Scoliosis is a deformity in the spine that causes an abnormal C-shaped (one curve) or S-shaped curvature (two curves). The spine is not straight but curves to one or both sides. There are three types of scoliosis depending on when it develops. Infantile occurs from birth to three years of age. Juvenile scoliosis develops between four and nine years of age. Adolescent presents between 10 years and when growth is complete. Adults can have residuals of childhood scoliosis.
This guide will help you understand:
- what parts of the spine are involved
- what causes the condition
- what treatment options are available
What parts of the spine are involved?
The human spine is made up of 24 spinal bones, called vertebrae. Vertebrae are stacked on top of one another to create the spinal column. The spinal column is the body's main upright support.
When viewed from the side, the spine forms three curves. The neck, called the cervical spine, curves slightly inward. The thoracic spine curves outward. The low back, also called the lumbar spine, curves slightly inward. When viewed from the back, the vertebrae form a straight column keeping the head centered over the body.
Each vertebra is made of the same parts. The main section of each vertebra is formed by a round block of bone, called the vertebral body. Each vertebra increases slightly in size from the neck down. The increased size helps balance and support the larger muscles that connect to the lower parts of the spine.
How does this problem develop?
A specific cause of scoliosis is unknown or idiopathic. Idiopathic scoliosis is the most common type and affects about two to three per cent of the population. It tends to run in families and is more common in girls than in boys. Most often it develops in middle or late childhood during a rapid growth spurt.
The condition can also be congenital (present at birth) or it may develop as a result of another neurological condition such as cerebral palsy, spina bifida, or spinal muscular atrophy.
Any part of the spine can be affected by scoliosis including the cervical, thoracic, or lumbar vertebrae. Most often the thoracic and lumbar spine are affected. The vertebrae curve to one side and may rotate, which makes the waist, hips, or shoulders appear uneven.
At first, a C-shaped curve may develop causing the shoulders and hips to tilt down on one side. In an effort to keep the head in the middle, the spine may compensate by curving the lower part of the spine in the other direction, forming an S-curve.
The most common curve in infantile idiopathic scoliosis is in the low thoracic region. Single curves are almost always in the thoracic region with variable amounts of vertebral rotation. As the vertebrae rotate, the attached ribs shift causing a noticeable rib bump or hump on one side of the spine. Most of the curves (85 per cent) are to the right when they occur after the age of two years. The curve doesn't always attempt to correct but when it does, a double (S-shaped) curve develops.
Infantile idiopathic scoliosis with the thoracic curve to the left occurs most often in boys observed before one year of age. This type of scoliosis tends to resolve on its own without treatment. It does not get worse with puberty during growth spurts.
Juvenile idiopathic scoliosis develops in boys at an earlier age than in girls. Boys also mature skeletally at a later age. This means there is a greater risk of curve progression in boys with this type of scoliosis compared to girls.
The typical curve patterns of juvenile and adolescent idiopathic scoliosis are similar with right thoracic and double major curves present most often.
What does this condition feel like?
Scoliosis is a painless condition. You may not feel any change in the spine but instead notice that your clothes don't fit quite right. As the spine starts to curve, the body adjusts to keep the head in the middle over the pelvis.
As a result, the shoulders and hips may be uneven, causing one shirtsleeve or pant leg to seem shorter than the other. Often there is rotation of the vertebrae causing an uneven waist so that a pair of pants or skirt twists to one side.
The most common signs of scoliosis are:
- uneven shoulders
- uneven hips
- uneven breasts (girls) or nipples (boys)
- prominent or winging shoulder blades
- leaning to one side
- bump or rib hump on one side of the spine, most noticeable when bending forward at the waist
The presence of one or more of these signs suggests a need for a medical exam by your pediatrician, primary care physician, or orthopedic surgeon. Severe scoliosis can cause pressure on the heart, lungs, liver, and other internal organs. Early diagnosis and treatment are important to prevent problems with breathing and cardiovascular function.
How do doctors identify the problem?
Many children are examined during a school screening program by the school nurse or physical therapist. The Adams forward bend test is used to look for prominence of the ribs or changes in the spine. From a standing position, the child slowly bends forward at the waist as if diving into a pool. Anyone with signs of scoliosis is referred to his or her family doctor.
Your doctor will examine the spine and look for any possible causes of scoliosis.
X-rays may be taken to look for any tilt or rotation of the vertebrae causing a curvature. X-rays are not immediately ordered for everyone in order to avoid needless exposure of growing children to radiation. Signs of asymmetry (unevenness) and other changes observed with scoliosis during the exam usually result in x-rays being taken. An MRI may be ordered if the physician suspects an infection, tumor, or problems in the nervous system.
When an x-ray is warranted, your doctor will use a technique called the Cobb method to measure the location and degree of each curve. Curves must be more than 10-degrees to be considered scoliotic.
X-rays are also used to identify skeletal maturation or bone growth. The Risser sign is applied to the x-rays of the pelvic bone to judge whether or not the child has stopped growing. The amount of spinal curvature is compared with the stage of growth activity to help guide treatment.