Scoliosis

What is Scoliosis?

Scoliosis is sideways curvature of the spine that most often occurs just before puberty. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is actually unknown. About 3% of adolescents have scoliosis.

Most cases of scoliosis are mild, but left untreated, some spine deformities continue to get more severe as children grow. Severe scoliosis can be disabling and can eventually reduce the amount of space within the chest, making it difficult for the lungs to function properly.

Signs and Symptoms of Scoliosis may include:

  • Uneven shoulders
  • One shoulder blade that appears more prominent than the other
  • Uneven waist
  • One hip higher than the other
  • Pediatricians physically examine their patients’ spine at yearly well check-ups

If a scoliosis curve gets worse, the spine will also rotate or twist, in addition to curving side to side. This causes the ribs on one side of the body to stick out farther than on the other side.

Causes of Scoliosis

Doctors don't know what causes the most common type of scoliosis — although it appears to be hereditary. Less commonly scoliosis may be caused by:

  • Age - Signs and symptoms typically begin pre puberty.
  • Female Gender - Although both boys and girls develop mild scoliosis at about the same rate, girls have a much higher risk.
  • Family history

While most people with scoliosis have a mild form of the disorder, scoliosis may sometimes cause complications, including:

Lung and heart damage - In severe scoliosis, the rib cage may press against the lungs and heart, making it more difficult to breathe and harder for the heart to pump.

Back problems - Adults who had scoliosis as children are more likely to have chronic back pain than are people in the general population.

Appearance - As scoliosis worsens, it can cause more noticeable changes — including uneven hips and shoulders, prominent ribs, and a shift of the waist and trunk to the side. Individuals with scoliosis often become self-conscious about their appearance.

Treatment

Children who have mild scoliosis are monitored with X-rays, to see if the curve is worsening. Often, no treatment is necessary. In other cases, some children will need to wear a brace to stop the curve from worsening. Others may need surgery to keep the scoliosis from worsening and to straighten severe cases of scoliosis.

Because the nerves extending from the spinal cord travel to different parts of the body, people will experience different symptoms, depending on where in the spine the nerve compression occurs.

Cervical radiculopathy occurs when a nerve in the neck or upper back is compressed. The symptoms associated with cervical radiculopathy include:

  • pain in the neck, shoulder, upper back, or arm
  • weakness or numbness typically experienced on one side

Thoracic radiculopathy is when a person may experience pain in the chest and torso when the nerve compression or irritation occurs in the mid back region. Thoracic radiculopathy is an uncommon condition that may be misdiagnosed as shingles, heart, abdominal, or gallbladder complications. Symptoms associated with thoracic radiculopathy include:

  • burning or shooting pain in the rib, side, or abdomen
  • numbness and tingling

Lumbar radiculopathy is when a person may experience pain in the low back, legs, and hip region when the nerve compression or irritation occurs in the lower part of the back. Lumbar radiculopathy is also known as sciatica, and symptoms include pain and numbness in the low back, hips, buttock, leg, or foot. Symptoms are typically made worse with long periods of sitting or walking. In some cases, nerves affecting the bowel and bladder can become compressed, leading to bowel or bladder incontinence or loss of control. Other generalized symptoms of radiculopathy may include:

  • sharp pain starting in the back, extending to the foot
  • sharp pain with sitting or coughing
  • numbness or weakness in the leg and foot
  • numbness or tingling in the back or leg
  • sensation or reflex changes, hypersensitivity
  • pain in the arm or shoulder
  • worsening pain with movement of the neck or head

In addition to a physical exam and symptom review, doctors may diagnose radiculopathy using:

  • radiologic imaging with X-ray, MRI, and CT scans
  • electrical impulse testing called electromyography or EMG, to test nerve function

Typically, radiculopathy is treatable without surgery. Depending on the severity of the radiculopathy and other health conditions, doctors may recommend certain medications, including:

  • non-steroidal drugs, such as ibuprofen, aspirin or naproxen
  • oral corticosteroids or injectable steroids
  • narcotic pain medications
  • physical therapy
  • a soft cervical collar
  • ice and heat application

In some cases, doctors may recommend surgery to treat the cause of the nerve compression. Some surgical procedures include repair of a herniated disc, widening of the spinal canal space, removing a bone spur, or fusing the bones. Each case is unique, and surgical recommendations will be discussed in detail. The choices will depend on the cause of the radiculopathy, the overall health of the person, and other individual factors.

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