Scoliosis is a deformity of the spine that causes an abnormal lateral curve in the spine. It can occur anywhere along the spine and result in multiple curves.
The most common form of scoliosis is Idiopathic (we used to say during our training that an idiopathic disorder has an “idiot physician and a pathetic patient”). This form of scoliosis is genetic in origin (clusters in families).
Other causes of scoliosis can be Congenital (present at birth), Neuromuscular (as in cerebral palsy), and Degenerative (such as from an illness or injury).
Who Are At Risk For Scoliosis?
Generally, scoliosis is more common in females. It is often first identified in children when their mother notices that one shoulder is lower than the other or their clothes are not fitting correctly.
These days most physicians screen children for scoliosis so that it is not missed when they are regularly followed. However, growth can occur beyond the pediatric years such that late developing scoliosis can be missed.
Identifying scoliosis during the growth years lends itself to be treated by bracing.Later diagnosis (after the growth years) limits the non-invasive options for real treatment.
Most pediatric scoliosis comes without symptoms such that if there is the complaint of back pain in that group an alternate cause for the pain should be investigated. Adult scoliosis more commonly causes back pain, shortness of breath, chest wall pain, and fatigue.
What Does Scoliosis Do To The Spine?
Essentially scoliosis causes the spine and attached structures to bend, rotate, compress, and apply tension to their attachments. In the pliable skeleton of a child this is usually well tolerated. In adults, the twisted skeleton causes an inefficient movement of the spine with accelerated “wear and tear” (degeneration).
The degeneration cases the joints, discs, ligaments, tendons, and muscles of the back to become inflammed. At times, scar tissue can form in the spinal canal as well as in the attached structures.
Severe spinal curves can also compress the normal inflation of the lungs. The process of gas exchange in the alveoli of the lung is effected causing shortness of breath.
How Does Scoliosis Cause Pain?
The pain of scoliosis is due to the accelerated spinal degeneration that can occur. The tension on nerves, ligaments, tendons, and muscles also generates pain. The curving of the spine causes an enhanced tension and wear of the attached structures (this is particularly true of the facet joints and discs).
Finally, the chronic inflammation that can occur can cause scar tissue in the spinal canal and associated structures. This can masquerade as a herniated disc or a facet syndrome.
What Is The Best Approach To The Therapy Of Scoliosis?
THE PATIENT WITH SCOLIOSIS WILL NEED A COMPLETE HISTORY AND PHYSICAL, A SERIES OF SPINAL XRAYS CALCULATING THE COBB ANGLE, AND A REFERRAL TO AN ORTHOPEDIC SURGEON.
The most important non-surgical treatment for scoliosis is bracing. This was first introduced in 1946 and was called the Milwaukee Brace. Bracing is most effective in young people who have less than a 40 degree Cobb angle scoliosis and at least 2 years of remaining growth. Adults can also benefit from spinal bracing but will not be able to normalize the curve in most cases.
Other forms of therapy (chiropractic, massage, injections, ultrasound, etc.) give relief of symptoms but do not reverse the curvature of the spine. They would be expected to give temporary relief at best.
The best therapy for scoliosis is the therapy that will correct, to the greatest degree, the spinal curve. Any other therapy is purely symptomatic and does not address correcting the structural abnormality of the spine.
When the Cobb angle exceeds 40 degrees, or the curve remains unchanged with bracing, or symptoms are worsening, the choice for surgery becomes the most effective alternative. The best approach to this form of therapy is to seek the advice of an orthopedic surgeon who has dedicated his practice to corrective spinal surgery for scoliosis.
The surgery for spinal scoliosis can be one of the most extensive of all surgical procedures. The rehabilitation after surgery may take many months. However, the result can be a correction of the spinal curve such that symptoms and progressive deterioration of the spine is minimized. A complete spinal correction is unusual.
I have discussed the definition of scoliosis, history, physical, diagnosis, and best treatments. If you or your loved one suffer from this malady there is hope. In the adult years of life, surgery offers the only remedy for correction of the spinal curve and associated symptoms.
All other therapies may offer symptomatic relief that is usually temporary.
If you have further questions or comments, please leave it below. I would love to be of service to you.
To your health.