What is scoliosis?
Scoliosis is a sideways curve of the spine that shows up as an “S” or “C” shape rather than a straight line down the back. This back condition can occur in children, adolescents and adults. According to the American Academy of Orthopedic Surgeons, approximately 2% of the population has scoliosis.
Scoliosis symptoms vary with age and severity of the curvature. Many people have some degree of curvature of the spine, yet experience little or no discomfort. Those with more severe scoliosis may experience back pain, disfigurement and nerve compression that can cause numbness, weakness and leg pain, especially upon standing or walking.
Scoliosis symptoms
Scoliosis can be a hidden disorder with no obvious symptoms, or it can cause severe disfigurement, pain and disability. Some patients can live with undetected scoliosis for many years until their curve starts to increase, often resulting in pain. Some common scoliosis symptoms include:
- Idiopathic scoliosis—This literally means “of undetermined cause.” This type of scoliosis is thought to be genetic, involving involves multiple genes and a concept called variable penetrance meaning. This means that in each generation, there is variability in how severe the spine curve is.
- Infantile idiopathic scoliosis—Scoliosis that occurs from birth to 3 years of age.
- Juvenile idiopathic scoliosis—Scoliosis that occurs from 3 to 10 years of age.
- Adolescent idiopathic scoliosis—Scoliosis that occurs from 10 to 18 years of age. This is the most common scoliosis diagnosis in children, representing nearly 90% of scoliosis cases.
- Adult idiopathic scoliosis—Scoliosis that occurs at 18 years and older.
Scoliosis causes and risk factors
Many physicians don't know what causes the most common type of scoliosis, although hereditary factors and environmental factors, like injuries such as spinal cord injuries, may come into play.
Family history
Scoliosis is thought to be genetic and tends to run in families. However, with each generation, there is a variability of how strongly the genes that cause scoliosis are expressed, which determines how severe the spine curve may be. For example, a mother may have a mild curve, but her daughter may have a very severe curve, or a mother may have a severe curve, and her grandchildren may develop scoliosis, but their parents did not.
Gender
While the incidence of a scoliosis diagnosis in men and women is approximately the same, the progression rate is seven to eight times more common in females who were diagnosed with scoliosis as an adolescent or young adult than among boys who were diagnosed at the same age.
Age
Most people typically think of scoliosis as a childhood disease. In fact, scoliosis is commonly diagnosed in the juvenile and adolescent stages—ages 9, 10, 11 or 12. There is, however, adult onset or degenerative scoliosis, which develops as a result of disc degeneration and is different from adolescent idiopathic scoliosis.
Spinal cord injuries
Polio was once one of the most common neurological causes of scoliosis. During the polio epidemic in the 1930s through the 1950s, it was very common for children to develop scoliosis. We see many of those patients as adults at the Baylor Scott & White Scoliosis Centers.
Environmental factors
Research into the environmental causes of scoliosis is ongoing, and, while there have been some findings, a clear connection has not been established between scoliosis and medications or environmental factors yet.
Unknown factors
The vast majority of patients with scoliosis fall under the category of what’s called idiopathic scoliosis. This simply means that we don't know what causes it as opposed to cases that are due to neurological causes, congenital abnormalities, developmental issues or as the result of a traumatic injury to the spinal cord. In some cases, either the vertebrae in the spine are congenitally malformed or congenitally fused together, or the spinal cord developed incorrectly from birth, leading to very severe curves.
Typically, there is an environmental cause for this, such as drug abuse during pregnancy, or complications from medications and other environmental causes, which put children at risk while they are developing during pregnancy.
Diagnosing scoliosis
A scoliosis diagnosis usually happens during a physical examination when a physician looks for the degree of rotation in the curvature of the spine, as well as secondary changes in other parts of the body that may include:
- Uneven shoulders
- Rib hump or asymmetry
- Low back hump or asymmetry
- A change in the shape of the waist
- Uneven pelvic bones or hips
Frequently, these changes are not visible in a person while they are standing, but they become noticeable when the person bends forward.
X-rays are important for pinpointing the shape and location of the curvature, as well as for measuring the degree of the curvature, so it can be classified.
