Scoliosis is a sideways curvature of the spine which may cause the spine to be in the shape of a C or S instead of being straight. It sometimes causes the body to look uneven through the shoulders, waist, or hips. There are certain conditions that can cause scoliosis, but the most common scoliosis is called idiopathic, which means we don’t know what the cause is. Often the curve becomes more obvious during a growth spurt in early adolescence. Because of this, many curves are noted by the school nurse or pediatrician during school screening for scoliosis.
Scoliosis can be mild to severe, and small curves do not always progress enough to need treatment. The size of the curvature determines the treatment options. We monitor the progression of the curvature through x-rays over time. The more growth the individual has remaining, the greater the risk of progression over time.
Scoliosis is not uncommon It is not a disease but rather a term used to indicate an abnormal curving of the spine. Scoliosis is not contagious and does not usually cause pain. One out of every ten young people in the United States develops scoliosis, but only some of them will require treatment. Increasing size of the curve is more frequent in girls, although it happens with some boys also. Scoliosis generally is not inherited but it can run in families.
What causes scoliosis?
Scoliosis is not caused by poor posture, being left or right handed, or carrying heavy objects such as back packs. Some factors contributing to scoliosis are muscle diseases, such as cerebral palsy or muscular dystrophy, birth defects in the development of the spine, or injuries. However, in about 80 % of cases the cause is not known.
Is this a problem?
In severe cases it can be. If the curve is large and left untreated, it may continue to grow in size and put pressure on organs such as the heart and lungs.
What are the treatment options?
There are three treatment options for scoliosis – observation, bracing, and surgery. The treatment of scoliosis depends on a few different factors; the size of the curve, the skeletal maturity of the patient, and if female, the menarche status.
As a general rule, small curves (those less than 25-30 degrees) are observed every six months or so to make sure they do not become worse. X-rays are typically used to assess whether or not the curve is getting bigger. If the curve is not getting bigger, usually there is no further treatment recommended. Studies have shown that the natural history of small curvatures is good in that there is no increased risk of back pain or other side effects as an adult.
Curves of moderate size (between 30- 40 degrees) or curves that are progressing are considered for bracing. Skeletal maturity is also considered in addition to the size of the curve when determining which patients should be treated with a brace. Your physician will determine if bracing is appropriate in your individual case. Braces are used in an attempt to prevent the curve from getting worse. Braces do not improve scoliosis or cause it to go away. The brace is usually worn until the bones reach maturity and the likelihood of curve progression is less. Bracing is not always effective and sometimes the curve increases despite using a brace. In this instance, surgery may be necessary.
If the curve has progressed despite bracing, or is too advanced for bracing to be effective (greater than 40 degrees), surgery is needed. Large curves that continue to progress are at an increased risk of interfering with normal heart and lung function if nothing is done to prevent the progression. Typically, surgery will be recommended for curves around 50 degrees or greater. The intent for surgery is to fuse the spine, preventing further progression, as well as to gain correction. The spine may not be made completely straight, but the curve will be less than it was before surgery.
It is important to continue to check the curve through scheduled appointments in scoliosis clinic. Your doctor will keep you informed about your scoliosis and help you understand which form of treatment is appropriate for you. For further information, you may look at the Scoliosis Research Society website: https://www.srs.org/patients-and-families .