Scoliosis is a medical condition in which a person’s spine has a curvature that is abnormal or unusual. This curve can take the shape of an “S” or a “C” and can be either mild or severe. Scoliosis can occur in people of any age, but it is most commonly diagnosed in children and teenagers. It can be caused by a number of factors, including genetics, birth defects, and other underlying medical conditions. Scoliosis is typically diagnosed by a physical examination and imaging tests, such as x-rays. Treatment options vary depending on the severity of the condition, and may include observation, physical therapy, bracing, or surgery.
What is Scoliosis?
Scoliosis is a medical condition in which a person’s spine has a curvature that is abnormal or unusual. The spine, or backbone, is made up of a series of small bones called vertebrae, which are stacked on top of each other and connected by ligaments and muscles. In a person with scoliosis, the vertebrae are not aligned correctly, and the spine has a curve to one side. This curve can take the shape of an “S” or a “C” and can be either mild or severe. Typically, a diagnoses of scoliosis is given when there is at least 10% spinal angulation.
Causes of Scoliosis
Scoliosis can have a variety of causes, and in many cases, the exact cause is unknown. Some potential causes of scoliosis include:
- Genetics: Scoliosis can run in families, and people who have a family history of scoliosis may be more likely to develop the condition.
- Muscle imbalance: If the muscles on one side of the spine are stronger or weaker than those on the other side, it can cause the spine to curve.
- Abnormal growth patterns: Scoliosis can be caused by abnormal growth patterns in the spine, such as when the spine grows faster on one side than the other.
- Birth defects: Some people are born with scoliosis due to birth defects in the spine.
- Neuromuscular conditions: Certain medical conditions that affect the muscles or nerves, such as cerebral palsy or muscular dystrophy, can cause scoliosis.
Prevalence
Scoliosis is a relatively common condition, affecting about 2-3% of the population. It is most commonly diagnosed in children and adolescents, and it is more common in girls than in boys. The prevalence of scoliosis varies by age, with the highest rates occurring in children and adolescents between the ages of 10 and 18.
Symptoms of Scoliosis
The symptoms of scoliosis can vary depending on the severity of the curvature and the location of the curve in the spine. Some common symptoms of scoliosis include:
- Uneven shoulders: One shoulder or shoulder blade may appear higher or more prominent than the other.
- Uneven waist: The waist may appear uneven, with one hip appearing higher or more prominent than the other.
- Back pain: Scoliosis can cause back pain, especially in more severe cases.
- Difficulty breathing: In severe cases of scoliosis, the curvature of the spine can put pressure on the lungs and make it more difficult to breathe.
It’s important to note that not all people with scoliosis will experience all of these symptoms, and the severity of the symptoms can vary widely. Some people with scoliosis may not experience any symptoms at all.
Diagnosing Scoliosis
Scoliosis is typically diagnosed through physical examination by a healthcare professional. Sometimes, an X-ray is used to confirm the diagnosis and determine the severity of abnormal curvature.
Physical Examination
There are several physical examination maneuvers that a healthcare provider may use to diagnose scoliosis. These may include:
- Adam’s forward bend test: The patient is asked to bend forward at the waist while keeping their legs straight. The healthcare provider will look for any curvature in the spine and for any unevenness in the shoulders, hips, or waist.
- Prone press-up test: The patient is asked to lie face down on a table and is then asked to lift their head and chest off the table. The healthcare provider will look for any curvature in the spine.
A doctor may also use a scoliometer to help diagnose scoliosis. A scoliometer is a small, handheld device that measures the angle of the curve in the spine. The patient is asked to stand upright and the scoliometer is placed on their back to measure the curvature.
Imaging: X-ray
An x-ray is a common test used to diagnose scoliosis. During an x-ray for scoliosis, the patient is asked to stand upright and an x-ray machine is used to take several images of the spine from different angles.
The x-ray images can show the curvature of the spine and allow the healthcare provider to measure the angle of the curve. This is known as the “Cobb angle,” and it is used to determine the severity of the scoliosis.
- Mild: Cobb angle of 10-20 degrees
- Moderate: Cobb angle of 20-40 degrees
- Severe: Cobb angle greater than 40 degrees
Treatment of Scoliosis
The treatment for scoliosis depends on the severity of the curve and the age of the patient. In most cases, scoliosis is a mild condition that does not require treatment. However, in more severe cases, treatment may be necessary to prevent the curve from getting worse.
Some common treatments for scoliosis include:
- Observation: For mild cases of scoliosis (angle less than 25 degrees), the healthcare provider may recommend simply monitoring the curve over time to see if it progresses. This may involve regular check-ups and x-rays to track the progression of the curve.
- Physical therapy: Physical therapy can help strengthen the muscles around the spine and improve posture, which may help reduce the curvature of the spine in some cases.
- Bracing: For moderate cases of scoliosis (angle between 25-45 degrees), the healthcare provider may recommend a back brace. The brace is worn under the clothes and is designed to hold the spine in a straight position and prevent the curve from getting worse. Bracing is most effective in children and adolescents who are still growing.
- Surgery: In severe cases of scoliosis (angle greater than 50 degrees), surgery may be needed to straighten the spine. There are several different types of surgery that can be used to treat scoliosis, including spinal fusion, instrumentation, and vertebral column resection.
It’s important to note that not all cases of scoliosis require treatment, and the best course of action will depend on the individual patient’s needs.
Prognosis
In most cases, scoliosis is a mild condition that does not cause any significant problems and does not require treatment. In these cases, the prognosis is generally good, and most people with scoliosis can expect to lead normal, active lives.
However, in more severe cases of scoliosis, the curvature of the spine can cause pain and discomfort, and it can also affect the function of the lungs and other organs. In these cases, treatment may be necessary to prevent the curve from worsening and to improve quality of life.
Sources
Janicki, Joseph A, and Benjamin Alman. “Scoliosis: Review of diagnosis and treatment.” Paediatrics & child health vol. 12,9 (2007): 771-6. doi:10.1093/pch/12.9.771
Konieczny, Markus Rafael et al. “Epidemiology of adolescent idiopathic scoliosis.” Journal of children’s orthopaedics vol. 7,1 (2013): 3-9. doi:10.1007/s11832-012-0457-4
Maruyama, Toru, and Katsushi Takeshita. “Surgical treatment of scoliosis: a review of techniques currently applied.” Scoliosis vol. 3 6. 18 Apr. 2008, doi:10.1186/1748-7161-3-6
