Scoliosis: A Problem That Needs Treatment

The spine is made up of bones and intervertebral disc, playing a vital role in weight-bearing and connecting the nerves from the brain to the lower extremities. When viewed from the front, the spine should align in a straight line. When seen from the side, the spine has natural curves, which is normal.

However, individuals with scoliosis (abnormal curvature of the spine) will have a spine that appears tilted by more than 10 degrees in an X-ray image. This is a sign that requires medical attention. This article covers essential information about scoliosis, including its symptoms, causes, treatments, and how to detect it early.

Causes of Scoliosis

Scoliosis can occur at any age and from various causes, including:

1.Congenital Scoliosis: A developmental abnormality in the spine present at birth. It occurs due to issues during fetal development, such as one-sided bone formation or incomplete spinal development, resulting in a tilted spine. This type of scoliosis can cause significant abnormalities, requiring immediate treatment.

2. Neuromuscular Scoliosis: This type occurs due to neurological or muscular disorders that affect the balance of the spine, causing it to curve. Common conditions associated with neuromuscular scoliosis such as cerebral palsy and muscular dystrophy.

3. Degenerative Scoliosis: The most common cause of scoliosis in older adults. It results from the deterioration of the spinal joints or uneven degeneration of the intervertebral discs, leading to spinal imbalance and curvature.

4. Idiopathic Scoliosis: This is the most common form of scoliosis found in children, where the cause is unknown. There are no clear abnormalities in the bones, discs, or muscles. Diagnosis involves ruling out other potential causes. If no other cause is identified, it is classified as idiopathic scoliosis.

Who Can Develop Scoliosis?

Scoliosis can affect individuals of all ages, including children, adults, and the elderly. Different age groups have different contributing factors for scoliosis:

• Young Children (0-5 years): Scoliosis in this group is often congenital, and the condition may be detected early or accidentally through X-rays. It’s important to look for associated abnormalities in other systems, such as kidney or heart issues.
• Adolescents (10-15 years): The most common type of scoliosis in teenagers is idiopathic scoliosis. During this time, rapid growth occurs, and the spinal curve may worsen quickly. Parents should monitor their children for signs of worsening curvature.
• Older Adults (>50 years): In this group, degenerative scoliosis is common due to the wear and tear on the spine over time. The imbalance between left and right spinal joints or intervertebral disc degeneration leads to scoliosis. In these patients, nerve compression may also occur, causing additional symptoms like back pain, leg pain, numbness, and weakness.

Impact of Scoliosis on Daily Life

The spine is a crucial part of the body, and when scoliosis occurs, it significantly impacts daily life. Additionally, scoliosis can affect mental health and cause other symptoms.

• Physical Impact: When the spine tilts, the body tends to compensate by adjusting the torso to align the spine. This compensation can lead to further curvature in the future. People with scoliosis may experience faster degeneration of the spine, back pain, and, in severe cases may cause respiratory problem. Those with scoliosis in the thoracic region may have reduced lung expansion, leading to shortness of breath. For older patients, nerve compression due to degenerative scoliosis can cause leg pain, numbness, and difficulty walking long distances.

• Psychological Impact: Chronic pain and visible changes in appearance can lead to a lack of self-confidence and anxiety about one’s physical condition.

Early Signs of Scoliosis

The symptoms and severity of scoliosis can vary, but here are some signs you can look for:

• Uneven shoulder heights
• Tilting of the torso when standing or walking
• Uneven hips or pelvis
• Uneven ribs or chest , hump
• Visible spinal curvature

Observing the Symptoms of Scoliosis from Early Signs: If the scoliosis is not severe, it may be difficult to notice on your own. You may need someone close to you to help observe the patient’s condition from behind. Easy way to check is through a test called the Forward Bending Test. In this test, the patient bends forward, and the observer checks if the left and right sides of the back are equally rounded, or if both sides of the waist are even. Normally, when bending forward, whether at the chest or waist, both sides should be level. If scoliosis is present, the left and right sides of the back will appear uneven when bending forward, as shown in the image.

In addition, the patient can observe changes in their body themselves, such as uneven hips or pelvis, shoulders that are not at the same height, or by observing themselves while standing or walking.

Diagnosis of Scoliosis

If you notice any of the signs mentioned, it’s important to consult a doctor for a clear diagnosis. The diagnostic process includes:

• Physical Examination: The doctor will assess your posture, check for leg length discrepancies, evaluate shoulder alignment, and examine the spine for abnormalities. Neurological evaluation is also performed to check for potential spinal cord involvement.
• X-rays: If the X-ray shows a spinal curve greater than 10 degrees, the doctor will diagnose scoliosis.
• Further Tests: Depending on the severity, additional tests like a Pulmonary Function Test (to assess lung capacity), MRI (to evaluate the spinal cord and nerves), or CT scans (for detailed bone analysis) may be recommended, especially when planning for surgery.

Treatment Options for Scoliosis

There are three main approaches for treating scoliosis, often referred to as the “3O” approach: Observe, Orthosis, and Operation. The treatment choice depends on the severity of the curvature:

• Observe: Monitoring the condition is the primary approach for patients with a spinal curve of less than 20 degrees, especially if there are no pain or visible abnormalities.
• Orthosis: This involves using a brace or back support to prevent the curve from worsening. It is suitable for younger patients whose spine is still growing and those with a curve greater than 20 degrees. The goal is to prevent further curvature,but  not to purposely straighten the spine.
• Operation: Surgery is considered for patients with severe curves (>40 degrees) or those who experience significant pain and difficulty walking. The surgical procedure involves straightening the spine by using screws and rods to correct the spinal curve and fusion.

Conclusion

Scoliosis is a condition that can occur at any age, from childhood to old age. Common signs include uneven hips or shoulders, tilting of the torso, or visible spinal curvature. Treatment depends on the severity of the condition, and early diagnosis can help manage the symptoms and prevent further complications. If you suspect scoliosis, seek professional medical advice to receive proper evaluation and treatment planning.

Article by: Assoc. Prof. Koopong Siribumrungwong, M.D., Specialist Spine Surgoen