What is Scoliosis?
Scoliosis is spinal disorder. It affects around 6 million people in the United States and approximately 12 million worldwide. An abnormal formation of the vertebral column or backbone, those who have the condition usually display a curved spine that looks like a long “C” (one curve) or an “S” (two curves) when observed from the rear view of the body, whereas it should form a fairly straight line.
Scoliosis causes the spine to curve from side to side, rather than from front to back or top to bottom. In more medical terms, it is defined as any lateral curvature of the spine of more than 10 degrees (determined by x-ray). Anything below 10 degrees is considered “postural changes”. Abnormal curvatures that can be seen from the side may be due to kyphosis, hypo-kyphosis, thoracic lordosis or hyper-lordosis, and can sometimes accompany scoliosis.
The condition, which can rightly be described as an abnormal curvature of the spine, is more prevalent in adolescents, particularly girls between the ages of 10 and 15, and can lead to unpleasant scoliosis pain, atypical gait and many other complications. There are mild forms that affect a person in a mild, limited way, and other more extreme types that can bring on serious pain and complete debilitation as part of the list of scoliosis symptoms and signs.
Types of Scoliosis
There are different forms of this spinal disease, mainly 4:
Idiopathic Scoliosis (IS) – This type, which is the most common type overall, is most often found in children. It usually shows up in the pre-teen and teenage years. Although there is no certain cause (that’s what idiopathic means), it appears to be genetic, and girls are much more likely to show symptoms than boys. Under this category, the condition is further divided into 3 sub-types:
• Infantile Idiopathic Scoliosis (IIS): IIS has only recently been recognized. It is quite rare, occurring about 5% of the time – normally in boys between birth and three years old. It affects the left-upper thoracic spine, most frequently, and curves that show up this early on tend to resolve themselves.
• Juvenile Idiopathic Scoliosis (JIS): JIS occurs between the ages of three and ten, in about 10-15% of all cases. Between ages 3 and 6, the abnormal curve often presents as left-sided, and in boys. Between the ages of 7 and 10, it seems to be more typical in girls, and manifests as right-hand-sided curves.
• Adolescent Idiopathic Scoliosis (AIS): AIS affects children between the ages of 10 and 18, and is by far the most widespread. It presents as both a thoracic curve (of more than 10%) and as spinal rotation. Fortunately, of the children with AIS, only 1 in 10 require surgery to correct the problem.
Congenital Scoliosis (CS) – CS usually occurs in utero – between the 3rd and 6th week after conception. It happens when a child’s spine doesn’t form correctly during this phase. When some of the vertebrae don’t form as they should (aka failure of formation), or the spinal vertebral segments don’t separate as they should (aka failure of segmentation), or both, a side-to-side curvature forms, in which case it needs to be treated surgically or there’s a 7/10 chance that it will worsen.
Within the first month and half of pregnancy, the spine develops simultaneously alongside other systems involving the organs. Therefore, over 50% of children with congenital scoliosis end up with vital systems that have not formed properly and thus cannot function properly, such as the cardiac system, the nervous system, the genitourinary system, the auditory system or the renal system, for example. Not to mention that other spinal problems are also linked to CS and may occur.
Neuromuscular Scoliosis (NS) – NS is often caused as a symptom of another disorder. Diseases like spina bifida, muscular dystrophy/atrophy or cerebral palsy can cause weakness and deterioration, and eventually abnormal curvature of the spine. Spinal cord injuries that cause abnormalities on the spine are another form of neuromuscular scoliosis. NS patients have the same concerns as IS and CS patients, but since this form has an underlying cause, it can be even more difficult for them to cope.
In cerebral palsy, for example, not only are spinal bones and ribs affected, but the entire nervous system cannot function correctly and there are often mental delays and cognitive challenges. In the case of spina bifida (split spine, a congenital birth malformation) NS is only one issue to contend with. There is not only an abnormal curvature of the vertebral column, but the spine may be missing segments of bone, or parts of the spinal cord may protrude from the body due to malformation.
Degenerative Scoliosis (DS) – DS, sometimes referred to by doctors as adult onset scoliosis, typically occurs in adults over the age of 65. It is also characterized by a distinctive side-to-side curve in the spine. Usually starting at around age 40 and progressing gradually from there, it forms a C-shaped curvature in the lumbar spine region due to deterioration of the facet joints, for a variety of reasons. Sometimes, undetected or untreated childhood scoliosis is identified as the cause.
When it develops during adulthood, it is often the result of another degenerative condition that affects the spinal vertebrae, especially if an individual has undergone surgery to treat it. Disorders like osteomalacia (where the bones soften) and osteoporosis (where there is bone loss) are known causes. Other causes include degenerative disc disease (DDD), spinal stenosis (spinal canal narrowing) and compression fractures of the vertebrae (broken spine bones).
