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Idiopathic Scoliosis in Children and Adults: Your Questions Answered

Scoliosis is a broad medical term comprising a group of similar conditions in which the shape and position of your spine, thorax, or trunk is altered. Read on for more info on how idiopathic scoliosis affects your body, along with various options for addressing the problem. 

Ordinarily, the spine in your neck (i.e., cervical spine) has a slight inward curvature known as a lordotic curve. Your upper-to-mid back (i.e., thoracic spine) curves slightly outward in a kyphotic curve. Lastly, your lower back (i.e., lumbar spine) also features a lordotic curve.

A healthy spine shows 0 degrees of spinal curvature from side to side. When viewed from behind, it should run straight down the middle of your back. In medical imaging, scoliosis appears as side-to-side spinal curves, resembling a “C” or “S” shape. A curvature of greater than 10 degrees is classified as scoliosis.

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Scoliosis is capable of causing internal respiratory issues, due to rib deformity or visible external deformity. Resulting emotional distress is another common complication.

Scoliosis is categorized as congenital, neuromuscular, or idiopathic. The congenital variety is present at birth, while neuromuscular scoliosis is brought on by muscular dystrophy, cerebral palsy, or spina bifida. However, more than 80 percent of adolescent scoliosis conditions are idiopathic, meaning their cause is indeterminate.

Idiopathic scoliosis may be further classified by age of onset. Infantile scoliosis appears between birth and 2 years of age, juvenile scoliosis develops between 3 and 9 years, and adolescent scoliosis occurs at 10 years or older.

This issue tends to present itself during growth spurts: the first months of life, between 6 and 24 months, 5 to 10 years, and during puberty. Typically, adolescent idiopathic scoliosis appears somewhere between 10 and 18 years. Though its prevalence is similar in males and females, the latter are up to 10 times more likely to have significant curve progression.

Juvenile curvature that reaches 30 degrees requires treatment, or it is likely to worsen.

As children age, their curvature usually slows progression. However, some curves, especially when greater than 50 degrees, continue to progress well into adulthood. Juvenile curvature that reaches 30 degrees requires treatment, or it is likely to worsen.

Note, many adolescents do not exhibit visible external deformities. However, if they do, it could manifest in the following ways:

  • Rib hump

The most common sign of scoliosis looks like a hump on your back or ribs.

  • Shoulder height asymmetry

One shoulder sits higher than the other when you’re standing in a neutral position.

  • Torso lean

It’s a shift of your body to the right or left. The torso lean is particularly prevalent when there’s a single “C” curve in the thoracic or lumbar region of your spine. It lacks a second balancing curve, failing to form a full “S” shape.

Adult idiopathic scoliosis is a continuation, or poorly treated case, of adolescent idiopathic scoliosis. It might increase as much as 0.5 to 2 degrees per year. Because severe curves (greater than 50 degrees) are capable of worsening in adulthood, they must be closely monitored by a health care provider.

Adult idiopathic scoliosis is a continuation, or poorly treated case, of adolescent idiopathic scoliosis. It might increase as much as 0.5 to 2 degrees per year.

It occurs in the same locations as juvenile or adolescent idiopathic scoliosis. Age-related disc degeneration, narrowing of your spinal sac, and arthritis trigger more pronounced deformities and stronger symptoms like:

  • Lower back pain and stiffness (most common)
  • Numbness, cramping, shooting pain (due to pinched spinal nerves)
  • Fatigue (the result of lower back and leg muscle strain)

The exact reasons behind idiopathic scoliosis remain unknown. The Scoliosis Research Society reports that approximately 30 percent of idiopathic scoliosis patients have some family history, but no specific genetic connection has been identified.

It’s suspected there are many different genes involved in the onset of idiopathic scoliosis. While some contribute to its initial development, others affect the severity and progression of the curvature.

Various methods of screening and diagnosis of idiopathic scoliosis exist for both adolescents and adults.

