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What is Scoliosis? Causes, Symptoms and Treatment Methods

Table of Contents

What is scoliosis?

Scoliosis implies abnormal side curvature of a group of vertebrae by more than 10 degrees along with a rotation relative to the anatomic mid-line position. Idiopathic scoliosis is a structural deformity, but not a posture disorder, and it accounts for 80% of all scoliosis cases. The most common form, the “Adolescent Idiopathic Scoliosis”, develops before the puberty; the direction of abnormal curvature is right at thoracic level and left at lumbar level; it is more common in girls.

In fact, scoliosis does no progress beyond a certain curvature and does not require any treatment in a large part of the cases. However, the quick increase in height affects the scoliosis seriously in other cases and treatment is required. For this group of patients who are considered to progress into serious problems, corset can be used to prevent the progression and it may really help approximately one third of those patients. Surgery is considered to prevent the progression and correct the deformity in scoliosis that is deemed beyond the critical degree, but age of the patient and progression risks are also taken into consideration. Surgery is recommended especially for lumbar scoliosis above 40 degrees and thoracic scoliosis above 50 degrees.

Radiography is the basic modality to treat the patient and evaluate the patient in the follow-up. Routine roentgenograms should be scanned on AP and lateral views while standing still. Radiology images should be acquired in traction and while bending forward following the initial roentgenograms scanned in standing position for diagnosis, if conservative or surgical treatment is indicated; flexibility of the curvature can be evaluated on hyperextension roentgenograms, if the kyphosis increases. CT or MRI is indicated especially for advanced-stage scoliosis for which congenital scoliosis and cord compression are considered and for patients with atypical thoracolumbar and lumbar scoliosis.

The surgery should be dictated by severity of the curvature, balance of the curvature, its rotation, extent of the hump in ribs and inclinations on the sagittal contour. The widely accepted indications of surgical treatment include the curvatures with an angle above 45 degrees, the progression that cannot be controlled with conservative treatment, the curvatures leading to balance problems and serious back and low back pain or significant pulmonary and psychological effects of the deformity on the patient.

No treatment is required in a large of the patients diagnosed with idiopathic scoliosis. Treatment is indicated for patients with risk of progression in scoliotic curvatures and with severe curvature when the condition is diagnosed. The treatment aims to prevent progression of the deformity, correct the deformity and maintain the positive effects of the correction. Growth potential of the adolescent, severity of the curvature at the diagnosis and location and pattern of scoliosis should be considered in the treatment selection. At the decision-making phase, the social factors should also be taken into consideration that may affect the cosmetic appearance and the treatment outcomes.

Although many treatment methods have been developed throughout the history of scoliosis, the treatment method performed in spinal surgery centers involve correction of the curvature with pedicle screws and rods at all levels and the bone fusion.

Frequently Asked Questions About Scoliosis

Does Adolescent Idiopathic Scoliosis cause back or low back pain?

Scoliosis does not cause pain in most adolescents with scoliosis. However, presence of pain should be attached importance in this age range and probable causes should be investigated and eliminated.

Is scoliosis or kyphosis a genetic disorder? If I or my spouse has scoliosis, does it imply that my children will also have the same condition?

It is believed that genetic factors contribute to development of scoliosis. However, a hereditary pattern has not been clearly revealed out for scoliosis. Even if genetic predisposition is a factor, it is not the only causative component in development of scoliosis. If the family history is positive for scoliosis, the children should be closely followed up in quick growth periods and we also recommend a visit to a spine surgeon, if possible.

How can I prevent development of scoliosis in my child?

Unfortunately, there is no preventive method.

What is adolescent idiopathic scoliosis?

