What are the other Names for this Condition? (Also known as/Synonyms)

• Curved Spine
• Scoliosis Deformity of Spine (Disorder)
• Spinal Curvature

What is Scoliosis? (Definition/Background Information)

• The backbone (spine or vertebral column) helps in holding the body upright and in performing a host of other functions, like walking, running, or playing
• Scoliosis is a common medical disorder characterized by abnormal curvature of the spine; a side to side spinal curve is observed. This disorder is caused by a defect that causes the spine (or the backbone) to bend or curve sideways, to look like an “S” or “C” instead of an “I”
• Even though (vertebral) bone malformations may be present in newborn infants at birth, Scoliosis may not develop until the child reaches adolescence (9-12 years)
• It is a hereditary condition, which means the disorder can be passed on through generations; the condition may run in the family
• Using diagnostic (radiological) imaging methods, the spinal curvature angle is calculated. If the curve angle (known as Cobb angle; measured by considering the ‘most-tilted’ top and bottom vertebra) is above 25-30 degrees, then the condition is termed as Scoliosis, requiring medical intervention. This angle is important in planning suitable treatment/management measures

There are several different types of Scoliosis, and the common types include:

• Congenital Scoliosis
• Infantile Scoliosis
• Juvenile Scoliosis
• Adolescent Idiopathic Scoliosis (Idiopathic Scoliosis in Children & Adolescents)
• Neuromuscular Scoliosis

Who gets Scoliosis? (Age and Sex Distribution)

• Scoliosis generally develops during childhood, although it may affect an individual at any age
• It is common among children between the ages 9-12 years
• Girls are much more affected then boys (in a 7:1 ratio) at a younger (adolescent) age. However, if Scoliosis develops during adulthood, then both sexes are equally affected

What are the Risk Factors for Scoliosis? (Predisposing Factors)

Each type of Scoliosis has its own set of risk factors. However, the common risk factors associated with most Scoliosis types are:

• Age: Children in the age group of 9-12 years (even up to15) have a high percentage of risk
• Gender: Though boys and girls can contract Scoliosis, girls are at a higher risk, than boys
• Heredity factors: Parents or close relatives with Scoliosis may pass on the condition to their children, or to subsequent generations

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Scoliosis? (Etiology)

The exact cause of Scoliosis is still not known in about 85% of the cases. Some of the possible causes in others, may include:

• Heredity: Scoliosis is hereditary and genetic factors are suspected
• Neuromuscular conditions like: Cerebral palsy (disorder involving the brain and nervous system functions) and muscular dystrophy (disorder causing muscle weakness and loss of muscle tissues)
• Improper or faulty growth of the vertebrae
• Fusing together of ribs during the early stages of growth
• Spina bifida: A medical disorder in which the backbones do not close (form) around the spinal cord, before birth
• Polio: A viral disease that affect the nerves
• Marfan’s disease: A genetic disorder of the connective tissues
• Down syndrome
• Spondylosis: Changes in spine caused by arthritis
• Abnormal bone spurs
• Vertebral compression
• Disc degeneration
• Spine tumors
• Any injury/trauma to the spine

Often, undetected cases of idiopathic Scoliosis (that occurred during childhood/adolescent phase) may develop/progress, with advancing age and the spine wears and tears. Other relatively infrequent adult Scoliosis causes include: Spine fractures, osteoporosis, spondylolisthesis (slipping forward of the vertebra), tumors, and infectious diseases.

What are the Signs and Symptoms of Scoliosis?

Scoliosis is characterized by the following signs and symptoms:

• Curving of the spine to one side
• Shoulders appear uneven; one of the shoulder blade is more prominent than the other
• Waist is uneven, hip positions appear different, shifted pelvis observed
• Protrusion of ribs on one side of the body
• Back pain
• Breathing difficulties
• Nerve response becomes slower
• Uneven arms, legs
• Extreme fatigue, after standing or sitting for a long time

How is Scoliosis Diagnosed?

