What is scoliosis?


Scoliosis is an abnormal curvature of the spine.  When looking at someone while they’re facing you, a person with scoliosis would have an “S” or a “C” shaped spine in some portion of their spine, as opposed to a straight spine.

Are there different types of scoliosis?

They’re are many types of scoliosis.  The two most common are adolescent idiopathic scoliosis and degenerative scoliosis. 

Adolescent idiopathic scoliosis has no known cause, but usually develops in the teenage years during growth spurts, and usually affects females, although males can also be affected.  Treatment is usually bracing until skeletal maturity, although surgery can be indicated if the curve is severe enough or if the curve is progressing.  Bracing does not correct the curve.  It is mainly geared toward preventing progression of the curve.  Surgery is the only way to correct the curve, but carries great risks, hence its use only when necessary.

Degenerative scoliosis develops as a result of arthritic changes in the lumbar spine.  Once a disc begins to degenerate, it collapses.  In some patients, it can collapse asymmetrically.  If it collapse more on the left than the right, for example, you now have a slight curve.  Once this starts, it alters the forces on adjacent vertebrae, so the are more more to collapse asymmetrically as well, and the curve can, and frequently does, propagate. Think of a stack of boxes.  When they’re lined up straight, they’re very stable.  When lined up in a crooked line, they’re much less stable, even if only one box is misplaced.  This is especially true at the bottom of the stack.  Degenerative scoliosis is much more common in the lumbar spine because this is the bottom of the spine.  Once it develops, it does tend to progress, although slowly in most cases.  The more severe the curvature, however, the more likely it is to progress, and the more rapidly it is likely to progress.

How is it diagnosed?  What are the symptoms?

Most adolescent idiopathic scoliosis is asymptomatic and is discovered by physical exam.  Pain can occur, usually in the back, but is uncommon.  Neurologic deficit is rare.  Confirmation of the diagnosis is made by spinal XRays.

Degenerative scoliosis is usually discovered by MRI once the patient develops symptoms.  MRI, however, poorly defines the extent of scoliosis.  The best way to diagnose the severity and extent of scoliosis is with XRays or CT scan of the spine.  Symptoms are usually back or buttock pain, sometimes associated with radiation of pain into one leg or the other.  Other common presenting symptoms are cramping in the calves with walking, numbness or tingling in the legs, or weakness in the legs.  These symptoms can be intermittent or constant.

Does degenerative scoliosis require surgery?

No.  Most cases require no treatment, and are frequently asymptomatic.  Scoliosis becomes a consideration in three ways.  The first is when someone develops a separate problem in their lumbar spine that does require surgery, but are also found to have a degenerative scoliosis.  The scoliosis must be factored into surgical decision making.  This is because any surgery affects the biomechanics of the spine.  Therefore surgery runs the risk of taking a relatively stable scoliosis and making it unstable, leading to a rapid increase in the curvature that can lead to pain, deformity, and, in severe cases, neurologic damage.

A second time when degenerative scoliosis becomes an issue is when it causes symptoms.  These symptoms can include pain (this occurs most frequently) or neurologic deficits (numbness, weakness, or affect bowel or bladder control;  this is less frequent).  When this happens, every attempt should be made through conservative measure to control the symptoms (except in progressive neurologic deficits, which usually require urgent surgery).  Conservative options include medication, physical therapy, chiropractic care, pain procedures (such as epidural steroid injections), and acupuncture.  Other options exist, but have not been proven effective through randomized studies, and are therefore not mentioned here.  If these fail to control a patients symptoms, then surgery is considered.  Surgery, however, is a major undertaking in most cases.  It has a risk of complications that is similar to open heart surgery, so is nothing to take lightly.  It includes the use of instrumentation and fusion to stabilize the curvature.  Correction of the curvature is usually attempted to some degree, but is less important than restoring normal balance of the spine and stabilizing the curvature.  The recovery process is also long, difficult, and painful.  Once the patient is recovered, however, most patients are improved from a pain standpoint.

If I have scoliosis, what should I do? 

Consultation with a spine specialist is recommended, preferably one who has experience in the monitoring and treatment of scoliosis.  Degenerative scoliosis patients usually should obtain yearly XRays to determine the stability of their curvature.  Adolescent idiopathic scoliosis patients require close monitoring and possible treatment by a pediatric spine specialist usually every 6 months during adolescence, and sometime more frequently.  Once they reach adulthood though, close monitoring is usually not needed.

 
A Great 3 YearsNext month will mark 3 years since you did my back surgery.  It’s been a great 3 years.  Three ski seasons, miles and miles of biking, hiking and brisk walks (otherwise known as jogging)!  Three active, happy, quality years with my wife and kids that I wouldn’t have had if it weren’t for you.  I have referred many friends, clients and acquaintances to KeiperSpine and they have all come back with much greater quality of life, as well as renewed hope, than when they started their journey.