What Causes Scoliosis?

In most people with scoliosis, the cause is not known. In some cases, there is a known cause.

Doctors classify curves as:

• Nonstructural, which is when the spine is structurally normal and the curve is temporary. In these cases, the doctor will try to find and correct the cause.
• Structural, which is when the spine has a fixed curve. The cause could be a disease, injury, infection, or birth defect.

In 80 to 85 percent of people, the cause of scoliosis is unknown; this is called idiopathic scoliosis. Before concluding that a person has idiopathic scoliosis, the doctor looks for other possible causes, such as injury or infection. Causes of curves are classified as either nonstructural or structural.

• Nonstructural (functional) scoliosis: A structurally normal spine that appears curved. This is a temporary, changing curve. It is caused by an underlying condition such as a difference in leg length, muscle spasms, or inflammatory conditions such as appendicitis. Doctors treat this type of scoliosis by correcting the underlying problem.
• Structural scoliosis: A fixed curve that doctors treat case by case. Sometimes structural scoliosis is one part of a syndrome or disease, such as Marfan syndrome, an inherited connective tissue disorder. In other cases, it occurs by itself. Structural scoliosis can be caused by neuromuscular diseases (such as cerebral palsy, poliomyelitis, or muscular dystrophy), birth defects (such as hemivertebra, in which one side of a vertebra fails to form normally before birth), injury, certain infections, tumors (such as those caused by neurofibromatosis, a birth defect sometimes associated with benign tumors on the spinal column), metabolic diseases, connective tissue disorders, rheumatic diseases, or unknown factors (idiopathic scoliosis).  

How Is Scoliosis Diagnosed?

Doctors use a medical and family history, physical exam, and tests when checking a person for scoliosis. An x ray of the spine can help the doctor decide if a person has scoliosis. The x ray lets the doctor measure the curve in degrees (such as 25 degrees) and see its location, shape, and pattern.

Doctors take the following steps to evaluate patients for scoliosis:

• Medical history: The doctor talks to the patient and the patient's parent(s) and reviews the patient's records to look for medical problems that might be causing the spine to curve, for example, birth defects, trauma, or other disorders that can be associated with scoliosis.
• Physical examination: The doctor looks at the patient's back, chest, pelvis, legs, feet, and skin. The doctor checks if the patient's shoulders are level, whether the head is centered, and whether opposite sides of the body look level. The doctor also examines the back muscles while the patient is bending forward to see if one side of the rib cage is higher than the other. If there is a significant asymmetry (difference between opposite sides of the body), the doctor will refer the patient to an orthopaedic spine specialist (a doctor who has experience treating people with scoliosis). Certain changes in the skin, such as so-called cafi au lait spots (the color of coffee with milk) can suggest that the scoliosis is caused by a birth defect.
• X-ray evaluation: Patients with significant spinal curves, unusual back pain, or signs of involvement of the central nervous system (brain and spinal cord) such as bowel and bladder control problems need to have an x ray. The x ray should be done with the patient standing with his or her back to the x-ray machine. The view is of the entire spine on one long (36-inch) film. Occasionally, doctors ask for more tests to see if there are other problems.
• Curve measurement: The doctor measures the curve on the x-ray image. He or she finds the vertebrae at the beginning and end of the curve and measures the angle of the curve.

Doctors group curves of the spine by their location, shape, pattern, and cause. They use this information to decide how best to treat the scoliosis.

• Location: To identify a curve's location, doctors find the apex of the curve (the vertebra within the curve that is the most off-center); the location of the apex is the "location" of the curve. A thoracic curve has its apex in the thoracic area (the part of the spine to which the ribs attach). A lumbar curve has its apex in the lower back. A thoracolumbar curve has its apex where the thoracic and lumbar vertebrae join.
• Shape: The curve usually is S- or C-shaped.
• Pattern: Curves frequently follow patterns that have been studied in previous patients. The larger the curve is, the more likely it will progress (depending on the amount of growth remaining).

How Is Scoliosis Treated?

Treatment for scoliosis is based on:

• The person's age
• How much more he or she is likely to grow
• The degree and pattern of the curve
• The type of scoliosis.

The doctor may recommend observation, bracing, or surgery.

Observation:

The doctor will check every 4 to 6 months to see if the curve is getting better or worse. Observation is used for those who have a curve of less than 25 degrees and are still growing.