Scoliosis treatment decisions are based upon a combination of factors: The degree of curvature, curvature location, risk of progression, spinal imbalance, underlying disease progression and degree of pain the patient is experiencing.
Scoliosis treatment options
While many patients with scoliosis mistakenly believe there is no treatment option available to them or that as an adult their scoliosis cannot be treated, back doctors at Baylor Scott & White Scoliosis Centers across Texas offer new hope. Great advances in the diagnosis and treatment of scoliosis have been made in recent years, offering each scoliosis patient advanced treatment. To date, we have treated more than 3,000 scoliosis patients with a success rate few others can claim.
Non-surgical treatment options
In most cases, treatment for adult scoliosis begins with a combination of non-operative therapies that may be administered for weeks to months. These scoliosis treatments include:
- Observation—Many individuals we see do not require surgery to correct their spine curve. Pediatric patients, in particular, need to be observed closely before and during their adolescent growth spurt to identify curves that are progressing rapidly and those that remain stable over time.
- Spinal rehabilitation—Physical therapy is often needed to stabilize the spine for patients with scoliosis. Pilates can also be helpful for core strengthening. While physical therapy has not been shown to alter the rate of curvature progression in adults, strengthening and conditioning programs often help reduce back pain symptoms. If surgery should ultimately be required, these physically fit patients often have an easier time recovering.
- Pain management—Anti-inflammatory medications and mild narcotics can be administered via injections to help relieve back pain.
- Epidural steroid injections—These types of injections can be helpful in relieving the leg pain that occurs as a result of scoliosis.
Surgical treatment options
For scoliosis patients who are experiencing an increase in curvature of the spine and are in pain, scoliosis surgery may be needed. Scoliosis surgeries are serious and complex with multi-step procedures and usually take from four to six hours. Sometimes more than one procedure is needed—one performed from the front and one done from the back. Typically, this can be done in one spine operation, but there are times when two operations may be necessary.
The overall goal of spine surgery is to get to the root of the problem, while at the same time causing the least amount of disruption to the patient’s lifestyle. Spine surgery is typically a choice of last resort to treat scoliosis, after all nonsurgical methods have been exhausted, or when problems like severely herniated discs or damaged vertebrae simply will not respond to nonsurgical treatments. While studies show that more than half of back surgeries are unnecessary, there are times when surgery is the answer.
Revision surgery
Have you experienced an unsuccessful spine surgery? Have you been told you have to live with the pain and deformity? While many centers are reluctant to try to correct a failed first procedure, Baylor Scott & White specializes in complex or challenging deformities—particularly those resulting from unsuccessful surgeries.
The orthopedic specialists and back surgeons at our Scoliosis Treatment Centers in Dallas, Plano, Lakeway and Round Rock help patients realize positive outcomes and long-lasting, pain-free results—even those who were told nothing could be done.
The most common reason for spine revision surgeries is pseudarthrosis, a condition in which the spine does not heal correctly. Surgical revision may also be needed for proximal junctional kyphosis that occurs when the discs above or below the initial fused area of the spine become worn, shrink or lose their shape. In some cases, individuals require revision surgery because they’ve developed a new deformity that is a secondary outcome of their primary surgery.
Revision surgery is essential to help identify the underlying problem. Every patient is different. That’s why patients at Baylor Scott & White go through a rigorous preoperative regimen to pinpoint the underlying problem, determine the best course of action and identify potential complications.
Scoliosis treatment locations
Baylor Scott & White Health Scoliosis Treatment Centers gives new hope to people suffering from the pain and disfigurement of scoliosis—even those who previously thought their back condition was untreatable.
Frequently asked questions about scoliosis care
Scoliosis is one of the more common disorders of the spine. Most people experience few symptoms or problems, but for those with a progressive curvature, problems can be severe.
If you or someone you know has been diagnosed with scoliosis, you may have questions. We have provided answers to the most common questions below.
General scoliosis FAQ
Surgery FAQ
Expert advice from our blog
Scrubbing In® is a place where hands-on healthcare discussions are happening every day with the people whose own hands are on the front lines of patient care—the doctors, nurses and medical staff who are saving lives and advancing medicine.