  • Postural screening exam

Your doctor assesses your posture, looking for midline orientation and body symmetry. Scoliosis assessments at school are frequently performed, as experts recommend early screening and detection.

  • Spine exam

It’s conducted via the “Adams forward bend test,” using an inclinometer or scoliometer to measure and understand asymmetry of the torso. These measurements determine if additional imaging is required. Ligament laxity and neurologic responses will also be assessed.

  • Standing X-ray

This is used to confirm a scoliosis diagnosis with the Cobb Method. Your doctor views x-rays to examine the severity of the curve. Lateral radiograph images are also helpful for diagnosing thoracic kyphosis (or round back) and lumbar lordosis (or swayback).

  • Magnetic resonance imagining (MRI)

In rare cases, MRIs may be utilized for complaints of leg pain or neurological abnormalities.

Optimal results are achieved when you have a team of providers monitoring treatments and educating you on idiopathic scoliosis. The team is usually composed of a primary provider, a physiotherapist, an orthotist, and possibly, a psychologist.

Conservative treatments

  • Observation

This is usually the first step for patients who are still growing or exhibit curves less than 45 degrees. Evaluation occurs anywhere from every 3 months to every 3 to 4 years.

  • Physiotherapeutic scoliosis-specific exercises (PSSE)

These depend on the character of your curvature. Frequency of sessions ranges from once a day to once or twice a week.

  • Special inpatient rehabilitation (SIR)

Based on your doctor’s recommendation, you could spend a few weeks in a special facility where hours of PSSE are practiced daily.

  • Bracing

Evidence for the effectiveness of bracing is limited, but ideally, it may halt or slow curve progression and eliminate the need for spinal fusion therapy.

  • Nerve blocks and epidurals

Intended only for adults, these options offer temporary relief for persistent leg pain and pinched nerves.

Alternative treatments

Some patients report benefiting from alternative treatments like chiropractic care and yoga practice. However, there is currently no scientific evidence to back these practices and they may or may not be included in your care plan.

Surgery

Unless the idiopathic scoliosis curvature is greater than 45 degrees, surgery isn’t generally recommended for adolescents. Fusion surgery attaches metal implants to the spine, using rods to hold it in its anatomically correct position. Eventually, the implanted segments fuse like bone.

Unless the idiopathic scoliosis curvature is greater than 45 degrees, surgery isn’t generally recommended for adolescents.

Adult scoliosis surgery is considered a last resort, when all other methods have been exhausted or scoliosis complications prove debilitating. The goal is to relieve nerve pressure, reduce pain, restore balance, and stabilize spinal segments. Surgical procedures could include:

  • Microdecompression

It alleviates pressure on your spinal nerves.

  • Surgical stabilization

Using anchor hooks, screws, and wires, spinal segments will be stabilized until proper fusion occurs.

  • Fusion

Your surgeon relies on either your own bone (or synthetic bone) to adjust the spine into a straighter position.

  • Osteotomy

It involves removing spinal segments and realigning them.

  • Vertebral column resection 

Entire vertebral sections are removed and your spine is realigned. This type of surgery is only performed after other corrective measures have failed.

Idiopathic scoliosis is a frustrating condition that could inhibit growth and activity at an early age. Not every case requires significant medical intervention, and it’s important to talk to a medical professional about managing idiopathic scoliosis. With proper care, you can still achieve an optimal level of wellness.

https://www.srs.org/patients-and-families/conditions-and-treatments/adolescents

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5795289/

https://www.srs.org/patients-and-families/conditions-and-treatments/parents/scoliosis

https://www.aafp.org/afp/2014/0201/p193.html

https://www.srs.org/patients-and-families/conditions-and-treatments/parents/scoliosis/adolescent-idiopathic-scoliosis

https://ghr.nlm.nih.gov/condition/adolescent-idiopathic-scoliosis#inheritance

https://www.srs.org/patients-and-families/conditions-and-treatments/adults/scoliosis

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