Common Questions & Glossary Our goal in preparing and disseminating this information is to provide patients or parents with a better understanding of scoliosis and its diagnosis and management, using idiopathic scoliosis—the most common type—as a model. This information is intended as a supplement to the information your physician will provide you. Just as no two individuals are exactly alike, no two patients with a spinal deformity are the same. Therefore, your orthopaedic surgeon will be the most important source of information about the management of your particular spinal problem. Here, orthopaedic surgeons from the American Academy of Orthopaedic Surgeons and the Scoliosis Research Society answer some of the questions they most commonly hear from patients and their parents.
Treatment & Coping
Frequently Asked Questions: What are spinal deformities? When the body is viewed from behind, a normal spine appears straight. When the trunk is viewed from the side, the normal spine will demonstrate normal curves. The upper chest area has a normal roundback, or kyphosis, while in the lower spine there is a swayback, or lordosis. However, when a spine with a scoliosis is viewed from behind, a lateral, or side-to-side, curvature may be apparent. This gives the appearance of leaning to one side and should not be confused with poor posture.Increased roundback in the chest area is called hyperkyphosis, while increased swayback is termed hyperlordosis.
Can spinal deformities be prevented? At present, there is no known prevention for spinal deformities.
What is scoliosis? Scoliosis is a common condition that affects many children and adolescents. Simply defined, scoliosis is a sideways curve of the spine that measures greater than 10 degrees. Instead of a straight line down the middle of the back, a spine with scoliosis curves, sometimes looking like a letter "C" or "S." Some of the bones in a scoliotic spine also may have rotated slightly, making the person’s waist or shoulders appear uneven.
What ill effects can result from scoliosis? Back pain may be present. This usually tends to be mild and does not limit activities in most patients. However, a few patients have more back pain than the average. Patients with severe back pain should be carefully evaluated for other causes of back pain than scoliosis. Elderly patients with scoliosis may have greater back pain due to arthritis or disc disease in the spine. Severe scoliosis may be associated with diminished lung function due to distortion and stiffness of the rib cage.
What causes scoliosis? In more than 80 percent of the cases, a specific cause is not found and such cases are termed “idiopathic,” meaning “of undetermined cause.” Conditions known to cause spinal deformity are congenital spinal column abnormalities (abnormally formed vertebrae present at birth), neurological disorders, muscular diseases, genetic conditions (e.g., Marfan’s syndrome, Down syndrome) and a multitude of other causes such as infections or fractures involving the spine.
What does not cause scoliosis? There are many common misconceptions and incorrect assumptions. To set the record straight, scoliosis does not come from carrying a heavy book bag or other heavy things, athletic involvement, poor sleeping or standing postures, lack of calcium, or minor leg length difference.
Who gets scoliosis? In childhood, idiopathic scoliosis occurs in both girls and boys. However, as children enter adolescence, scoliosis in girls is five to eight times more likely to increase in size and require treatment. Progression is most common during the growing years. Severe curves may, however, progress during adulthood.
What causes abnormal kyphosis? Excessive roundback deformity may simply be postural, and can often be corrected with exercises and proper posture. A small percentage of patients with kyphosis may have more rigid deformities associated with wedged vertebrae—called Scheuermann's kyphosis—and its cause is unknown. The least common cause of excessive roundback is congenital kyphosis—resulting from one or more bones of the spine formed incorrectly—and requires evaluation by an orthopaedic surgeon. Excessive roundback may also be seen as a result of medical diseases such as ankylosing spondylitis or osteoporosis.
What is congenital kyphosis? In the first six to eight weeks of embryonic life, a genetic change occurs that results in the failure of formation or failure of segmentation on the front part of one or more vertebral bodies and disc. This defect causes the spine to develop a sharp forward angulation as it grows. The forward bend of the spine is called kyphosis and is considered to be congenital as it occurred prior to birth. Congenital kyphosis does not appear to be inherited but rather something that happened for no known reason.
What are the two basic types of congenital kyphosis? Failure of formation and failure of segmentation. The failure of formation (Type I deformity) of a portion of one or more vertebral bodies, most often occurring in the thoracolumbar spine, results in a kyphosis that usually worsens with growth. The deformity is usually visible at birth as a lump or bump on the infant's spine. The failure of segmentation deformity (Type II deformity) occurs as two or more vertebrae fail to separate and to form normal discs and rectangular bones. This type of congenital kyphosis is often more likely to be diagnosed later, after the child is walking.
What is the difference between a functional or structure curve? A scoliotic curve may be functional or structural in nature. Functional curves may be positional. For example, if a person stands asymmetrically, with one knee bent, and the pelvis tilted downward, a curve will be present, but this will go away as soon as the knee is straightened and the pelvis is held parallel to the floor. Structural curves are those that have stiffness within them, such that they do not go away with changes of position. These therefore have much more significance than functional curves.
What are symptoms and signs of scoliosis?
One shoulder may be higher than the other.
One scapula (shoulder blade) may be higher or more prominent than the other.
With the arms hanging loosely at the side, there may be more space between the arm and the body on one side.
One hip may appear to be higher or more prominent than the other.
The head may not be exactly centered over the pelvis.
The waist may be flattened on one side; skin creases may be present on one side of the waist.
How is scoliosis diagnosed? When the patient is examined from the rear and asked to bend forward until the spine is horizontal, one side of the back may appear higher than the other. This test, called the Adams test, is a very sensitive test for scoliosis; it is therefore the most frequent screening test for scoliosis. Determining whether or not you have scoliosis is best done by a physician who performs a physical examination of your back. The examination is done with you standing in a relaxed position with your arms at your sides. The physician will view you from behind looking for curvature of the spine, shoulder blade asymmetry, waistline asymmetry and any trunk shift. You will then bend forward at the waist and the physician will view your back once again to look for the rotational aspect of the scoliosis in the upper part of the back (rib prominence) or in the lower part of your back (flank or waist prominence). Following this simple examination, the physician will usually initial radiographs of the spine viewed from the back and the side to see the entire spine from the neck to the pelvis. If scoliosis is present, the physician will measure the radiographs and provide you with a numerical value, in degrees, to help describe the scoliosis.
How early should children be screened for scoliosis? Children can be screened at any age, although idiopathic scoliosis is more commonly discovered during a child's growth spurt (10 to 15 years old). The Scoliosis Research Society recommends that girls be screened twice, at 10 and 12 years of age (grades 5 and 7), and boys once at 12 or 13 years of age (grades 8 or 9). A great deal of controversy exists as to the benefits of school screening.
What can I do to prevent my scoliosis from getting worse? The only treatments that have been shown to affect idiopathic scoliosis are bracing and surgery. There is no evidence in the current medical literature that physical therapy, electrical stimulation, chiropractic care, or other options have any impact on scoliosis curves.
Can scoliosis curves get better on their own? Idiopathic scoliosis curves do not straighten out on their own. Many children have slight curves that do not need treatment. In these cases, the children grow up to lead normal lives—but their small curves never go away. If larger curves are not treated, the best you can hope for is that they will not get worse. This depends on how much growing a child has left to do. Curves in children who are almost full-grown may stop getting worse. If a child's spine is still growing, it is more likely that the curves will worsen.