Types of Scoliosis Curves
Defining the types of curvature of the spine…
The distinct spinal curves that are typical of scoliosis are usually described based on their direction and where exactly they are located. Although there are various comprehensive methods that professionals use to determine and categorize particular curves, they are normally medically described as follows…
Descriptive terms based on the location of curvature:
Lumbar Scoliosis – Describes a curve in the lower region of the spine.
Thoracic Scoliosis – Describes a curve in the middle region of the spine.
Thoracolumbar Scoliosis – Describes curvature in both the thoracic and lumbar regions.
Double Major Scoliosis – Describes two curves of equal size in both the thoracic and lumbar regions.
Descriptive terms based on the direction of curvature:
Dextroscoliosis – This is the medical term that is used when the spine curves to the right (dextro). It normally occurs in the thoracic spine region (middle-upper back) and is the most common type of spinal curving. There can be a single C-shaped curve or there can be a second curve that bends in the opposite direction, forming what looks like the letter S.
Levoscoliosis – When the spine bends to the left (levo) side, this is the term that is used to describe it. It tends to occur in the lumbar spine (lower back), but rarely it does occur in the thoracic spine region, indicating that there may be a tumour in the spinal cord. In that case, an MRI (magnetic resonance imaging) scan is usually done to confirm the diagnosis.
When the terms above are used together, specific curves can be described quite accurately. For instance:
Thorocolumbar Dextroscoliosis – This can describe a single C curve that covers the vertebrae of the lower thoracic and upper lumbar regions.
Thoracic Dextroscoliosis & Lumbar Levoscoliosis – An S-type curvature that comprises a right thoracic curve and a left lumbar curve.
There are many, but often none.
As mentioned earlier, the condition can present itself either as mild or acute – scoliosis symptoms will vary depending on severity and type: idiopathic, congenital or neuromuscular. Many times, however, there are no symptoms—especially in teenagers and children—and a curvature can go completely unnoticed. The symptoms and signs of this spinal disease include but are not limited to:
• The inability to sit still or straight.
• A head that appears to be off-centre.
• A body that appears to lean more to one side.
• A leg that looks shorter than the other.
• A shoulder that seems higher than the other, or a shoulder blade that protrudes.
• A rib cage that seems higher on one side of the body.
• A waist that looks uneven.
• An aesthetic difference in the spine compared to others, i.e. it doesn’t look straight.
• Hips that seem to be misaligned, or one that is more prominent.
• Mild or acute pain due to overall misalignment, resulting is dull muscular pains, slipped discs, bulging discs, aggravated spinal nerves, or shooting pains like sciatica.
• Lumbar scoliosis that sometimes causes lower back pain.
• Scoliosis pain related to twisted or malformed vertebrae.
• Impaired physical movement.
• Delayed nerve response.
• Urinary incontinence (inability to control the bladder).
• Bowel incontinence (inability to control the bowel).
• Erectile dysfunction (failure to achieve/maintain an erection).
• In severe cases, a heart and lungs that work in an impaired way.
A few key considerations:
Contrary to popular belief, pain is not usually a scoliosis symptom, and there could be an underlying cause that needs to be treated – never ignore these symptoms. During puberty, the body grows at its fastest. Therefore a curvature of the spine can progress relatively quickly during this time. Significant curvature is much more common in girls, and they are said to be 8 times more likely to have curves that progress to the point that they require urgent treatment.
It’s quite a long list, and there are more.
Scoliosis is associated with various other disorders, and it often accompanies them. When it is related to certain syndromes, it is medically referred to as “syndromic scoliosis”. While this is by no means a definitive list, here are some of the conditions that have been linked to abnormal spinal curvatures and scoliosis deformity over the last hundred years or so:
• Marfan’s Syndrome
• Spina Bifida
• Ehlers–Danlos Syndrome
• Charcot–Marie–Tooth Disease
• Osteogenesis Imperfecta
• Prader–Willi Syndrome
• Lordosis, Kyphosis
• Cerebral Palsy
• Muscular Dystrophy
• Spinal Muscular Atrophy
• Fragile X Syndrome
• Friedreich’s Ataxia
• Proteus Syndrome
• Nail–Patella Syndrome
• CHARGE Syndrome
• VATER Syndrome
• Mitral Valve Prolapse
• Arnold–Chiari Malformation
• Amniotic Band Syndrome
• Congenital Diaphragmatic Hernia
• Familial Dysautonomia
• Connective Tissue Disorders
• Angelman Syndrome
• Noonan Syndrome