It is natural for the spine to curve forward and backward to a certain degree. This is what gives the side-view of the spine its "S"-like shape. But sometimes the spine twists and develops curves in the wrong direction — sideways. When the spine twists and develops an "S"-shaped curve that goes from side to side, the condition is known as scoliosis (sko-lee-oh-sis) and may require treatment .
What are the the different types of scoliosis?
Scoliosis is divided into categories based on the age you are when it is diagnosed:
- Infantile scoliosis is diagnosed before age three
- Juvenile scoliosis is diagnosed from age three to puberty
- Adolescent scoliosis is diagnosed during puberty, usually between the ages of 10 and 15
- Adult scoliosis is diagnosed in adulthood after the spine has stopped growing
Adolescent Idiopathic scoliosis
The word "idiopathic" (id-e-oh-path-ic) means that the cause of this form of scoliosis is unknown. Adolescent idiopathic scoliosis can affect a child who is healthy and not having nerve, muscle or other spine problems. It is the most common form of spinal deformity doctors see, affecting about three percent of the general population.
Adolescent idiopathic scoliosis affects children between 10 and 18 years old, and affects girls more often than boys. There are many theories as to why this type of scoliosis develops, including:
- Genetics. Scoliosis appears to run in certain families, so it may be hereditary. Significant research is ongoing in the field of genetics.
- Growth. Curves progress rapidly during growth spurts, which may mean there is a link between scoliosis and hormones.
- Structural and biomechanical changes.Some studies have shown that muscle activity increases around the spinal curves. Differences in leg lengths have also been noted in adolescents with idiopathic scoliosis.
- Central nervous system changes.Some forms of scoliosis are associated with central nervous system disorders.
- Equilibrium and postural mechanisms. Idiopathic scoliosis could be related to body alignmemt. If a child has problems with posture, balance, and body symmetry, it could affect the way the spine is positioned. If the problems are chronic, it may disrupt the way the spine and muscles develop.
When scoliosis is diagnosed in children, there is often concern that the curves will continue to grow bigger. Each child is different but we do know:
- Curves in the thoracic spine are more likely to progress than lumbar curves.
- The likelihood of progression is linked to the size of the curve — larger curves are more likely to get bigger.
- If the curves start at a young age or before a girl begins her period, they are more likely to progress.
- The higher the child's Risser sign at diagnosis, the less chance there is of progression. A Risser sign measures skeletal maturity. It is based on a 0 to 5 scale, with 5 being full skeletal maturity.
Scoliosis that occurs (or is discovered) after puberty is called adult scoliosis. Adult scoliosis can be the result of untreated or unrecognized childhood scoliosis, or it can arise during adulthood. The causes of adult scoliosis are usually different from the childhood types.
Most cases of adult scoliosis are idiopathic because the cause is not known. Sometimes adult scoliosis is the result of changes in the spine due to aging and degeneration. The causes of adult scoliosis are further categorized into several types:
- Idiopathic curve. Usually there is no clear-cut reason why the spine is curved.
- Congenital curve. A congenital curve is when you were born with a curved spine that may not have been recognized, or severe enough, to require treatment during childhood. Although it is rare, the scoliosis can get worse later in life due to wear and tear around the abnormal area of the spine.
- Paralytic curve. Occurs often from injury to the spinal cord. When the muscles around the spine are not working, the spine may be thrown out of balance, causing abnormal curvature in the spine.
- Myopathic deformity. Like a paralytic curve, "myopathic" also means that the muscles do not work. With myopathic deformity, the muscles do not work because of a muscular or neuromuscular disease such as muscular dystrophy, cerebral palsy, or polio.
- Secondary Scoliosis. Developed in adulthood as a result of other spinal conditions that affect the vertebrae, such as degeneration, osteoporosis, or osteomalacia (ost-eyo-mal-ace-ia) (softening of the bones). Scoliosis can also appear following spinal surgery for other conditions if the surgery causes an imbalance in the spine.
Degenerative adult scoliosis occurs because of a combination of age and deterioration of the spine. It usually starts after age 40. In older patients, particularly women, it is also often related to osteoporosis. Osteoporosis weakens the bone, making it more likely to deteriorate. The combination of these changes causes the spine to lose its ability to maintain a normal shape. The spine begins to "sag" and as the condition progresses, a scoliotic curve can gradually develop.
How is scoliosis treated?
Surgery may be needed to keep scoliosis from worsening and to straighten severe cases of scoliosis, depending on the individual’s condition.
The Polyclinic spine surgery believes in providing the least invasive services and procedures to treat each patient’s scoliosis individually. We prefer patients work first with their primary care physician to implement nonsurgical options as appropriate. Patient referrals from primary care providers are welcome after trying appropriate nonsurgical options.
Our spine surgeon has the experience and expertise to address even the most challenging scoliosis surgical cases, assisting patients who have not found help elsewhere.
When is surgery recommended for scoliosis?
Surgery for adolescents with scoliosis is only recommended when curves are extensive and continue to progress.
Unlike back braces, which do not correct existing spinal curves, surgery can significantly correct curvature. Surgery also prevents further progression of the curve. There are several approaches to scoliosis surgery, but all integrate a modern instrumentation system, applying hooks and screws to the spine to anchor long rods. The rods compress and hold the spine while additional bone is fused with existing bone.
Scoliosis at The Polyclinic
At The Polyclinic, your scoliosis care will be led by a board certified orthopedic spine surgeon. We provide the latest in intraoperative imaging technology, state of the art facilities and minimally invasive spine and back surgery.
Sean Keem, MD, with more than 17 years of spine surgery experience, works closely with onsite neurologists, pain management experts and physical therapists to ensure your quick and complete recovery.
Contact the Spine Program at 206-860-5383 to make an appointment or for more information.