Kraus Back & Neck Institute: 281.446.3876(281.44.Neuro)

Conditions

Scoliosis and Spinal Deformity

Scoliosis is the most common cause of spinal deformity. It is an abnormal side-to-side spinal curve that develops in the thoracic (mid back) and/or lumbar (low back) spine. If progressive, scoliosis may cause the spine to turn or rotate. Rotational forces can distort the shape of the spine, disrupt physical symmetry (e.g., cause one hip to be higher than the other), and cause deformity—such as a rib hump on the back. Sometimes, scoliosis is caused by muscle problems, does not involve spinal rotation, and is almost always reversible.

Types of scoliosis

Scoliosis can develop at any age. It can be classified as congenital (at birth), infantile (age 3 or younger), juvenile (ages 4 to 10 years), adolescent (ages 10 to 18), and adult.

  • Idiopathic scoliosis means the cause is not known.
  • Functional scoliosis, or nonstructural scoliosis, results from poor posture, a difference in leg-length, or a neuromuscular problem.
  • Causes of neuromuscular scoliosis include cerebral palsy or muscular dystrophy. The scoliotic curve(s) may worsen during spurts of growth.
  • Syndrome associated, such as skeletal dysplasias (growth disorders) or Marfan's syndrome (connective tissue disorder, hereditary).
  • Degenerative scoliosis affects adults. An abnormal spinal curve may develop as a result of degenerative disc disease, osteoporosis, or spondylosis. These disorders are associated with aging.

Further, scoliosis is classified by the type of curve. Some patients may develop one curve while others develop another curve called a compensatory curve. A compensatory curve may develop to compensate for imbalance created by the major scoliotic curve. Often, the compensatory curve is less severe than the major scoliosis.

Symptoms

Your symptoms may depend on your chronological age, and the type, cause, and progressive nature of the scoliosis.

  • Leg-length difference
  • Abnormal gait
  • One shoulder higher than the other
  • A prominent shoulder blade or rib when bending forward
  • Visible spinal curve
  • Uneven hips
  • Hemlines or trouser lengths uneven
  • Clothing does not fit correctly
  • Back pain
  • Shortness of breath (severe scoliosis)

Accurate diagnosis

If anyone in your family has (had) scoliosis, this important for your spine specialist to know. Scoliosis runs in families. In addition to your medical history, the spine doctor performs a physical and neurological examination. Examinations include evaluating heart and lung function, spinal range of motion, and assessing the spine by hand (called palpating, feeling the spine).

The Adam's Forward Bending test involves you bending forward at the waist, with your arms extended. Your doctor checks for shoulder blade, rib or other prominence. A Scoliometer can be used to measure the prominence in degrees. A scoliosis can be found during a Plumb Line test. This involves holding a plumb line at the back of your neck and allowing it to hang. Scoliosis may be found if the plumb line does not hang between the buttocks.

A neurologic examination assesses your reflexes and tests for muscle weakness, loss of feeling, and/or signs of neurological injury.

Imaging studies often include x-rays taken while standing (front, back and side) and bending. Special measurement techniques are used to calculate the curve angle(s), degree of vertebral rotation, type of scoliosis, and patient's skeletal maturity.

Non-operative treatment

The treatment plan depends on the diagnosis, which considers your chronological age, skeletal age (if young), type and cause of scoliosis, curve size and type, and if the scoliosis is progressive.

Observation: Small curves—less than 15- to 20-degrees—are observed for possible progression over a period of time. During this time, no treatment is necessary. In children, larger curves—between 20-40 degrees—require bracing to help prevent curve progression.

Spinal bracing: Adult scoliosis is not treated by bracing. A brace may help manage adult back pain, but will not correct scoliosis. However, bracing may be a treatment option for a child. Why? Because a child is growing—he or she has not reached skeletal maturity. Bracing may help control a scoliotic curve from progressing.

Scoliosis surgery

Sometimes spine surgery is recommended. The goal of spine surgery is to stop the curve from progressing, manage deformity, and stabilize the spine. This involves spinal instrumentation and fusion. You (or your child) may be a candidate for a minimally invasive spine surgery. There are different ways the surgery can be performed, and your spine surgeon explains the possible benefits and risks associated with his surgical recommendations.

We hope this information about scoliosis, and spinal deformity has answered some of your immediate questions. Remember, your doctor is your most valuable source to answer your questions about symptoms and your child's spine health.

Gary Kraus, MD,
Neurosurgeon, is Board Certified
Meet Gary Kraus, MD
Masaki Oishi, MD,
Spine Fellowship at the University
Meet Gary Kraus, MD
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