What is Scoliosis?

Do you have an unusual sideways curve accompanied by ongoing back pain? Do you lack the ability to pinpoint the precise source of this ailment? The spine curves excessively to one side due to a condition known as scoliosis. It is crucial to comprehend this condition given the large number of people who experience it. 

An abnormal curvature of the spine (backbone) is often called scoliosis. The spine naturally curves backwards and forwards. In scoliosis, the spine rotates and develops a side-to-side curve. Treatment focuses on symptom relief rather than necessarily correcting the curvature. Pain reduction and function enhancement are the constant goals. 

Milder cases may not show any symptoms, while more severe cases may produce spinal abnormalities, unequal shoulders or hips, back pain, muscle exhaustion and, in rare instances, breathing problems when the curvature impacts the chest cavity. A good understanding of the condition, given by this article, will help you better understand scoliosis so you can increase your quality of life and that of those affected around you.  

Overview

The vertebrae are a series of rectangular  blocks that makes up the spine. From behind, the spine normally appears straight.  On the other hand, scoliosis causes the vertebrae to rotate, resulting in a bent spine that frequently looks like an S or C. This curvature gives the impression that the person is leaning to one side.

Small curves often don't pose any issues. If thecurve worsens,  this might negatively impact one’s health. Big curves can harm the spine's joints and lead to conditions like arthritis. The ribs may rub against the pelvis in bent curves, which could be painful. Lung issues could occur in those with a heavily curved spine. Scoliosis is suspected when an X-ray shows a 10-degree or greater curvature of the spine. It can cause the spine to curve in distinct regions on either the right or left side of the body. The thoracic (middle) and lumbar (lower) spines are both affected by the spinal deformity known as scoliosis.^1,2

Scoliosis is estimated to affect  between  2 to 3 percent of the American population. It can have an impact on both early development and infancy.. Biological females are eight times more likely than  biological males to have the magnitude of their curve progress to needing physical therapy. Each year, more than 600,000 people with scoliosis visit private doctors' offices; 30,000 children are given braces; and an estimated 38,000 people undergo spinal fusion surgery.³

Causes of scoliosis

Although the precise cause of scoliosis cannot always be determined, there are several common variables and underlying illnesses that have an impact on how it presents it self.

• Idiopathic scoliosis

The most common spinal abnormality, idiopathic scoliosis (IS), affects growing but healthy children and adolescents. Genetic factors play a significant role, but the exact cause is unknown. Although it has been observed to run in families, no associated genes have been identified.

• Congenital scoliosis

This condition iscaused by birth anomalies in the spine, frequently coexists with other organ disorders. Although a diagnosis can be made during the newborn stage if there are obvious signs, many cases are only detected later in childhood.

Growing children may experience worsening scoliosis. Congenital scoliosis is typically managed with a "watch and wait" strategy. Only when curvature is progressing the child is at continued deformity risk, and surgery is an option.¹

• Neuromuscular scoliosis

This isscoliosis that develops as a result of neurological or muscle conditions. It consists of spinal cord injuries, muscular dystrophy, spinal muscular atrophy, and spina bifida, as well as scoliosis linked to cerebral palsy. The advancement from this type of scoliosis is typically faster than that of idiopathic scoliosis, and surgery is frequently needed to correct it.³

• Degenerative scoliosis

It could be brought on by arthritis or disc degeneration (which separates the vertebrae). This type of scoliosis develops later in adulthood as opposed to the first three, which develop in childhood.⁶

• Traumatic scoliosis

Traumatic scoliosis is the term used to describe scoliosis that develops after severe damage to the spine. Although substantial damage is necessary for the disorder to begin, accidents can result in the development of spinal anomalies.⁷

Carrying heavy items (such as large school bags on one shoulder), participating in sports or other physical activities, adopting poor posture while standing or sleeping, or not getting enough calcium in one's diet will not make one develop scoliosis.⁶

Signs and symptoms of scoliosis

Scoliosis most frequently is identified by the following symptoms. However, each person may have different symptoms.

• There is a shoulder height difference
• The body's centre of gravity is off, and the head is not
• Hip position or height difference
• A variation in the position or height of the shoulder blades
• There is a variation in how the arms hang beside the body when standing up straight
• The sides of the back appear to be taller when leaning forward
• If the nerves in the lumbar spine are compressed, leg pain, numbness, or weakness may emerge

Scoliosis symptoms might look like  those of other spinal disorders or deformities, signs of an infection or injury to the spine.

Idiopathic scoliosis-unrelated symptoms include back discomfort, changes in bowel and urine habits, and leg pain. To determine the cause of the symptoms, a person with these symptoms must be evaluated by a doctor immediately.^1,8

Management and treatment for scoliosis

There is no recognised method to prevent scoliosis because the majority of cases have unknown causes. The main objectives of treatment are to stop the curvature from advancing and to prevent deformities. The "watch and wait" method observation and repeated exams is required to determine if the spine is still bending. These are provided to people whose curves are less than 20 degrees and are still growing.

