Scoliosis is a spinal deformity characterized by lateral curvatures of the spine AND rotation of the vertebral bodies of the spine. Low back pain is usually the initial symptom, if there is one. Often, patients will live decades before even knowing they have a scoliosis. Scoliosis is defined as either Functional or Structural.
Functional scoliosis can be due to malpositioning or unilateral paraspinal muscle spasm. With functional scoliosis, there is NO significant vertebral body rotation, and the curve is usually reversible, once the underlying posture or spasm is addressed.
Structural scoliosis, however, is NOT reversible; idiopathic scoliosis is the most common and accounts for 80% of structural scoliosis. The cause is unclear, but there appears to be a multifactorial etiology with a genetic predisposition.
Within idiopathic scoliosis, the adolescent presentation is the most common. This is the type usually picked up by a school nurse and diagnosed after age 11. It is 10x more prevalent in females and carries a high risk of curve progression.
Simple xrays taken in the doctor’s office help to establish diagnosis and prognosis. We will follow these with serial xrays taken over time depending on the patient’s age, skeletal maturity, and degree of curvature.
A measurement called the Cobb Angle is the standard tool to establish degree of curvature. This angle is what largely guides treatment. The ultimate goal of treatment is early diagnosis and to keep the curvature controlled during the growth spurt. During growth spurts, progressive curves can increase at the rate of 1 degree/month. Fortunately, though, studies have shown that the likelihood of curve progression during adult life is very small.
Typically, I will observe and follow curves 1-20 degrees and brace curves 20-40 degrees during a growth spurt. Fortunately, surgery is rarely indicated. A surgical consultation would be prudent, however, in the following cases:
- relentless progression
- curve > 40 degrees in skeletally immature
- curve > 50 degrees in skeletally mature
- neurologic or pulmonary compromise
- severe pain despite conservative care of medications, physical therapy, and injections
Written By Nathan Walters, M.D.
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