Scoliosis

Scoliosis is a common condition that causes the spine to curve abnormally. Most cases develop during childhood or adolescence, affecting approximately 1 in every 40 children. Most cases are diagnosed when children are age 10 or older. With prompt treatment, almost all children will be able to live normal, active lives. The majority of cases can be treated successfully without surgery. Summit Orthopedics has the expertise Minneapolis/St. Paul residents need to diagnose, treat and manage scoliosis.

What Is Scoliosis?

Your spine, or backbone, consists of 33 bones called vertebrae that connect your skull to your tailbone. Everyone’s spine has a slight curve, where the upper back usually curves out and the lower spine curves in. However, people with scoliosis have a spine that also curves side to side. Instead of appearing as a straight line, an affected spine may curve in a “C” or an “S” shape. The more severe this curve is, the more problems the spinal deformity can cause if left untreated.

What Causes Scoliosis

There is no known cause of 80% of scoliosis cases. However, some people are at a higher risk of developing the condition than others, including those with a family history of spinal curvature.

Rarer types can be caused by congenital birth defects, neuromuscular diseases, injury to the spine or spinal tumors. Some adults, usually over age 65, may develop scoliosis due to age-related changes in their spine.

There is nothing a parent can do to prevent scoliosis from developing. It is not caused by poor posture, carrying a heavy backpack or an inactive lifestyle. Young athletes are at risk of scoliosis, and so are children who never play sports.

Types of Scoliosis

There are several types of scoliosis. Knowing the type you or your child has can help determine a treatment plan. The most common types include:

• Congenital scoliosis: This condition is present at birth and caused by defects to the vertebrae that develop in the womb. It may be visible at birth, or it may not appear until your child hits a growth spurt.
• Degenerative scoliosis: Most common in people over age 65, this adult-onset condition usually develops as lumbar scoliosis in the lower spine. It is often accompanied by degenerative changes such as spinal stenosis.
• Idiopathic scoliosis: This is the most common type and has no known cause. When it affects children 3 years old and younger, it is called infantile scoliosis. In children ages 4 to 10, the condition is called juvenile scoliosis. It is called adolescent scoliosis when it affects children ages 11 to 18. Adolescence is the most common time for idiopathic scoliosis to develop.
• Neuromuscular scoliosis: This condition develops in conjunction with certain chronic conditions and disorders, including cerebral palsy, Down syndrome, Marfan syndrome and muscular dystrophy.

Any type of scoliosis that develops in a child under age 10 is considered early-onset scoliosis. This type may be associated with health complications, including heart and lung problems. Prompt treatment is important to reduce your child’s risk of health problems in adulthood, but it is especially critical for early-onset cases.

Symptoms of Scoliosis

Scoliosis often has no symptoms. While some curves in the spine may be visible to parents, other curves may look normal without specialized training to notice them. However, the more severe the curvature of the spine is, the more likely that scoliosis symptoms will develop, such as:

• A hump on the rib cage
• Changes in posture
• Hips that may appear uneven
• Lower back pain
• One shoulder that appears higher than the other
• One shoulder blade that seems to stick out more than the other
• Tendency to lean to one side

In rare, severe cases, breathing may be difficult.

Diagnosis

Scoliosis is generally diagnosed with a physical examination and X-ray imaging. X-rays allow providers to see the full extent of the curvature of the spine. In some cases, additional diagnostic imaging such as CT scans or MRI may be needed.

Nonsurgical Treatments

Treatment plans usually vary depending on how small or large the curves in the spine are. These curves are measured in degrees—the smaller the degree, the smaller the curve. For those with smaller curves, there are two common treatment options:

• Observation: Many people with curvature of the spine do not need treatment, only monitoring. These people have mild scoliosis, or spinal curves under 25 to 30 degrees. Every four to six months, a provider will X-ray the spine to see if the curve has changed. If it does not progress during peak adolescent growth, doctors’ visits may become less frequent and stop once the child stops growing.
• Bracing: If a child is still growing and the curves are above 25 degrees but under 50 degrees, the child may need a scoliosis brace. This prosthetic is fitted to the torso and must be worn 16 to 23 hours of the day, depending on the child. How long a child needs to wear a brace will depend on how well the brace is working and where they are in their growth. Braces often need to be worn as long as the child is still growing.

Some people may also be prescribed physical therapy for scoliosis to strengthen their core muscles. Physical therapy alone will not improve scoliosis, but it may help improve certain symptoms. Support for mental and emotional health is also an important part of scoliosis treatment, as it can be hard for teens to balance scoliosis self-care with the normal challenges of adolescence.

Surgical Treatments

When a spinal curvature is over 50 degrees or bracing has not been effective, scoliosis surgery is usually recommended.

Spinal fusion surgery is the most common option to surgically correct scoliosis curvature.  During this surgery, a vertebral bone is attached, or “fused,” to an adjacent vertebral bone. The body grows new bony tissue over the bone graft between the two vertebral segments, fusing them together. When the fused bones heal, the fusion prevents movement at the joint. 

A fusion will reduce freedom of movement in the spine by making the fused vertebral bones immobile, but that immobility prevents the spine from curving further. Most people can return to normal activities a few months after surgery, including noncontact athletics and exercise. It may take six months to a year to safely return to contact-based sports.

If your child has a scoliosis diagnosis or what seems like abnormal spine curvature, request an appointment with a Summit Orthopedics expert.