When the thoracic spine is involved the rib cage rotates as well and this is often called a “rib hump” seen on forward bending. This test, called the Adam’s forward bend test, is a sensitive test for scoliosis; it is therefore the most frequent screening test for scoliosis.

Following this simple examination, the physician will usually request radiographs of the spine, viewed from the back and the side, to see the entire spine from the neck to the pelvis. If scoliosis is present, the physician will measure these radiographs and provide you with a numerical value, in degrees, to help describe the scoliosis – the Cobb angle measurement.

Screening for children can be conducted at any age. Idiopathic scoliosis usually presents during a child’s growth spurt between the ages of 10 to 15 years. It is recommended therefore that girls be screened twice – at ages 10 and 12 – and boys once – at age 12 or 13 if a family history is known.

For information about the specific scoliosis terminologies visit our page on Identifying Scoliosis.

Abnormal Kyphosis defines the curvature or roundedness of the spine.

Excessive roundback deformity may simply be postural in nature, and in many cases can be corrected with specific exercises and proper posture.

Scheuermann’s kyphosis is a condition affecting a small percentage of patients with a kyphosis of more rigid deformities associated with wedged vertebrae—the exact cause of this is currently unknown.

The least common cause of excessive roundback is congenital kyphosis. This results when one or more bones of the spine form incorrectly and requires evaluation by an orthopaedic surgeon. Medical diseases such as ankylosing spondylitis or osteoporosis may also result in excessive roundback diagnoses.

Congenital Kyphosis is a defect of spinal formation in the very early stages of embryonic life. The forward bend of the spine is referred to as Kyphosis. The spinal defect causes the spine to develop a sharp forward angulation as it grows. The congenital nature is due to the malformation occurring prior to birth.

Congenital kyphosis does not appear to be inherited. The medical reasons for this kyphosis are currently unknown.

There are two basis types of Congenital Kyphosis – failure of formation and failure of segmentation.

Type I is the failure of formation, whereby a portion of one or more vertebral bodies, most often occurring in the thoracolumbar spine, results in a kyphosis that usually worsens with growth. The malformation is usually visible at birth as a lump or bump on the infant’s spine.

Type II is the failure of segmentation which occurs as two or more vertebrae fail to separate. The failure to form normal discs and rectangular bones is more likely to be diagnosed later, after the child is walking.

A scoliotic curve may be functional or structural in nature. Functional curves relate to the position of the knee and pelvis, changing in relation to the body’s position. Structural curves do not transition with changes in the body’s position.

Functional curves may be positional. If a patient stands asymmetrically, with one knee bent, and the pelvis tilted downward, a curve will be present. When the patient straightens the knee, and the pelvis is held parallel to the floor, the curve will go away.

Structural curves are those that have stiffness within them. These curves do not go away with changes of position. These therefore have much more significance than functional curves.

Effective treatments shown to affect idiopathic scoliosis are bracing and surgery. There is some evidence in the medical literature that supports the conclusion that physical therapy and chiropractic care, and other options do have any impact on scoliosis curves. Postural training for growing children is important.

Unfortunately Idiopathic scoliosis curves do not straighten out on their own.

Many children experience slight curves that do not need treatment. In these instance, whilst the curves do not go away, the children grow up to lead normal lives.

For larger curvatures that are left untreated, the best situation is that they do not worsen. For growing children it is highly recommended that the spine is monitored, as is it more likely that curves will worsen with growth.