Scoliosis is a condition characterized by an abnormal lateral curvature of the spine. It can occur at any age but is most commonly diagnosed during adolescence. The curvature can take on a “C” or “S” shape and may affect the thoracic (mid-back), lumbar (lower back), or both regions of the spine.

Types of Scoliosis:

• Idiopathic Scoliosis: Most common type, with no known cause. Subtypes based on age: infantile, juvenile, adolescent (most common), and adult idiopathic scoliosis.
• Congenital Scoliosis: Present at birth due to malformations of the spine during fetal development.
• Neuromuscular Scoliosis: Associated with conditions that affect muscles and nerves, such as cerebral palsy, muscular dystrophy, or spinal cord injury.
• Degenerative Scoliosis: Occurs in adults due to age-related changes in the spine, such as arthritis or disc degeneration.
• Functional Scoliosis: A temporary curvature resulting from an underlying condition, such as muscle spasms or leg length discrepancy.

Common Symptoms

• Visible Curvature: Noticeable curvature of the spine, often detected during routine physical exams.
• Uneven Shoulders: One shoulder higher than the other.
• Prominent Rib Cage: One side of the rib cage protrudes more than the other.
• Asymmetrical Waist: Uneven waistline or hips.
• Back Pain: Common in adults and severe cases in adolescents.
• Fatigue: Due to muscle strain from the abnormal curvature.

Cause & Anatomy

• Genetics: Family history of scoliosis increases risk.
• Congenital Defects: Abnormal vertebral formation during fetal development.
• Neuromuscular Conditions: Disorders affecting muscle and nerve function.
• Age-Related Degeneration: Changes in the spine due to aging.

Risk Factors

• Age: Most commonly diagnosed during the growth spurt before puberty.
• Sex: Females are more likely to have progressive scoliosis.
• Family History: Increased risk if scoliosis runs in the family.

Diagnosis

• Detailed assessment of symptoms, medical history, and physical evaluation.
• Adam’s forward bend test to visually assess spinal curvature.
• X-rays: Confirm diagnosis and measure the degree of curvature (Cobb angle).
• MRI or CT Scan: Evaluate the spinal cord and detect underlying conditions in complex cases.

Non-Surgical Treatment

• Observation: Regular monitoring with X-rays to track the progression of mild curves.
• Bracing: Used for moderate curves in growing children and adolescents to prevent progression. Common types include thoracolumbosacral orthosis (TLSO) and Milwaukee brace.
• Physical Therapy: Exercises to improve posture, strength, and flexibility. Schroth method is a specialized physical therapy approach for scoliosis.

Surgical Treatments

Surgery is considered for severe curves (typically greater than 40-50 degrees) or rapidly progressing curves that do not respond to conservative treatment.

• Spinal Fusion: The most common surgical procedure for scoliosis. Involves fusing the affected vertebrae together using bone grafts, rods, and screws to stabilize and straighten the spine.
• Growing Rods: Used in young children with severe curves to allow for continued spinal growth. Rods are lengthened periodically as the child grows.
• Vertebral Body Tethering (VBT): A newer, less invasive surgical option for skeletally immature patients. Involves placing a flexible cord along the side of the spine to correct the curvature while allowing for continued growth.

Recovery & Rehabilitation

Immediate Postoperative Care (for surgical patients)

• Hospital Stay: Typically lasts a few days to a week, depending on the procedure and recovery progress.
• Pain Management: Medications to control postoperative pain.
• Physical Therapy: Early mobilization and exercises to restore function and strength.

Rehabilitation

• Physical Therapy: Continued exercises to improve flexibility, strength, and posture.
• Activity Modification: Gradual return to normal activities, avoiding heavy lifting and high-impact activities initially.
• Follow-Up Care: Regular visits to monitor healing and progress.

Risks & Complications

• Infection: Risk of infection at the surgical site.
• Bleeding: Risk of excessive bleeding during or after surgery.
• Nerve Damage: Potential for nerve injury during surgery.
• Non-Union or Malunion: Failure of the bones to heal properly.
• Implant Failure: Risk of metal hardware loosening or breaking.
• Residual Curve: Remaining curvature after surgery.

Benefits

• Pain Relief: Significant reduction or elimination of pain.
• Improved Appearance: Enhanced cosmetic appearance and posture.
• Increased Mobility: Improved ability to perform daily activities.
• Prevention of Progression: Stabilizing the spine to prevent further curvature.

FAQ’s

How is scoliosis detected?
Scoliosis is often detected through physical exams, such as the Adam’s forward bend test, and confirmed with X-rays.

Can scoliosis be prevented?
There is no known way to prevent scoliosis, but early detection and treatment can prevent progression.

How effective is bracing for scoliosis?
Bracing can be effective in preventing curve progression in growing children and adolescents, but it does not correct the existing curve.

Will scoliosis cause back pain?
While scoliosis can cause back pain, especially in adults or severe cases, many individuals with scoliosis do not experience significant pain.

Can adults develop scoliosis?
Yes, adults can develop degenerative scoliosis due to age-related changes in the spine or have a progression of a previously undiagnosed adolescent scoliosis.