Scoliosis is a condition where an individual has an abnormal curving of the spine. Technically, it is described as a spinal curvature of more than 10 degrees to the left or right as the doctor examines the patient from the rear. From this vantage point, the spine of a patient with scoliosis displays a characteristic “S” or “C” shape rather than a straight line. The cause of scoliosis onset in the majority of cases is unknown, but it can also be congenital or a result of some other condition.
In most cases, the pain associated with scoliosis is mild and does not much limit a patient’s activity. However, if left unchecked, severe scoliosis can result in intense pain and even difficulty breathing.
Scoliosis is a potentially serious condition that may occur at any age, including in very young children. Early diagnosis and treatment by an expert in scoliosis is recommended for the best outcomes. The physicians at the Ainsworth Institute of Pain Management are experts in treating scoliosis and can offer you numerous treatment options.
What is Scoliosis?
Scoliosis is the most common spinal deformity and is described as an abnormal side-to-side spinal curve. Scoliosis can develop in the thoracic (mid-back) and lumbar (low back) spine. When progressive, scoliosis may cause the spine to turn or rotate. Rotational forces can pull the ribs and further distort the shape of the spine, cause one side of the body to be a different height, and create a rib hump on the back. Sometimes, scoliosis is caused by muscle problems, does not involve spinal rotation, and is almost always reversible.
Five to seven million people in the United States suffer from scoliosis. It most commonly affects adolescents between the ages of 10-15, and is more prevalent in girls. Heredity seems to play a big part as scoliosis tends to run in families.
Read More About Scoliosis
There are many types of scoliosis. Sometimes the cause is known. When the cause of the disorder is unknown, it is termed idiopathic scoliosis. There are 3 types of idiopathic scoliosis:
-Congenital (at birth) and infantile: occurs in children three years old or younger
-Juvenile: patients are 4 to 10 years old
-Adolescent: patients are 10 to 18 years old
Scoliosis affects adults too. Causes of adult scoliosis include:
-Untreated congenital (at birth) or childhood scoliosis
-Spinal degeneration (i.e. degenerative disc disease, osteoarthritis, osteoporosis)
-Neuromuscular problems (i.e. muscular dystrophy, cerebral palsy, Marfan’s disease)
A component of a scoliotic curve is called a compensatory curve or counter curve. This means to compensate for the major curve, a curve develops above or below the major curve. The compensatory curve is usually less severe than the major curve. This is how the body tries to deal with maintaining balance. For example, if the major curve is to the left, the compensatory curve is to the right.
The 4 types of curve patterns are:
Right thoracic: The major curve is to the right in the mid-back and the compensatory curve may develop in the low back (lumbar spine).
Left lumbar: The major curve is to the left in the low back. A compensatory curve may develop in the thoracic spine in the opposite direction (right).
Right thoraco-lumbar: The major curve is to the left in the mid and low back (thoraco-lumbar). The spine resembles the letter “C”.
Right thoracic and left lumbar: This is a double curve where the spine resembles the letter “S.” The right mid-back curve is about the same size as the left low back curve.
One shoulder or hip is higher than the other
One leg is longer than the other
The head appears not centered over the body
Hemlines and trousers hang unevenly
Shoulder blade / rib cage prominence when bending forward at the waist
Visible curvature of the spine accompanied by back pain (severe scoliosis)
Shortness of breath (severe scoliosis)
As mentioned above, the majority of scoliosis cases are classified as idiopathic, cause unknown. Instances where the cause is known are broken up into three categories: functional, neuromuscular, or degenerative.
Functional scoliosis is also termed nonstructural scoliosis because poor posture, a short leg, and/or the back muscles cause the spine to curve abnormally. This type of scoliosis is almost always reversible.
Neuromuscular scoliosis can be caused by cerebral palsy, Marfan’s disease, muscular dystrophy, muscle atrophy, polio, spina bifida, or spinal cord injury. Abnormal spinal curvature may worsen during growth spurts and lead to weak trunk muscles making it difficult to sit upright, stand, or walk.
Degenerative scoliosis affects adults and develops secondary to a spinal condition such as bone spurs, degenerative disc disease, osteoarthritis, osteoporosis, spinal fracture, or weakening of soft tissues such as the spine’s ligaments.
Depending on the patient’s age, diagnosis often includes:
Medical and family history (i.e. family members who have/had scoliosis)
Physical and neurological examination
X-rays such as full body, side and back to front views*
Magnetic resonance imaging (MRI)*
Adam’s Forward Bending test to identify the curve(s)
Plumb Line test to see if the spine is straight or curves
Scoliometer to measure the size of the rib hump
*X-rays are essential and help the specialist to measure the size of the curve(s). Curves measuring greater than 25-30 degrees are considered significant. Curves greater than 45-50 degrees are considered severe. Depending on the severity of the scoliosis and symptoms, an MRI may be needed.
The type of treatment is dependent on many factors, such as the patient’s age (i.e. skeletal maturity, when the patient stops growing), severity of the curve(s), curve progression, and symptoms. Basically, treatment falls into 3 categories:
Observation – The curve is observed and diagnostic imaging tests (i.e. x-rays) are performed every 6 months until the patient reaches skeletal maturity. Adult scoliosis may also be monitored for progression.
Symptomatic Treatment – In many cases, the curve of scoliosis might not progress or worsen but the pain might. In cases such as these, a pain management doctor may be able to offer relief from the pain caused by scoliosis. Facet joints typically bear the brunt of impact from the abnormal curvature and the pain felt is due to inflammation within the facets themselves. Radiofrequency ablation is an easy, minimally invasive technique that can be used to relieve the pain caused by scoliosis.
Bracing – Bracing can help prevent curve progression in patients who are still growing and have not reached skeletal maturity (adulthood). Bracing is not appropriate treatment to correct adult scoliosis.
Surgery – Progressive or severe scoliosis is treated using spinal instrumentation (i.e. rods, screws) and fusion (bone graft) to help realign and stabilize the spine.
Schedule an Appointment Today
The doctors at the Ainsworth Institute of Pain Management specialize in treating scoliosis. Dramatic improvements in pain and quality of life are a single phone call away. Schedule an appointment today with one of our board certified pain management experts to discuss what options for treatment may best suit your needs.