Conservative approach

The majority of adult scoliosis cases can be treated without an operation  with routine medical visits, over-the-counter pain relievers, and core-strengthening activities to strengthen your back and abdomen and increase flexibility. If you smoke, it is recommended that  stop immediately. There is evidence that smoking hastens the degenerative process. Most of the time, your doctor will suggest physical therapy to retain strength and manage discomfort. These consist of

• Attempting to correct posture
• Exercising with moderate impacts, like swimming
• Everyday stretching
• Exercise routine

Your doctor may advise epidural (administered around the spinal cord) or nerve block injections for more effective pain management if pain cannot be managed with oral drugs or physical therapy.

Surgical procedure

Some forms of adult scoliosis require surgery. Due to the dangers associated with spine surgery-related problems, this treatment is a last resort. For the following causes, surgery might be advised:

Pain: If scoliosis-related back and leg discomfort gets severe, persists, and is unresponsive to non-surgical treatment, surgery might be necessary.

Spinal abnormalities: Evaluation of the evolution of scoliosis and the requirement for surgery depends on whether the spine remains balanced. When we stand, the head should be evenly distributed over the hip joints when viewing from the side and over the centre of the pelvis while viewing from the front. 

Improving the quality of life: Some people find the symptoms of their spinal deformity intolerable, although surgery is not advised purely to enhance looks. Typically, surgical therapies aim to stabilise the spine, regain balance, and relieve nerve pressure. Bone grafts and metallic implants are used during spine stabilisation surgery to fuse the spine's bones keeping it in place.

Through advancements in surgical methods and computer-assisted navigation systems, less invasive surgeries are made possible and the healing process is accelerated.⁸

Diagnosis of scoliosis

To make a diagnosis, the medical professional will examine and record your medical history. Because scoliosis can run in families, queries regarding your family's health are part of the medical history. The Cobb Method is a tool for determining the number of degrees and the severity of the curve.

• A mild curvature is one of less than 20 degrees
• A moderate curve ranges from 25 to 40 degrees
• A severe curve exceeds 50 degrees

The Adam's Forward Bend Test is a typical examination done occasionally by paediatricians and in grade school screenings.

For a precise and successful diagnosis, radiographic examinations are necessary.

X-ray: Using radiation to create a film or picture of a body portion can reveal the vertebral column's structure and the location of joints. X-rays of the spine are examined to look for further potential sources of pain, such as infections, fractures, abnormalities, etc.

Computed tomography scan (CT scan): A diagnostic image produced after a computer interprets X-rays; can display the size and shape of the spinal canal as well as the contents and structures surrounding it. Excellent at identifying bony features.

Magnetic resonance imaging (MRI): Creates three-dimensional images of bodily structures using powerful magnetic fields and computer technology; it can reveal enlargements, degeneration, and deformities in the spinal cord, nerve roots, and surrounding tissues.^2,3

Risk factors

• Age: Scoliosis can appear at any age regardless of whether some age groups are at higher risk. Idiopathic scoliosis, the most prevalent kind, frequently starts in adolescence during the growth spurt stage
• Gender: Women are more prone than men to develop scoliosis. There may be differences between the sexes for unknown reasons
• Family history: The tendency for scoliosis to run in families points to a hereditary cause
• Structural abnormalities: Anomalies of the structure can cause differences in leg length or hip dislocation
• Neuromuscular problems: More likely to occur in people with underlying neuromuscular conditions such as cerebral palsy, muscular dystrophy, spinal muscular atrophy, and other neurological illnesses
• Connective tissue disorders: People suffering from conditions like Ehlers-Danlos syndrome or Marfan syndrome are more likely to develop scoliosis
• Prior spine surgery: Due to the altered spinal structure, individuals who have gone through prior spine surgery may be more prone to developing scoliosis^9,10

Complications

Striking scoliosis curves can impact the chest cavity and restrict lung function, causing issues associated with breathing. This may result in breathing problems, shortness of breath, a reduced capacity for activity, and respiratory infections. In particular, if their curvature is significant and untreated, people who had scoliosis as children may be more prone than adults to experience chronic back pain.

More obvious alterations, such as a shift in the waist and trunk to one side, protruding ribs, and unequal hips and shoulders, can occur as scoliosis progresses. Sufferers frequently experience self-consciousness about their appearance. In some circumstances, scoliosis can compress the heart and lungs, resulting in cardiovascular concerns like elevated blood pressure or decreased cardiac output. Strong curves can also have an impact on circulation and blood flow.

Neurological problems can include numbness, tingling, muscle weakness and bowel incontinence or urinary incontinence when severe scoliosis curves push on the spinal cord or nerve roots. Only a small portion of patients experience this.^9,11

Summary

The most successful method of treating scoliosis is early intervention. Most individuals with scoliosis can lead regular lives and participate in most activities, including sports and exercise. After therapy, those with scoliosis can lead active, fulfilling lives. People's spines often stop curving once they reach adulthood as long as they receive the appropriate care when they are children or teenagers.