Types of Scoliosis

Learn about the various types of scoliosis and the potential causes and symptoms of each.

Types of Scoliosis

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Introduction

It is natural for the spine to curve forward and backward to a certain degree; this is what gives the side-view of the spine its "S"-like shape. But occasionally the spine twists and develops curves in the wrong direction--sideways. When the spine twists and develops an "S"-shaped curve that goes from side to side, the condition is known as scoliosis.

A scoliosis curve can occur in the thoracic spine, the lumbar spine, or both areas at the same time. When the vertebrae in the mid and low back curve to the side, the normal appearance and condition of the spine and its muscles changes. The severity of the scoliosis is measured in degrees by comparing the curves to "normal" angles. Curves can range in size from as little as 10 degrees to severe cases of more than 100 degrees. The amount of curve in the spine helps your doctor decide what treatment to suggest.

Scoliosis_posterior

Adolescent Idiopathic Scoliosis

Most cases of scoliosis are first discovered and treated in childhood or adolescence--particularly during puberty when the curvature becomes more noticeable. When an adolescent has scoliosis with no known cause, doctors call the condition adolescent idiopathic scoliosis. The word "idiopathic" means that the cause of this form of scoliosis is unknown. This form of scoliosis can affect a child who is healthy and not having nerve, muscle, or other spine problems. It is the most common form of spinal deformity doctors see, affecting about three percent of the general population.

Causes

Adolescent idiopathic scoliosis affects children between 10 and 18 years old. There are many theories as to why this type of scoliosis develops, but the root of the condition has yet to be discovered. Some of the theories include:

  • Genetics— Scoliosis appears to run in certain families, so it may be hereditary. Significant research is ongoing in the field of genetics.
  • Growth— Curves progress rapidly during growth spurts, perhaps showing a tie to hormonal causes.
  • Structural and Biomechanical Changes— Differences in leg lengths have also been noted in adolescents with idiopathic scoliosis. But there is no clear evidence that this type of change causes scoliosis; it may simply be a secondary result.
  • Central Nervous System Changes— Some forms of scoliosis are associated with central nervous system disorders, so a lot of research has been focused on this topic. To date, such disorders have not been proven as the root of idiopathic scoliosis.
  • Equilibrium and Postural Mechanisms— Idiopathic scoliosis could be related to factors that affect body alignment. If a child has problems with posture, balance, and body symmetry, it could affect the way his or her spine is positioned. If the problems are chronic, it may disrupt the way the child's spine and muscles develop.

Symptoms

In many cases of adolescent scoliosis, the child will not even notice the problem. Because the majority of scoliosis patients do not suffer any physical pain from this disorder, it is often not discovered until the curves have progressed to become more obvious. In fact, if the child is suffering from severe back pain, a diagnosis other than idiopathic scoliosis must be considered.

hough the spine may curve sideways, in minor cases the curves are not obvious until the person bends over. Many schools currently screen young students for scoliosis, so referrals often come from school health workers. Parents or physical education instructors are also frequently the first to notice signs of scoliosis in a child. Signs of scoliosis may include the following abnormalities in appearance:

  • One shoulder or hip may be higher than the other.
  • One shoulder blade may be higher and stick out farther than the other.
  • These deformities are more noticeable when bending over.
  • A "rib hump" may occur, which is a hump on the back that sticks up when bending the spine forward. This occurs because the spine and ribs also rotate as the curve develops.
  • One arm hangs longer than the other because of a tilt in the upper body.
  • The waist may appear asymmetric.

Once scoliosis is diagnosed, concern may arise whether the curves will continue to grow bigger. There is no absolute way to tell, but this much is known.

Adult Scoliosis

Scoliosis that occurs (or is discovered) after puberty is called "adult scoliosis." Adult scoliosis can be the result of untreated or unrecognized childhood scoliosis, or it can arise during adulthood. The causes of adult scoliosis are usually different from the childhood types.

Causes

Most cases of adult scoliosis are idiopathic, which means that the cause is not known. Sometimes adult scoliosis is the result of changes in your spine due to aging and degeneration.

The causes of adult scoliosis are further categorized into several subtypes:

  • Idiopathic
  • Congenital
  • Neuromuscular
  • Syndromic

Symptoms

Adult scoliosis is often painless. Patients with adult scoliosis commonly see a spine specialist because they notice a problem with the way their back looks. You may notice some of the following things about your body:

  • One shoulder or hip may be higher than the other.
  • One shoulder blade may be higher and stick out farther than the other.
  • These deformities are more noticeable when bending over.
  • A "rib hump" may occur, which is a hump on your back that sticks up when you bend your spine forward. This occurs because the ribs on one side angle more than on the other side.
  • One arm hangs longer than the other because of a tilt in your upper body.

Back pain can eventually develop as the condition progresses. The deformity may cause pressure on your nerves and possibly even on your spinal cord. This can lead to weakness, numbness, and pain in your lower extremities. In severe cases, pressure on your spinal cord may cause loss of coordination in the muscles of your legs, making it difficult for you to walk normally. If your chest is deformed due to the scoliosis, your lungs and heart may be affected, leading to breathing problems, fatigue, and even heart failure. Fortunately these severe symptoms are rare.

Degenerative Scoliosis

Degenerative adult scoliosis occurs when the combination of age and deterioration of your spine leads to the development of a scoliosis curve in your spine. Degenerative scoliosis may be related to osteoporosis. Osteoporosis weakens your bones, making them more likely to deteriorate. The combination of these changes causes your spine to lose its ability to maintain a normal shape. Your spine begins to "sag" and as the condition progresses, a scoliotic curve can slowly develop.

Causes

Scoliosis developed in adulthood can be "secondary" to other spinal conditions that affect your vertebrae. Other conditions such as degeneration, osteoporosis (loss of bone mass), or osteomalacia (softening of the bones) can cause scoliosis. Scoliosis can also appear following spinal surgery for other conditions. The surgery may cause an imbalance in your spine that leads to scoliosis. Most of these secondary causes of scoliosis are considered degenerative adult scoliosis.

Symptoms

Degenerative adult scoliosis usually begins as low back pain. While there may also be a deformity that causes your back to look abnormal, usually pain is what motivates patients to seek treatment. The pain is probably not coming from the curve, but rather from the degeneration occurring in your spine.

A combination of the degeneration of your spine and scoliosis deformity may cause pressure on nerves and possibly even your spinal cord. This can lead to weakness, numbness, tingling and pain in your lower extremities. In severe cases, pressure on your spinal cord may cause loss of coordination in the muscles of your legs, making it difficult to walk normally.

Diagnosis

If scoliosis is suspected, a diagnosis must be made before an appropriate treatment plan can be developed. Your doctor will begin by performing a complete history and a physical exam. Usually afterward, your doctor will order additional diagnostic tests including an X-ray so your doctor can see the structure of your spine and measure the curve.

Depending on the outcome of your history, physical examination, and initial X-rays, other tests may be ordered to look at specific aspects of your spine.

References

http://www.srs.org/patients-and-families/conditions-and-treatments/parents/scoliosis/early-onset-scoliosis

IMPORTANT SAFETY INFORMATION As with any medical treatment, individual results may vary.
There are potential risks and recovery takes time. People with conditions limiting rehabilitation should not have this surgery. Only a spine surgeon can tell if spine treatment is right for you.

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