Scoliosis is among the most common spinal deformities. If you’ve been diagnosed with scoliosis, you’ve learned that your spine has an abnormal lateral curvature, i.e., it curves from side to side. Gentle forward and backward curvature of the spine is normal; lateral curves are not. Adolescent idiopathic scoliosis is by far the most common form of scoliosis.
Types of Scoliosis
Adolescent Idiopathic Scoliosis
Among adolescents under the age of 16, two to three percent will have adolescent idiopathic scoliosis (IS). For most, the curvature of their spine will remain moderate (less than 45 degrees) and will not progress after they reach puberty. However, because it is impossible to predict how quickly the curve will progress before puberty, orthotic bracing is recommended for any pre-pubescent adolescent with a curve greater than 25 degrees.
Scoliosis can affect the thoracic (mid) or lumbar (low) spine—or both. The most common presentation of curvature is a double curve in an “S” shape. Less commonly, the spine will have a single curve in a “C” shape.
Symptoms of adolescent IS can include:
- Asymmetry (unevenness) in the shoulders, waist, or hips with one leg appearing longer than the other
- Pain, although most with adolescent IS are pain-free unless their condition is advanced
- Trouble with breathing, circulation, and standing upright (with severe disease progression)
Adult Idiopathic Scoliosis
Adult idiopathic scoliosis is just a continuation of adolescent idiopathic scoliosis. Infrequently, idiopathic scoliosis from adolescence will progress into adulthood. For teens who have reached full growth potential with a spinal curvature of 30 degrees or less, it is unlikely to continue progressing. In contrast, spinal curves greater than 50 degrees are likely to get bigger. This is why idiopathic scoliosis requires routine monitoring by doctors.
For people with this form of scoliosis, symptoms and curves tend to worsen with advanced age due to factors like disc degeneration, spinal stenosis, and arthritis. Increasing symptoms can lead to a loss of function.
Symptoms of adult IS can include:
- Low back pain
- Low back stiffness
- Fatigue resulting from muscle strain
- Numbness or shooting pain from pinched nerves
Adult Degenerative Scoliosis
This type of scoliosis arises only in adults and is caused by spinal conditions like disc degeneration, arthritis of facet joints, and narrowing or collapsing disc spaces. Adult degenerative scoliosis usually affects the lower spine, and can cause the following symptoms:
- Back pain
- Shooting pain down the legs
A diagnosis of scoliosis is typically made through imaging techniques that visualize the curvature of the spine and the shape of the vertebrae:
- Standing X-ray images the entire spine from both a back view and a side view, making measurements in degrees
- Magnetic resonance imaging (MRI) is usually ordered if you are experiencing leg pain, if your physician finds signs of neurological issues, or if you have an atypical curve pattern
Scoliosis Treatment Options
In most cases, scoliosis is neither terribly painful nor disabling. For patients who are not experiencing significant discomfort, the following treatment protocol is usually followed:
- Routine observation to X-ray and monitor curve progression
- Braces, for adolescents to stop curve growth and avert surgery
- Exercises or Schroth physical therapy for strength and flexibility in the core back muscles
- Non-steroidal anti-inflammatory drugs (NSAIDs) if needed
- Epidurals or nerve block injections for temporary relief of persistent leg pain and other symptoms
Surgical Treatment: Spinal Fusion
Most people respond well to bracing and won’t need surgery. However, those who fail non-surgical measures, have curves greater than 45 degrees, and are experiencing disabling symptoms, surgical treatment is recommended. Surgical goals include restoring function and balance while reducing pain, numbness, and other symptoms.
Spinal fusion is the most common surgical intervention for correcting severe curvature of the spine. With fusion, a surgical approach is made through the back (posterior) or side (anterior). Through the incision, rods are affixed directly to vertebrae to connect them together so they can’t move independently.
As an alternative to fusion surgery, very young children who have failed treatment with an orthotic brace might be candidates for “growing rod” surgery. This method involves surgically inserting rods into the spine without fusing the spine. Every six months, the rods are elongated as the child grows.
Outcomes of fusion surgery and correction of spinal deformity are outstanding, as long as the surgeon is experienced and skilled.