Don’t Get All Bent Out of Shape with Scoliosis

<p>Scoliosis has got to be one of the crappiest curveballs that life can throw at you. Wonky spines affect millions worldwide, and they’re particularly damaging during childhood and adolescence. Scoliosis is characterized by an abnormal lateral curvature of the spine, and it has a big spectrum of severity that can have a serious impact on a person’s life.</p> <p>Below is a breakdown of the causes, symptoms, diagnosis, and treatment of scoliosis. </p> <h2>Scoliosis: a tale of two curves</h2> <p>Scoliosis is all about the dreaded curve that forms an “S” or “C” shape instead of going up relatively straight like everyone else’s.</p> <p>As opposed to the normal spinal curves that you see in a profile view of a human body, scoliosis curves can be apparent from the back or front. The curves range from mild (20 degrees) to severe (>45 degrees). Significant curvatures can lead to serious health complications and a great deal of pain. </p> <figure><img style="max-width: 100%;" src="https://cdn.storymd.com/optimized/Nq4yyygS7A/medium.jpg" alt="Scoliosis cobb | Source: Skoliose-Info-Forum.de, Skoliose-Info-Forum.de/Wikimedia" /> <figcaption>Cobb angle measurement in scoliosis. <em>Source: Skoliose-Info-Forum.de/Wikimedia</em></figcaption> </figure> <h2>Why would a spine not grow straight?</h2> <h3>Idiopathic scoliosis</h3> <p>For something so fundamental as your spine, it’s amazing to learn that most cases of scoliosis are registered as idiopathic, i.e., we don’t know what happened. Around 80% of cases are idiopathic, and genetic factors are believed to be involved. The issue usually arises during the growth spurt before puberty. </p> <h3>Congenital scoliosis</h3> <p>This malformation occurs during fetal development. The vertebrae of the spine may be incompletely formed or fused together, causing a curve to form. </p> <h3>Neuromuscular scoliosis</h3> <p>Scoliosis is a complication of conditions like cerebral palsy, muscular dystrophy, and spinal muscular atrophy. These neuromuscular conditions affect your muscles’ ability to support the spine properly.</p> <h3>Degenerative scoliosis </h3> <p>As an adult, you can develop scoliosis through the degeneration of spinal discs and joints. This type of scoliosis is often seen in older adults and is associated with arthritis and osteoporosis.</p> <h2>Signs of scoliosis</h2> <p>The signs of scoliosis vary a lot, and its cosmetic appearance can be concerning for parents and children. Some of the signs include:</p> <ul> <li>Differences in height between their shoulders </li> <li>An uncentered head</li> <li>Hip height and shoulder blade position may differ</li> <li>Tilted pelvis</li> <li>Clothing does not hang straight</li> <li>Rib prominence on one side</li> <li>Leaning to one side</li> </ul> <figure><img src="https://cdn.storymd.com/optimized/pA7JBpTlq9/thumbnail.jpg" alt="Different scoliosis patterns: Similar Cobb angles clinically may look different depending on curve pattern. | Source: Weiss HR, Goodall D" /> <figcaption>Different scoliosis patterns. <em>Source: Weiss HR, Goodall D</em></figcaption> </figure> <h3>Severe cases</h3> <p>In severe cases, scoliosis can cause serious issues like:</p> <ul> <li>Back pain</li> <li>Difficulty standing up straight </li> <li>Weakness, numbness, or pain in legs or core muscles</li> <li>Breathing difficulties</li> <li>Reduced lung function owing to deformation of the chest cavity</li> </ul> <h2>Diagnosing scoliosis</h2> <p>Catching scoliosis as early as possible allows us to manage and treat it before it gets out of hand. This is why many US states either mandate or recommend scoliosis screening at school. Diagnostic tests for scoliosis include:</p> <ul> <li><strong>Adam’s forward bend test</strong>. The patient bends forward, allowing the doctor to observe any asymmetry in the ribs or shoulder blades.</li> <li><strong>X-rays.</strong> These are essential for confirming scoliosis and determining the degree of curvature. X-rays provide a clear image of the spine, helping to assess the severity and monitor progression.</li> <li><strong>MRI or CT scans.</strong> These imaging tests may be used if there is suspicion of underlying conditions like spinal cord abnormalities.<br /> <figure><img src="https://cdn.storymd.com/optimized/MANPG2UNdl/thumbnail.jpg" alt="Initial diagnosis of scoliosis with Adams test and x-rays | Source: Rigo M, Negrini S, Weiss HR, Grivas TB, Maruyama T, Kotwicki T/Wikimedia" /> <figcaption>Diagnosis of scoliosis with Adam's test and x-rays. <em>Source: Rigo M, Negrini S, Weiss HR, Grivas TB, Maruyama T, Kotwicki T/Wikimedia</em></figcaption> </figure> </li> </ul> <h2>Treatment options</h2> <p>The age of the patient and the severity of the curve are what dictate the treatment approach. The options range from monitoring the curve to see if it progresses to using bracing to pull it in and even surgery as a drastic measure.</p> <h3>Mild to moderate scoliosis</h3> <p>With milder curves, the approach is to usually sit back and keep an eye on it by monitoring it every 4 to 6 months during growth spurts. For moderate cases (20 to 40 degrees), wearing a brace can prevent further progression of the curve. Bracing is most effective when the patient is still growing, so it’s mostly something you see worn on teens.</p> <p>Physical therapy forms an important part of the treatment program because it helps to correct imbalances by strengthening the muscles around the spine. This improves posture and reduces discomfort and pain.</p> <figure><img src="https://cdn.storymd.com/optimized/KAMBXbhLo7/thumbnail.jpg" alt="Scoliosis bracing | Source: Weiss HR/Wikimedia" /> <figcaption>Scoliosis bracing. <em>Source: Weiss HR/Wikimedia</em></figcaption> </figure> <h3>Surgery</h3> <p>Surgery is usually called for in severe cases (>45 degrees) or cases that progress despite bracing. Spinal fusion is the most common surgery, and it involves fusing the vertebrae together to straighten up the curve.</p> <figure><img src="https://cdn.storymd.com/optimized/Oo5QMwHDoK/thumbnail.jpg" alt="Surgical result after ventral fusion of scoliosis | Source: Weiss HR, Goodall D/Wikimedia" /> <figcaption>Surgical result after ventral fusion of scoliosis. <em>Source: Weiss HR, Goodall D/Wikimedia</em></figcaption> </figure> <h2>Living with scoliosis</h2> <p>Children with scoliosis can live normal healthy lives, but there will be bumps along the way. As helpful as bracing is, it can be difficult for teenagers struggling with social development and insecurity since the braces can be unfashionable and awkward. The effect of pain and limitations in severe cases can also have an impact on mental health.</p> <p>Still, with early detection and work, there’s a lot that can be mitigated, and many people with scoliosis can manage their problem and lead productive lives into adulthood.</p><h2>More on Scoliosis</h2><ul><li><a href="https://soulivity.storymd.com/journal/xjnpp68trm-scoliosis" target="_blank">Scoliosis: Causes, Symptoms, Treatment</a></li><li><a href="https://soulivity.storymd.com/journal/rjykzk40yw-adolescent-idiopathic-scoliosis" target="_blank">Adolescent Idiopathic Scoliosis (AIS): Causes, Symptoms, Treatment</a></li><li><a href="https://soulivity.storymd.com/journal/yj5ddvn0nm-spine-injuries-and-disorders" target="_blank">Spine Injuries and Disorders</a></li></ul>