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Spinal curvature (Scoliosis)

Dr. Nadheer K M (AIIMS)MBBS

September 18, 2020

September 18, 2020

Spinal curvature
Spinal curvature

An abnormal curvature of the spine in a person, often in a C or S shape, is known as scoliosis. In most people, the spine is mostly straight from under the neck all the way down to the lower back where it joins the hip, but the curvatures are only at both ends, one at the top of the shoulder and the other at the lower back. 

However, this curvature is not unusual and supports the balance of the body from the head to the lower limbs. In the case of scoliosis, the curvature occurs sideways and in between both the ends. In most cases, the unusual curvatures are seen in the areas around the chest and the lower back.

Scoliosis usually appears in people during their teenage years when boys and girls are undergoing puberty, where the body goes through a higher than normal growth spurt between the ages of 10 and 18 years. Typically, girls are said to experience scoliosis more than boys, and are reportedly eight times more likely to develop this condition.

While scoliosis is usually a mild condition, severe conditions are also known to affect people, which can lead to permanent problems like difficulty breathing. While the prevalence of this condition differs from region to region, it affects about 2-3% of the American population, which is not a small number.

Types of spinal curvature (scoliosis)

Scoliosis is categorised in at least two different ways.

The condition can be divided into categories based on the age when the person develops this condition:

  • Infant scoliosis: Between birth and four years
  • Juvenile scoliosis: Between four and 10 years
  • Adolescent scoliosis: Between 11 and 18 years
  • Adult scoliosis: 18 years and above

As mentioned earlier, adolescent scoliosis is the most common among these.

Scoliosis is also divided into structural and non-structural parts:

  • Structural scoliosis: This is caused by birth defects, diseases, infections or genetic conditions. These cases typically cannot be cured.
  • Non-structural: All other causes. The curvatures that can be corrected through treatment if they are due to temporary issues that are categorised as non-structural scoliosis.

Spinal curvature (scoliosis) symptoms

The unusual curving of the spine is the sign to look out for. Keep a check on the spines of growing children, as the condition may begin earlier in life with no discernible cues.

Depending on the severity of the condition, the curve in the spine may or may not be visible. This difficulty in perceiving visual cues may make it harder to identify the problem.

In some cases of scoliosis, the general posture of the patient may help to identify the condition. If a person leans excessively to one side or has shoulders that are not aligned with each other, these can be signs to identify such a condition. Even the hip bone may be misaligned due to the curvature of the spine.

Scoliosis can go undetected in many people as the curvature of the spine isn't pronounced enough to cause problems. However, excess curving of the spine may require extensive treatment. So, to recap the symptoms:

  • Uneven shoulders
  • Uneven hips or waist
  • One shoulder blade is more defined or prominent than the other
  • One side of the body is higher than the other
  • A curve in the back is visible from behind

Spinal curvature (scoliosis) causes

According to the American Association of Neurological Surgeons (AANS), about 80% of all cases of scoliosis have no identifiable cause. It is usually identified early in life, and some of the causes may include:

  • Having one leg longer than the other, leading to a curve in the spine
  • Muscle spasms are also known to cause curves in the spine, which can be treated
  • Inflammatory conditions in the body such as appendicitis can also lead to a curving of the spine, which usually goes away after treatment
  • Birth defects
  • Genetic defects or conditions such as Down syndrome
  • Neurological problems such as cerebral palsy (CP) or muscular dystrophy
  • Diseases and other infections such as tumours. One can also develop scoliosis later in life due to conditions like osteoporosis

Prevention of spinal curvature (scoliosis)

Most cases of scoliosis cannot be prevented. Regular exercises, strengthening the muscles of the back and other practices may improve your overall posture, but they cannot prevent scoliosis.

Read more: Best yoga poses for the spine

Temporary cases of scoliosis can be addressed with treatment and exercise, besides strengthening the back by increasing the intake of vitamins and calcium. Early detection is also important to ensure that the condition doesn't worsen with time and its after-effects can be contained to a manageable level.

Diagnosis of spinal curvature (scoliosis)

Physical examinations can help to identify any problems with posture or difficulty in assuming certain postures. The doctor may ask the person to bend forward all the way, so he/she can see any abnormality in the curvature of the spine.

The doctor may order imaging tests such as X-rays, CT scan and MRI scan along with specific tests for the spine to confirm their doubts.

A sideways curve of more than 10 degrees is enough to diagnose the condition—a curvature of over 25 degrees means that it is considerable. If the curvature is close to 50 degrees, the condition can be labelled as severe.

Spinal curvature (scoliosis) treatment

In some cases of scoliosis, the excess curvature in the middle of the spine can be seen with the naked eye. If you or a loved have this symptom, it is important to get it checked by a doctor.

If you are not sure that there is excessive curvature but suspect it, observe your/your loved one's posture, gait and daily activities to check for any abnormalities—visit a doctor if your suspicions are confirmed.

Scoliosis can affect older teenagers and adults as well—age is one of the primary risk factors of this condition.

If the curvature is slight (under 10 degrees) and doesn't cause any discomfort to the patient, then the patient may not be advised any treatment besides monitoring their progress and advice towards improving their diet, adding exercise to their schedule and being mindful of their overall posture.

If the curvature of the spine is more than 25 degrees, doctors may advise the use of a brace— especially if the patient is not an adult yet. This brace can prevent the curvature from worsening in the long run as the child grows. It can also prevent further degeneration or other problems that the condition may bring with age. The brace has to be worn throughout the day until the child or the teenager has grown up fully.

In more severe cases, though, surgery may have to be performed, especially if the curvature of the spine is over 40 degrees. A procedure called spinal fusion is done in such cases of scoliosis. During this procedure, a surgeon attaches rods and screws to the spine to keep it straight. The bone graft and spine join to become one with time—the rods that are put in place may have to be adjusted as the paediatric patients grow up. The process can be time-consuming and may require multiple sessions.

Read more: Laminectomy

However, spinal fusion surgery is a last-resort procedure, as it has a considerably high risk of permanent damage to the nerves. There's also a chance that the procedure may not be able to address this condition for good.

Spinal curvature (scoliosis) risks and complications

Scoliosis can become debilitating over time. Younger patients are especially at risk of suffering some complications due to it. Here's a look at the risk factors of scoliosis:

  • Age is a risk factor for scoliosis: it is most commonly seen in adolescents.
  • Girls are at an increased risk of developing scoliosis as compared to boys
  • Certain genetic factors may also play a part in the development of this condition, although this rare.

People who develop scoliosis may develop further health issues as a result:

  • The excessive curvature of the spine can lead to long-term respiratory problems, as well as damage to the lungs and the heart as the spine may press against the rib cage.
  • People with an excessive curving of the spine, especially in the lower back, tend to develop chronic back problems such as back pain.
  • The condition may also have a psychological impact on patients, especially with regards to their physical appearance depending on how pronounced the curvature of their spine is.

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