Scoliosis: A Look at Causes and Treatment

Scoliosis is the most common deformity of the spine. Other spinal deformities include kyphosis and lordosis; however, these are much less common. The diagnosis of scoliosis is made when there are two abnormalities of the spine:

• Lateral curvature: A lateral curvature of the spine means that the vertebral column bends from side-to-side. If looking at an individual from behind while they bend to touch their toes, there is an S-shaped curvature of the spine. A slight degree of lateral curvature of the spine is not necessarily abnormal. A lateral curvatures of the spine that is less than 10 degrees is within the limits of normal.
• Rotation: The rotational deformity is usually subtle, but is always present in a true scoliosis deformity. The rotational aspect of scoliosis causes a twisting deformity of the vertebral bodies.

There are several categories into which scoliosis as a general syndrome is separated. The most common form of scoliosis (over 80 percent of cases) is called "idiopathic scoliosis." The word idiopathic simply means that the cause is not known. Idiopathic scoliosis is further classified by age group. The following are the four types of idiopathic scoliosis:

• Infantile (birth to 3 years)
• Juvenile (3 years to puberty)
• Adolescent (at or just after puberty)
• Adult (over age 20)

Congenital scoliosis is the result of an abnormality of the development of the vertebrae. When the bones of the spine fail to develop normally, a scoliosis deformity can result. Also, some specific congenital syndromes can include a scoliosis deformity. These syndromes include Marfan syndrome, Ehlers-Danlos syndrome, Osteochondrodystrophy (dwarfism), and others. These are all examples of structural scoliosis; this means that the spine has a problem within the vertebral column that is causing the abnormal curvature.

Another category of scoliosis is non-structural, or functional, scoliosis. This occurs when there is a problem with another part of the body that is causing a curve in the spine. For example, a discrepancy in leg length can cause the spine to curve to one side. Muscle spasms and inflammation may also cause this problem. When a scoliosis is classified as non-structural, treatment is aimed at the underlying problem, not the spine itself.

Scoliosis treatment is a subject that has been the cause of great debate for many years; unfortunately, there is not a definitive answer for all cases. The three basic scoliosis treatment options are as follows:

• Observation: Patients are observed when the curvature of the spine is minimal (the cutoff is debatable, but depending on the age of the patient, the stage of skeletal development, and symptoms, it is somewhere between 20 and 30 degrees of curvature). Over this cutoff, more aggressive scoliosis treatment is usually pursued. When being observed, patients are seen by a spine specialist about every six months until skeletal maturity is reached.
• Bracing: Braces will help control any worsening of a spine curvature, but do little to correct an existing deformity. Bracing is most effective for scoliosis treatment when used in children that are rapidly growing and have worsening scoliosis curves.
• Surgery: Surgery is often the best options for more severe curves. Depending on the site of the curve and the degree of curvature, the surgeon will fuse vertebrae in a more normal anatomic position.

Studies are investigating the effectiveness of many scoliosis treatments, including electrical stimulation, chiropractic manipulation, physical therapy, and other forms of treatment. None of these studies has been shown to alter the progression of scoliosis, but the jury is still out. Some patients find relief from symptoms when these scoliosis treatments are used.

Some parents are often worried about children with scoliosis exercising. It should be emphasized to these parents that it is important that all children exercise regularly. Participation in exercise or sports will not worsen the curve in the spine; only if there is back pain associated with the scoliosis should exercise be minimized. In fact, adequate back muscle strength is an important component of effective scoliosis treatment.