You may have seen individuals with scoliosis and wondered what it was. Scoliosis is a sideways curvature of the spine that most often is diagnosed in adolescents. Most cases of scoliosis are mild, but some curves worsen as children grow. Without treatment,  scoliosis can be disabling and cause many complications. An especially serious spinal curve can reduce the amount of space within the chest, making it difficult for the lungs to function properly. Symptoms can increase or appear as your body ages, which can result in a late diagnosis. This is why you need to find orthopedic specialists extensively experienced in diagnosing and treating scoliosis. You won’t find experts more highly competent and dedicated to their patients than those at Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado.

OVERVIEW

Scoliosis is a side-to-side curve of the spine that differs from the body’s natural front-to-back curve. Scoliosis affects 2-3 percent of the population or an estimated six to nine million people in the United States. Scoliosis can develop in infancy or early childhood. However, the primary age of onset for scoliosis is 10-15 years old. Scoliosis equally affects all genders and sexes but females are eight times more likely to progress to a curve magnitude that requires treatment. When parents hear scoliosis runs in families, they often say, ‘But nobody in our family has it,’” But in reality, it’s likely that someone does or did and it went unnoticed because it was a very mild case. Of course, there are also instances where a child is the first in the family to develop the condition. Every year, scoliosis patients make more than 600,000 visits to private physician offices, an estimated 30,000 children are fitted with a brace and 38,000 patients undergo spinal fusion surgery.

ABOUT THE SPINE

The spine is the body’s central support structure. It gives the body shape, supports the posture, and helps one to walk, twist, be flexible, and move. A healthy spine has three natural curves that make an S-shape-like curve when looking at it from the side. These curves work as shock absorbers that help a healthy spine withstand all kinds of stress. The spine includes bones, muscles, tendons, and other tissues that reach from the base of the skull to the tailbone. The backbone encloses the spinal cord and the fluid surrounding the spinal cord. Also called spinal column, spine, and vertebral column. Although the spine is made up of a chain of bones, it is flexible due to elastic spinal discs and ligaments. The structure of the backbone is incredibly complex when broken down. Aside from 33 individual bones, the spine contains 120 muscles and 100 joints connected by 220 different ligaments.

WHAT IS SCOLIOSIS?

There are three types of scoliosis:

• Idiopathic scoliosis: This is the most common type. “Idiopathic” means the cause is unknown. Research does indicate that it runs in families and has a genetic link.
• Congenital scoliosis: This is a rare spine abnormality that a healthcare provider may detect at birth. It occurs when vertebrae don’t form as they should during embryonic development.
• Neuromuscular scoliosis: Abnormalities in the muscles and nerves that support the spine cause this type.

Healthcare providers use different names to refer to idiopathic scoliosis according to when it is diagnosed:

• Infantile scoliosis: Younger than age 3
• Juvenile scoliosis: Age 4 through 10
• Adolescent scoliosis: Age 11 through 18

In adolescent scoliosis, most cases occur in the thoracic spine (rib cage) area.

In adult scoliosis, the main concern is in the lumbar or lower spine. The lumbar spine is most susceptible to the changes seen with aging or degeneration, which increases symptoms like pain.

CAUSES

The cause of scoliosis varies depending on the type, but may include:

• Vertebrae malformation during embryonic development
• A tumor on the spine
• A biological family history of scoliosis
• A spine injury
• Neurological or muscular conditions like cerebral palsy, spina bifida, or muscular dystrophy

SYMPTOMS

Symptoms of scoliosis may include:

• Back pain
• Difficulty standing upright
• Core muscle weakness
• Leg pain, numbness, or weakness
• One shoulder blade that appears more prominent than the other
• Uneven waist
• Uneven knee length
• Head that doesn’t center above the pelvis
• One hip higher than the other
• Constant leaning to one side
• One side of the ribcage jutting forward
• A prominence on one side of the back when bending forward
• Changes in skin appearance or texture along the spine

NON-SURGICAL TREATMENTS

Non-surgical treatments are typically recommended for those with mild to moderate scoliosis or those who are not candidates for surgery. The effectiveness of these treatments can vary depending on the severity of the condition and the age of the patient. Some treatments may include:

• Physical therapy: targeted exercises and stretching
• Bracing: Thoracolumbosacral Orthosis (TLSO)–a custom-fit brace worn under clothing to prevent curvature from becoming worse and/or nighttime bracing worn only during sleep
• Pain management medications: over-the-counter pain relievers like ibuprofen or acetaminophen
• Epidural steroid injections
• Posture training
• Ergonomic lifestyle modifications such as adjusting workstations, chairs, and beds to better support the spine
• Maintaining a healthy weight reduces strain on the spine

WHEN IS SURGERY INDICATED?

Surgery in adults may be recommended when the spinal curve is greater than 50 degrees and the patient has nerve damage to their legs and/or is experiencing bowel or bladder symptoms. Severe scoliosis typically progresses with time, so a healthcare provider might suggest scoliosis surgery to help straighten the curve and prevent it from getting worse. Spinal fusion is the most common method for surgically correcting scoliosis. The goal of this is to realign the curved area of the spine fusing metal rods or pieces of bone to form a new, straighter, solid section of the spine. With new opportunities for treatment that didn’t exist even a few years ago, providers are better equipped than ever to help stop the curve before it gets to a point where a person needs surgery.

GETTING THE RIGHT DIAGNOSIS.  GETTING THE RIGHT DOCTOR.

Scoliosis can be a frightening condition which is why you want an orthopedic specialist who is not only skilled and experienced but also compassionate, approachable, and understanding. You’ll find all of that and more at Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado. The first step in diagnosing scoliosis is a detailed medical history of you and your family (for genetic history). They’ll want to know the date you first noticed a change in the spine or the date of your initial screening. A physical exam will include having you stand up straight and then bend forward to touch your toes.

They will examine your back to check the shape of your spine and see how you move around. They’ll also check your nerves by testing your reflexes and muscle strength. The curve is measured by the Cobb Method or Cobb angle which is a mathematical tool for assessing the curvature of the spine. The size of the Cobb angle helps to determine what kind of treatment is needed. Ultrasound is another option, although it can be less precise in determining the seriousness of the scoliosis curve. Alternative diagnostic methods and innovative imaging technologies are available for scoliosis, but X-rays remain the gold standard. Plain X-rays can confirm the diagnosis of scoliosis and reveal the seriousness of the spinal curvature. Repeated radiation exposure can become a concern because multiple X-rays will be taken over the years to see if the curve is worsening. To reduce this risk, there are newer types of imaging systems that use lower doses of radiation. Treating scoliosis is treating the whole body and constant monitoring is key. At CCOE they consistently strive to meet standards of professional exceptionalism using both traditional and cutting-edge treatments. Above all, they will be there for you in all the ways you need them.