Scoliosis is a condition characterized by abnormal curvature of the spine causing a deviation to one side. It causes a physical deformity making the spine look like the letter “C” or “S” instead of the letter “I”. Scoliosis can affect either the mid or the lower back but the scoliosis of the mid back is more common. Scoliosis can occur at any age. It can be classified into five categories, depending on the age group affected:
Some patients may develop a compensatory curve to compensate for the imbalance due to scoliosis. However, this compensatory curve is less severe.
In the initial stage, idiopathic scoliosis may be asymptomatic. The symptoms of scoliosis depend on the cause, severity and age of the patient. Some of the common symptoms include spinal curvature, abnormal gait, uneven shoulders and hip, difference in leg lengths, more prominent rib or shoulder blade when the patient bends in the front and back pain. In severe cases it may also cause breathlessness.
The diagnosis of scoliosis, by a spine specialist, involves family and medical history along with physical and neurological examination. Physical examination involves palpation of the spine, Adam’s forward bending test and plumb line test. A neurologic examination involves the evaluation of any signs of neurological injury such as numbness, muscle weakness or abnormal reflexes. X-ray of the spine in different positions such as standing and bending forward is also helpful. Other specific tests for diagnosing scoliosis include a measure of the degree of spinal curve (scoliometre), degree of vertebral rotation and skeletal maturity. Additional tests to identify the cause of scoliosis may also be conducted.
The treatment plan is based on the cause of scoliosis, the degree and position of the spinal curve and the age of the patient. The non-operative treatment approach of scoliosis includes:
Observation: No treatment is required for a spinal curve below 20 degrees. However, the patients are advised regular follow up visits, by the spine specialist. These patients are carefully monitored for the progression of the curve.
Back bracing: A back brace may be recommended in children with a curve between 20-40 degrees to stop the progression of scoliosis and prevent surgery. Bracing is not effective in individuals with congenital or neuromuscular scoliosis.
Surgery is recommended only in individuals with a severe curve which may affect other vital functions of the body or those with a high progression rate and surgery cannot wait till the skeletal maturity is reached. Surgery for scoliosis aims at rectifying the curve with metal rods, screws and hooks to stabilize the spine. An open or minimally invasive approach can be used for surgery.
Consult your spine specialist if you have any questions about scoliosis or the advantages and disadvantages of the available treatment options.