Scoliosis | Causes and Risk Factors

Scoliosis is an abnormal sideways curvature of the spine that occurs most often during the growth spurt just before puberty. Understanding the various causes of scoliosis can help with early detection and management of this complex condition.

This guide will cover the different types, main causes, diagnosis, treatment, and prognosis for scoliosis to serve as a comprehensive resource for those wanting to learn more.

Types of Scoliosis

According to research, scoliosis can develop at any age and is categorized into different types depending on the age of onset or underlying cause.

By Age of Onset

Infantile Scoliosis

Infantile scoliosis emerges in children under 3 years old and may be due to birth defects affecting spinal vertebrae development. Curvature tends to worsen as the child grows, often requiring early intervention with bracing or surgery.

Juvenile Scoliosis

Juvenile scoliosis occurs between ages 4-9, often progressing around growth spurts. Though the cause is usually unknown, growth hormone imbalances or connective tissue abnormalities may play a role. Careful monitoring is needed given risk of progression.

Adolescent Scoliosis

Adolescent scoliosis represents about 80% of cases, arising in pre-teens and teens when rapid growth occurs in bones, muscles, ligaments. Though reasons are unclear, girls progress more often to severe curves. Screening & prompt treatment are key.

Adult Scoliosis

Adult scoliosis either persists from youth or emerges after skeletal maturity, frequently from age-related degeneration. Pain usually develops, sometimes with spine misalignment, pinched nerves, osteoarthritis.

By Underlying Cause

Idiopathic Scoliosis

When no distinct cause is found after diagnosis, it is deemed “idiopathic”, meaning arising spontaneously. Up to 80% of cases in adolescents are idiopathic, suspected from combo of genetic risks, hormonal changes, muscle imbalances.

Congenital Scoliosis

Present at birth, congenital scoliosis results when spinal vertebrae fail to segment or develop correctly in the womb. Curves from these osseous defects tend to rigidly progress without treatment.

Neuromuscular Scoliosis

Any medical issue compromising muscular strength & coordination − cerebral palsy, muscular dystrophy, spinal cord trauma − can trigger neuromuscular scoliosis. Severe curves lead to posture/breathing issues.

Degenerative Scoliosis

Later in adulthood, wear & tear on spine from aging or arthritis may spark degenerative scoliosis. Bone spurs and slipped discs promote asymmetrical instability with back pain, radiculopathy.

Main Causes and Risk Factors

Since over 80% of scoliosis is idiopathic with complex, unclear origins, researchers have proposed various theories about contributing factors, some with more evidence than others:

Genetic and Hormonal Causes

Numerous genes likely confer vulnerability for idiopathic scoliosis through effects on skeletal growth, bone density, metabolism. Female hormones may also facilitate progression. About 25% of cases are familial.

Musculoskeletal Abnormalities

Asymmetrical weakness of back muscles or differences in leg length are controversially thought to spur some cases of scoliosis. Scant evidence on whole.

Neurological Issues

While brain and spinal cord anomalies clearly instigate neuromuscular scoliosis, their relevance to other forms is debated. Theories like impaired proprioception or vestibular dysfunction lack solid proof.

Connective Tissue Disorders

Research finds higher rates of scoliosis with Marfan syndrome, Ehlers-Danlos syndrome and other disorders impacting collagen integrity − potentially from effects on skeletal development.

Skeletal Growth Problems

How growth plate disturbances or osteoporosis might promote spinal asymmetry lacks verification. But theory holds that bone deficits could enable deforming muscle forces during development.

Environmental Factors

No scientific link found between scoliosis and carrying heavy bags/sports trauma/diet. But data argues certain nutrient deficiencies may very modestly affect progression.

Risk Factors

Beyond a possible genetic predisposition, progression risk escalates with being female, having larger curves at younger age, and/or significant growth remaining during puberty. Up to 20% of adolescents with infantile or juvenile onset see worsening.

Diagnosis and Testing

Multiple exam components aid scoliosis evaluation – from clinical screening to advanced imaging:

Physical Exam

Doctors visually inspect spine alignment in different positions, check for shoulder/hip/rib asymmetry. Use of a scoliometer quantifies rotational deformity.

Imaging Tests

X-rays measure spinal curvature in degrees – the gold standard for scoliosis diagnosis. If nerve issues are suspected, CT myelograms, ultrasounds and MRIs provide further data.

Additional Diagnostic Tests

Pulmonary testing, EMG studies gauge impacts/complications in mod-severe cases. Genetic panels aim to uncover associated disorders or anomalies.

Treatment and Management

Mild to moderate scoliosis often needs only conservative treatment – via vigilant monitoring, physiotherapy, bracing, medication, etc.

Observation

For adolescent patients with curves under 25°, routine clinical check-ups plus X-rays as needed suffice to track changes.

Braces

Custom external braces are standard for progressive 25° to 40° curves in youth still growing; worn to deter worsening. Varies from 12-23 hours daily depending on device.

Surgery

Surgery like spinal fusion aims to stabilize spine progression in cases exceeding 40°-50° before adulthood or failing to improve from bracing.

Physical Therapy and Exercise

Special core & postural exercises, inversion therapy, yoga build supportive strength. Traction devices provide home stretching. Helps sustain flexibility & function.

Other and Alternative Therapies

Options like chiropractic and osteopathic manipulation, electrical muscle stim, acupuncture may assist chronic muscle/nerve irritation and pain symptoms. But clinical effectiveness is debatable.

Outlook and Progression

In adolescents, right-sided curvatures tend to progress more while double curves often prove most severe. Without intervention, boys likely see better outcomes than girls. Still, precise prognosis remains challenging, making consistent follow-up essential – through maturity until skeletal stabilization.

Careful diagnosis, periodic observation, bracing when indicated, and potential surgery for rigid large curves represents the mainstay of management in younger patients prior to growth completion – along with therapies for pain or complications after skeletal maturity. Ongoing research continues investigating pathogenesis and connected disorders to improve prevention, treatments and functionality for those affected by scoliosis. With comprehensive care, positive outcomes and quality of life are quite achievable for most patients.