Bracing:

Doctors may advise wearing a brace to stop a curve from getting worse. Bracing may be used when:

• The person is still growing and has a curve of more than 25 to 30 degrees.
• The person is still growing and has a curve between 20 and 29 degrees that is getting worse.
• The person has at least 2 years of growth remaining and has a curve that is between 20 and 29 degrees. If a girl, she should not have started having her monthly periods yet.

Surgery:

Doctors use surgery to correct a curve or stop it from getting worse when the person is still growing, the curve is more than 45 degrees, and the curve is getting worse. Surgery often involves fusing together two or more bones in the spine. The doctor may also put in a metal rod or other device. These devices are called implants. They stay in the body and help keep the spine straight after surgery.

Can Exercise Help?

Exercise programs have not been shown to keep scoliosis from getting worse. But it is important for all people, including those with scoliosis, to exercise and remain physically fit. Weight-bearing exercise, such as walking, running, soccer, and gymnastics, helps keep bones strong. For both boys and girls, exercising and playing sports improves their sense of well-being.

About Other Treatments for Scoliosis

So far, the following treatments have not been shown to keep curves from getting worse in scoliosis:

• Chiropractic treatment
• Electrical stimulation
• Nutritional supplements
• Exercise.

Are There Other Ways to Treat Scoliosis?

Some people have tried other ways to treat scoliosis, including manipulation by a chiropractor, electrical stimulation, dietary supplements, and corrective exercises. So far, studies of the following treatments have not been shown to prevent curve progression, or worsening:

• Chiropractic manipulation
• Electrical stimulation
• Nutritional supplementation
• Exercise Studies have shown that exercise alone will not stop progressive curves. However, patients may wish to exercise for the effects on their general health and well-being.

Which Scoliosis Brace Is Best?

The SpineCor non-rigid bracing system is a revolutionary way of managing scoliosis in adolescents and adults.

By allowing total freedom of movement, the SpineCor brace:

• Strengthens affected muscle groups
• Allows for proprioceptive input, which is an integral component in neuromuscular reeducation
• Provides relief from muscular strain due to chronic postural changes
• Provides relief of chronic pain 

For more on the Spinecor Brace. go to http://www.scoliosisspecialists.com/

If the Doctor Recommends Surgery, Which Procedure Is Best?

Many surgical techniques can be used to correct the curves of scoliosis. The main surgical procedure is correction, stabilization, and fusion of the curve. Fusion is the joining of two or more vertebrae. Surgeons can choose different ways to straighten the spine and different implants to keep the spine stable after surgery. (Implants are devices that remain in the patient after surgery to keep the spine aligned.) The decision about the type of implant will depend on the cost; the size of the implant, which depends on the size of the patient; the shape of the implant; its safety; and the experience of the surgeon. Each patient should discuss his or her options with at least two experienced surgeons.

Patients and parents who are thinking about surgery may want to ask the following questions:

• What are the benefits from surgery for scoliosis?
• What are the risks from surgery for scoliosis?
• What techniques will be used for the surgery?
• What devices will be used to keep the spine stable after surgery?
• Where will the incisions be made?
• How straight will the spine be after surgery?
• How long will the hospital stay be?
• How long will it take to recover from surgery?
• Is there chronic back pain after surgery for scoliosis?
• Will the patient's growth be limited?
• How flexible will the spine remain?
• Can the curve worsen or progress after surgery?
• Will additional surgery be likely?
• Will the patient be able to do all the things he or she wants to do following surgery?

Can People With Scoliosis Exercise?

Although exercise programs have not been shown to affect the natural history of scoliosis, exercise is encouraged in patients with scoliosis to minimize any potential decrease in functional ability over time. It is very important for all people, including those with scoliosis, to exercise and remain physically fit. Girls have a higher risk than boys of developing osteoporosis (a disorder that results in weak bones that can break easily) later in life. The risk of osteoporosis is reduced in women who exercise regularly all their lives. Also, weight-bearing exercise, such as walking, running, soccer, and gymnastics, increases bone density and helps prevent osteoporosis. For both boys and girls, exercising and participating in sports also improve their general sense of well-being.

What Are Researchers Trying to Find Out About Scoliosis?

Researchers are looking for the cause of idiopathic scoliosis. They have studied genetics, growth, structural and biochemical alterations in the discs and muscles, and central nervous system changes. The changes in the discs and muscles seem to be a result of scoliosis and not the cause. Scientists are still hopeful that studying changes in the central nervous system in people with idiopathic scoliosis may reveal a cause of this disorder.