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What is Scoliosis?
We all have curves in our spines, but scoliosis causes the spine to curve in the wrong direction. It causes sideways curves, and those are different from the spine's normal curves.
If you were to look at your spine from the side, you'd see that it curves out at your neck (cervical spine), in at your mid-back (thoracic spine), and out again at your low back (lumbar spine). Your back is supposed to have those curves.
However, if you look at your spine from behind, you shouldn't see any curves at all. When there are sideways curves in the spine from this view, that's scoliosis. The curves can look like an "S" or a "C." (You can learn more about spinal anatomy related to scoliosis in the anatomy section below.)
Scoliosis is generally associated with children (you may hear it calleed adolescent idiopathic scoliosis), but adults can have it, too. This typically happens when scoliosis is not detected during childhood or the disease progresses aggressively.
Scoliosis also brings up images of braces and perhaps memories of being tested for it in grade school by the school nurse. Bracing is one of the most common treatment options for scoliosis—a way to try to fix the curve without spine surgery.
Sometimes, though, the curve is too extreme and bracing doesn't help enough. In that case, you can have surgery to correct the curve. For children especially, it can be frightening to learn that they have scoliosis. Having that label makes them different at a time in their lives when they don't want to be all that different. They might not like the idea of wearing a brace, either.
But scoliosis is nothing to be scared or ashamed of. With the proper treatment, scoliosis doesn't have to define your life.
To understand scoliosis, which causes the spine to curve to the left or right, you first need to understand what a normal spine looks like. There are 4 regions in your spine:
- Cervical Spine: This is your neck, which begins at the base of your skull. It contains 7 small bones (vertebrae), which doctors label C1 to C7 (the "C" means cervical). The numbers 1 to 7 indicate the level of the vertebrae. C1 is closest to the skull, while C7 is closest to the chest.
- Thoracic Spine: Your mid-back has 12 vertebrae that are labeled T1 to T12 (the "T" means thoracic). Vertebrae in your thoracic spine connect to your ribs, making this part of your spine relatively stiff and stable. Your thoracic spine doesn't move as much as the other regions of your spine, like the cervical spine.
- Lumbar Spine: In your low back, you have 5 vertebrae that are labeled L1 to L5 (the "L" means lumbar). These vertebrae are your largest and strongest vertebrae, responsible for carrying a lot of your body's weight. The lumbar vertebrae are also your last "true" vertebrae; down from this region, your vertebrae are fused. In fact, L5 may even be fused with part of your sacrum.
- Sacrum and Coccyx: The sacrum has 5 vertebrae that usually fuse by adulthood to form 1 bone; the coccyx—most commonly known as your tail bone—has 4 (but sometimes 5) fused vertebrae.
Normal Spinal Curves: Lordosis and Kyphosis
When viewed from the side, you'll see that the spine has both inward and outward curves. These curves help our back carry our weight and are also important for flexibility.
There are 2 types of normal curves in your spine: kyphosis and lordosis. You can see those from the side view. Kyphosis means the spine curves inward; lordosis means the spine curves outward.
There are 2 kyphotic and 2 lordotic spinal curves in a normal spine. Your neck (cervical spine) and low back (lumbar spine) have a lordotic curve. Your mid back (thoracic spine) and pelvis (sacrum) have a kyphotic curve.
As you can probably tell from the basic curves of the spine, it's a complex structure. When you develop abnormal curves in the spine—scoliosis—there are many parts that are affected.
What causes scoliosis?
Because there are different types of scoliosis, there are different causes. The types of scoliosis are:
- Idiopathic Scoliosis: This is the most common type. 80% of scoliosis cases are idiopathic, which means "occurring without known cause."
- Congenital Scoliosis: With congenital scoliosis, there is a malformation of the spine in utero, so a child is born with this type of scoliosis.
- Neuromuscular Scoliosis: Children with a neurological system disorder, like muscular dystrophy, can develop neuromuscular scoliosis. Because they have a weak trunk and can't support the weight of their body, the spine starts to curve, generally into a long, C-shaped curve.
- Adult or Degenerative Scoliosis: Sometimes, scoliosis goes unnoticed-or untreated-during childhood. In that case, the scoliosis can cause problems later in adult life. Degenerative, or age-related, changes to the spine can also cause scoliosis in adults. Osteoporosis, disc degeneration, a spinal compression fracture, or a combination of these problems can contribute to the development of adult scoliosis.
Can adults have scoliosis?
Although scoliosis is most commonly associated with children, adults can develop it, too. In some cases, they have actually had it their whole lives, but it has gone unnoticed or untreated until it started to cause pain or other problems. In other cases, age-related changes in the spine, such as disc degeneration, lead to scoliosis.
Read more about adult scoliosis in our article that covers causes, diagnosis, treatments, and recovery.
What are some non-surgical ways to deal with scoliosis?
For children with scoliosis, there are two main non-surgical options: observation of the curve and bracing.
The doctor will develop a treatment plan that considers the patient's age, number of growing years that remain, curve pattern, curve size, likely rate of curve progression, and appearance. He or she will then recommend observation or bracing.
Most young patients with idiopathic scoliosis will see their doctor every 3 to 4 months so that the doctor can monitor if the curve is getting worse.
Bracing is the usual treatment for adolescents with curves greater than 20° and at least 2 years of growth remaining. Bracing is used to slow or stop the curve from getting larger and to improve spinal deformity.
Learn more about spinal bracing for scoliosis in children.
For adults with scoliosis, the non-surgical treatment options are slightly different. Because bracing won't help stop the curve in adults and because it usually doesn't control pain, adults generally do not have to wear braces. Instead, they can try moist heat, medication for inflammation and pain, and exercise.
What are the surgical options for scoliosis?
Doctors recommend surgery for children if they have progressive scoliotic curves greater than 40°. The goal of spine surgery for scoliosis is to stop the curve from getting worse, restore the spine to a more normal alignment and appearance, and also to address any back pain or heart or lung function problems caused by the scoliosis.
For scoliosis, spinal fusion using spinal instrumentation is the most common surgical procedure. Using a combination of rods, hooks, cables, screws, and cages, the surgeon very carefully moves the spine back into a more normal alignment. Then the surgeon puts in a bone graft (usually using bone from the patient's body) or a biological substance (which will stimulate bone growth) to help the bones in the spine fuse together over time.
Adults with scoliosis may also have surgery, but it will be for different reasons. Unlike scoliosis surgery for children, correcting the curve isn't the most important goal of surgery. Instead, trying to stop the curve from getting worse later is the main goal.
We have an article just on scoliosis surgery.