Scoliosis | Definition and Types

Scoliosis is defined as an abnormal sideways curvature of the spine. Instead of being straight when viewed from behind, a spine with scoliosis is shaped like an “S” or a “C”, with the upper back typically bending to one side. Scoliosis is actually a relatively common spinal condition, usually first developing in adolescence, and more often affecting girls.

Types of Scoliosis

There are a few ways to categorize the different types of scoliosis. First, there are three main causes – idiopathic, congenital, and neuromuscular. Scoliosis can also be described by the region of the spine that is affected.

By Cause

Idiopathic Scoliosis

Idiopathic scoliosis is the most common type, accounting for about 80% of cases. As the name suggests, the cause is unknown. There are three subtypes of idiopathic scoliosis, named after the age groups affected:

• Infantile – develops in children 3 years or younger
• Juvenile – develops in children ages 4-10 years
• Adolescent – develops in children 10 years or older, around the onset of puberty

Adolescent idiopathic scoliosis is the most frequently seen subtype. It tends to worsen during growth spurts in puberty which is why early detection and monitoring adolescence is so important.

Congenital Scoliosis

In congenital scoliosis, the abnormal spinal curvature is present right from birth and is caused by vertebrae that have formed incorrectly during development in utero. The malformed vertebrae obstruct normal spine growth, leading to worsening scoliosis later in childhood. Congenital scoliosis often requires early treatment to prevent complications.

Neuromuscular Scoliosis

Neuromuscular scoliosis develops secondary to disorders that affect muscle control and coordination, including:

• Cerebral palsy
• Spina bifida
• Muscular dystrophy
• Polio
• Spinal cord trauma or tumors

In neuromuscular conditions, the muscles around the spine become unbalanced, which allows scoliosis to progress more rapidly.

By Spine Region

Scoliosis can also be described based on the region of the spine affected. The three main anatomical regions are:

• Cervical scoliosis – abnormal curvature in the cervical (neck) section of the spine
• Thoracic scoliosis – abnormal curvature in the thoracic (mid/upper) section
• Lumbar scoliosis – abnormal curvature in the lower back

Both thoracic and lumbar scoliosis are more common types of scoliosis.

Symptoms and Diagnosis

Many children and teens with mild scoliosis do not experience any symptoms initially. Some signs to look out for include:

• Uneven shoulder heights
• Head not centered over pelvis
• Leaning of the body to one side
• Back pain may develop in moderate-severe cases

Screening and Diagnostic Tests

A simple bend test called the Adam’s forward bend test is often used as an initial screening tool for scoliosis. It involves having the child bend forward at the waist with feet together and knees straight, while letting the arms dangle freely. From this bent position, asymmetry along the spine or ribs might become more apparent.

If an abnormality is suspected, imaging tests are necessary to evaluate the spinal curvature and determine treatment options:

• X-rays – Used to view the alignment of vertebrae and outline the spine curves
• MRI – Creates 3D images of the spinal tissues and structures
• CT scan – Provides detailed visualization of spinal bones

Once imaging is obtained, the scoliosis curve is measured using a technique called the Cobb angle. This measurement is key for classifying the severity of scoliosis and guiding treatment.

Treatment Options for Scoliosis

There are a range of treatment options available for managing scoliosis, spanning observation, bracing, therapy, and surgery. The approach depends on multiple factors including the age of diagnosis, rate of progression, curve location, and degree of curvature.

Observation

In mild cases with a spinal curve less than 20 degrees and especially when skeletal growth is completed, cautious observation may the best option. Follow-up physical exams and x-rays every 4-6 months monitors for any worsening of the curve over time.

Bracing

The goal of bracing is to prevent further curvature progression. Braces are typically used for children with curves measuring 25-40 degrees, when substantial growth is still expected.

Wearing braces for the recommended hours is crucial for slowing curve progression, but can be challenging for children to adhere to fully. Close follow-up and emotional support helps maintain compliance.

Surgery

Surgery is generally recommended for curves over 50 degrees or situations when bracing has failed and the deformity continues to worsen. The main surgical approach is a spinal fusion – permanently joining vertebrae together within the curve region. Metal instrumentation like rods and screws are also implanted to stabilize the spine and prevent further rotation long-term after bones fuse.

While spinal fusion stops future curve progression, it also limits flexibility and mobility due to the joined vertebral segment. Modern surgical techniques aim to fuse as few levels as possible for a adequate curve correction. Alternative newer procedures like vertebral stapling/tethering also show promise for controlling curve progression without fusion.

Outcomes and Prognosis

The outlook for scoliosis varies widely and is closely tied to early detection. Children treated in adolescence generally have good outcomes and normal, active lives after bracing or surgery. Severe scoliosis can risk more adverse effects like chronic back pain and reduced lung/heart functioning, but even then treatment aims to limit long-term disabilities. Some key points regarding prognosis:

• Mild cases (less than 30 degree curves) can often just be monitored without treatment
• Braces successfully halt curve progression in 80% of children who wear them consistently
• Modern surgical techniques maintain spine flexibility and mobility better than decades prior
• Care from pediatric specialists and therapy/rehab guides recovery for kids after procedures

With a range of available treatment options and focused care from scoliosis experts, the majority of affected children can go on to thrive developmentally after management of their spinal curvature.