Full Description of Scoliosis

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The spine is a curved structure. This helps with weight-bearing, balance and shock absorption. Scoliosis is a three-dimensional, abnormal curvature of the spine often affecting the thoracic and lumbar spinal regions. Scoliosis may be present during adolescence or as an adult. Adult scoliosis is most commonly due to degeneration of joints in the spine. The cause of adolescent scoliosis is not completely known. Symptoms of scoliosis may include uneven shoulders and/or hip and a prominence of one shoulder blade over the other, and protruding ribs. Advanced scoliosis can cause back pain and difficulty breathing.

Screening and Diagnosis for Scoliosis

The diagnosis of scoliosis may be made by your child’s school nurse. The nurse generally uses the Adam’s Forward Bending Test, which has the child bending forward at the waist and reaching his or her arms straight outward. Abnormalities such as a protruding rib or an abnormally shaped back may be seen. Scoliosis can also be diagnosed during routine pediatric exams. The physician will examine the spine, hips, shoulders and legs to assess for signs of scoliosis. If scoliosis is suspected, X-rays may be ordered to confirm the diagnosis and determine the severity of the spinal curvature. A child’s scoliosis is determined by the shape, size, direction, location and angle of the curve.

Adult scoliosis is often diagnosed with X-rays taken during a search for the cause of back or leg pain. Scoliosis may also be diagnosed when an X-ray is taken for an unrelated issue and the radiologist notices the scoliosis on the X-ray.

Treatments for Scoliosis

For children, treatment options for scoliosis are based on age, gender and  the location and severity of the curve. The curvature is monitored closely and, if necessary, managed with bracing. Bracing does not cure scoliosis, but it may impede further progression of the curve. If the curve advances despite conservative measures or the measurement of the curve is greater than 40° to 50°, surgical correction is often considered.

With adult scoliosis, treatment planning is generally based on severity of pain and functional limits. Because of the malalignment of the spine, pain may arise from the facet joints, sacroiliac joints or nerve root compression. The pain from these conditions is managed with physical therapy, medication, facet injections, sacroiliac joint injections or epidural steroid injections. If pain persists or physical function is significantly limited, surgery may be considered. Posterior lumbar fusion (PLF), combined with pedicle screws and rods, is used to re-align the spine. Sometimes, anterior lumbar interbody fusion (ALIF) is also done to create a 360° fusion (fusing the front and back portions of the spine). It is important to discuss treatment options with your doctor in deciding which treatment, if any, may be best for you.