The procedure for diagnosing Scoliosis involves:

• Examination of family medical history for occurrence of Scoliosis
• Physical examination: The healthcare provider will ask the patient to perform certain simple tasks, such as standing, sitting, bending forward, etc. which can reveal:
  • The degree of abnormality of the curve
  • The difference in shoulder heights
  • Tilted pelvis
• X-rays, which show the actual extent of the curve
• Spinal curve measurement test, also called as scoliometer screening
• MRI of the spine, in order to obtain more clear images of the bones and soft tissues
• CT scan; which when combined with x-rays, gives a more clearer picture
• Bone scan; performed by injecting a radioactive material into the injured bones
• A neurological test may also be conducted to check for:
  • Weakness of the muscle
  • Numbness
  • Any abnormality in the individual’s reflexes

Scoliosis severity based on measurement of angle/degree of curve:

• Mild: < 20 degrees
• Moderate Scoliosis: Between 25-70 degrees
• Severe Scoliosis: > 70 degrees (up to 100 degrees)
• Very Severe Scoliosis: > 100 degrees

Management of Scoliosis is based on its classification and the degree of spine curve ascertained using radiological studies:

• Mild Scoliosis may not require any treatment; close monitoring of the condition is sufficient
• Moderate Scoliosis may or may not cause serious health issues, but it merits treatment
• Severe Scoliosis may cause heart/lung complications and require intense management of the condition
• Very severe Scoliosis is rare and may cause severe complications of vital organs leading to increase in mortality rates

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Scoliosis?

Complications of Scoliosis could include:

• Lung damage: The rib cage might press against the lungs and affects its normal function, causing breathing difficulties and may also lead to lung infections (pneumonia)
• Heart damage: As a result of Scoliosis, the rib cages presses against the chest causing damage to the heart and its malfunction
• Back problems: Severe back pain is an end result of Scoliosis
• Height problems: An individual may not be able to attain his/her full height
• Appearance or self-image issues, due to prominent unevenness of the ribs hips and shoulders. This may cause deep and long-term emotional and psychological stress, in both children and adults; affecting their performance at school, college, work, and at social life

How is Scoliosis Treated?

• Children with mild curves do not require any treatment. However, mild Scoliosis will need regular check-ups with the healthcare providers at regular intervals, every 4-6 months
• In the case of mild Scoliosis where the child’s bones are still growing, the doctor may recommend a padded brace to stop further curve progression. These are of two types:
  • Underarm, or low profile brace
  • Milwaukee brace
• In severe cases of Scoliosis, surgery may be recommended. The most common type of surgery is spinal fusion, where two or more bones in the vertebrae are joined together. Metal rods, hooks, screws, and wires, hold the bones in an upright position. Surgery is only recommended after the bones have stopped growing
• For children, who suffer a rapid progression of the curve, while the bones are still in the process of growth, the doctor may attach a growing rod that adjusts itself according to the child’s growth. This rod is attached to the top and bottom sections of the curved spine and its length is increased every six months

The treatment measures for adults with Scoliosis are slightly different from those of children/juveniles. Treatment is meant to prevent worsening of the condition, remove pain, restore function, and rectify the spinal curvature.

How can Scoliosis be Prevented?

Prevention of Scoliosis is not possible (mainly if it is caused due to unknown reasons); the treatment aims to mainly reduce progression of the curve.

What is the Prognosis of Scoliosis? (Outcomes/Resolutions)

• Early detection will lead to proper treatment at the right time and prevent further complications
• Individuals with Scoliosis can lead a normal, productive life with proper treatment
• A severe degree of spinal curve (or a rapidly progressing curve), an asymmetrical ribcage with additional complications affecting vital organs (lungs, heart), are all factors that require a higher intensity of treatment

Additional and Relevant Useful Information for Scoliosis:

The term Scoliosis is derived from the Greek word ‘skol’, meaning “twists and turns” and it refers to a sideways curve in the spine, which is either to the right or to the left.

The age group classification for Scoliosis is as given:

• Infantile – 3 years and younger
• Juvenile – Between the ages 4 and 9 years
• Adolescent – 10 to 15 years old (teenage)