It is not a posture disorder and it should absolutely be taken seriously. First, it is not very likely that scoliosis affects the overall health of patients. Scoliosis stops progression at a certain degree and does not require treatment in most of the cases; in this case, patients feel no adverse effect on their lives. The quick increase in height affects the scoliosis seriously in other cases and treatment is required. For patients who are diagnosed at an early stage, but considered to progress into a more serious condition, a corset is usually used to prevent the progression and this approach may be really effective in approximately one third of the children. Surgery is considered to prevent the progression and correct the deformity in scoliosis that is deemed beyond the critical degree. Surgery is recommended especially for lumbar scoliosis above 40 degrees and thoracic scoliosis above 50 degrees.

May scoliosis threaten the life by leading to lung or heart problems?

An honest answer should be “This may be correct rarely”. In fact, this does not apply to the scoliosis that is commonly faced. However, maturation of lungs is negatively influenced especially in congenital scoliosis, as the structural curvature occurs in very young ages; on the other hand, it progresses very substantially (above 100 degrees) especially in growth period and it may cause serious problems for lungs and heart.

Do heavy school bags lead to scoliosis?

No; carrying heavy school bags in back or always in same shoulder does not affect the scoliosis. However, we advise to avoid school bags that weigh more than 10% of the children’s body weight in order to prevent low back pain.

Why do scoliosis degrees differ when measured by different people?

Even if the degree is measured by experienced healthcare professionals, there may be 3- to 5-degree difference between surgeons due to millimetric changes in reference points. Same difference also applies to measurements made by same person in different times; it is an expected result. However, a second medical opinion will be rational if such differences are beyond the above mentioned degrees.

Does corset completely correct the scoliosis and eliminate the sideways curvature of the spine?

There are first-degree evidence based studies on benefits of wearing corset in treatment of scoliosis. However, it should not be expected that wearing a corset corrects the spine completely.

What is SpineCore corset? Is this corset superior to others?

The SpineCore corset may have an advantage of easier use than other corsets. However, there is no a scientific data based on first-degree evidence that it is curative for scoliosis or that it corrects the scoliosis more successfully than other corsets.

Is it correct that incidence of scoliosis increased recently? If yes, what is the reason?

Incidence of scoliosis is 1% to 3 percent. In fact, incidence of scoliosis did not increase in recent years. However, awareness on the scoliosis increased in the general population and the families act in a more informed manner. This leads to an impression of a relative increase in number of patients with scoliosis.

What can be done to prevent scoliosis?

Since the exact cause of the adolescent scoliosis – the most common form of the scoliosis – is not known, the preventive means are not known either. Therefore, there is no definitive means to prevent development of scoliosis. On the other hand, daughters of families with history of scoliosis should be very carefully followed up especially before the adolescence.

Does pregnancy aggravate the scoliosis?

Association of pregnancy with scoliosis is very commonly questioned, as scoliosis is common in girls. Results of various studies demonstrate that pregnancy does not cause a serious increase regarding the scoliosis.

My child is diagnosed with scoliosis and surgery is recommended. When can he/she go back to school again?

Advancement of implant systems and techniques used in scoliosis surgery has shortened the recovery period in our patients. Patients with adolescent idiopathic scoliosis may go back to school approximately three weeks after the surgery. However, physical activities should be limited in this period.

Scoliosis is detected in my daughter. May it develop in my other child?

Unfortunately, the answer is partially “Yes”. The risk of scoliosis is higher in sisters of a daughter with scoliosis relative to the general population. Although it is not a certain rule, it requires being careful and to be followed up.

Scoliosis is detected in my daughter. Are we late?

Parents are mostly uneasy as they believe that they are responsible for this condition or that they had done something wrong or incomplete. Many studies have been conducted and many theories have been suggested on the underlying cause of this condition, but none of them could be clearly proven. Since the etiology of the disease is not known, the triggering factors in growth period cannot be exactly demonstrated. Therefore, it is not possible for parents to have a direct effect on this process.

Is it necessary to operate on each scoliosis?

Besides the cases written in detail above, decision and correct time of the surgery should be based on expectations and decision of the patient and/or the family. In fact, scoliosis surgery is a cosmetic procedure for most of the case. If the disease does not lead to a cosmetic problem, it is not necessary to operate on the condition immediately or soon after it is diagnosed.

Which conditions may lead to serious problems in scoliosis?

Young-onset scoliosis (as there is a long growth period ahead); quickly progressing scoliosis (the critical threshold can be reached at younger ages or due to various underlying causes); the curvatures above 50 degrees in thoracic scoliosis and above 40 degrees in lumbar scoliosis irrespective of the age (due to lifelong progression risk or cosmetic reasons); the curvatures above 80 degrees irrespective of the age (due to the risk of serious respiratory problems); and scoliosis associated with muscle diseases (uncontrolled progression and life threatening problems).

Should a scoliosis >40 to 50 degrees be operated on?

The answer can be “Yes” or “No” depending on your perspective. In fact, the curvatures above 40 degrees in lumbar scoliosis and above 50 degrees in thoracic scoliosis pose the risk of lifelong progression. Principally, surgery is performed either for cosmetic reasons or for managing the pain in scoliosis > 40 to 50 degrees. However, timing of the surgery should be completely based on decision of the patient and there is no necessity of an urgent surgery.

Is scoliosis surgery a high-risk procedure?

Undoubtedly, it is not possible to mention about “zero risk”. However, those risks are substantially decreased thanks to surgical experience and neuromonitoring systems. Neuromonitoring allows the surgeon detect and prioritize management of the risk during the operation. Therefore, the system does not only make the surgery safer and more comfortable, but it also enables the correction at maximum extent while the scoliosis is corrected. Safety of the system reaches up to 97-98 percent.

What is the most common cause of hump (kyphosis) in childhood and adolescence?

The hump recognized in most of the children by their parents is a mild hump that is usually secondary to a postural disorder. It can be managed with strengthening the regional muscles and physical exercises.

What is postural kyphosis? What are the causes and how can it be prevented?

Postural kyphosis is a deformity that is commonly detected in children during school screenings. It is more prevalent in girls and in adolescence. The curvature is below 60 degrees and the spine is flexible. Roentgenograms do not show a structural abnormality in the vertebral column. Most significant cause of the postural kyphosis is bad sitting position and poor physical condition. Recently, mobility decreases in children due to computer addiction and they stay away from sportive activities. This life style makes our children spend a major part of their time in bad sitting position, but it also causes poor physical condition, as they don’t do sports.

What is structural kyphosis?

Structural kyphosis is a hump that measures above 55 degrees even in physiological standing posture of the patient and it is mostly secondary to an underlying bone and/or soft tissue pathology. This hump may be secondary to congenital spine anomalies, certain bone diseases, damage to vertebrae secondary to infections or fractures or various neuromuscular diseases. It may also be caused by Schuermann diseases in an idiopathic manner.

What is the most common cause of structural kyphosis in childhood and adolescence?

“Scheuermann disease” is an idiopathic disease that is the most common cause of structural kyphosis in patients at growth age; it is characterized by loss of rectangular shape and transformation into a wedge form in vertebrae. Although there are many comments on its etiology, the widely recognized one is the avascular necrosis in growth plates of the vertebrae. If Schuermann disease is left untreated, it may result in progression of the kyphosis into hazardous level.

Which sports are beneficial for scoliosis and which positions are better to prevent the condition?

Scoliosis is a structural disorder with hereditary origin and it is not affected by the posture. In other words, scoliosis does not develop as posture of your child is bad; on the contrary, your child stays in a bad posture due to the scoliosis. Since it is not a posture disorder, it is incorrect to speculate that a sport, such as swimming, is useful.

Is scoliosis surgery a contraindication for pregnancy?

The scoliosis surgery that you have undergone does cause a barrier against your pregnancy or future childbirth.

Do implants placed in the surgery trigger alarm in detectors?

The implants placed in your surgery are made of cobalt-chromium or titanium alloys. They do not trigger alarm in metal detectors in most cases, but especially long-segment implants may cause an alarm in metal detectors with very high sensitivity, such as the ones in airports or jails. Therefore, we advise you seek a certificate from your doctor.

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