Scoliosis: Symptoms, Severities, and Treatment

Scoliosis occurs when a vertebral body rotation causes an abnormal lateral curvature of the spine, meaning the spine curves to the left or right, resulting in a “c” or an “s” shaped pattern.

When scoliosis is diagnosed before skeletal growth is completed, during childhood or adolescence, it is called pediatric scoliosis. After complete skeletal growth, it is called adult scoliosis. Pediatric scoliosis is more common than adult scoliosis.

What causes scoliosis?

Most cases of scoliosis (about 80%) are defined as idiopathic, meaning the cause is unknown, while in the other 20%, other issues lead to scoliosis, hence the name secondary scoliosis.

These secondary causes can include many diseases, such as a congenital (from birth) spinal deformity, a neuromuscular condition like cerebral palsy, or a muscular imbalance that can pull the spine in different directions, leading to an alteration in the spinal curve.

Muscular imbalances that pull at the spine are commonly the result of some type of physical trauma, like a motor vehicle accident, a sports related injury, or even a slip and fall.

Are there different severities of scoliosis?

Yes, scoliosis can be mild, moderate, or severe, all differentiated by degrees of curvature. For instance, mild scoliosis occurs when the spinal curve is less than 20 degrees, moderate scoliosis is when the curvature is between 25 and 40 degrees, and severe curvature exists when the curve is greater than 40 degrees.

The different degrees of scoliosis directly correlate with the need for treatment and resulting complications.

In what areas of the spine does scoliosis occur?

In adolescents and children, scoliosis occurs mainly in the thoracic spine, which is the middle back. In contrast, scoliosis usually presents in the lumbar spine or lower back for older people.

What are the symptoms of scoliosis?

Many cases of scoliosis do not produce any symptoms and are usually first noticed during routine physical exams, by a pediatrician, or in school screening programs.

Usually, by adulthood, there are symptoms caused by muscle tightness or spasms (continued muscle contraction without relaxation), resulting in back pain, neck pain, and sometimes even neurological issues, such as numbness or tingling of the extremities.

In addition, scoliosis can cause an altered posture resulting in abnormalities, such as uneven hips or leg lengths, abnormal scapular (shoulder blades) height or position, or the person leaning towards one side.

How is scoliosis diagnosed?

When looking at someone’s back — called a posterior view — the spine is supposed to be in a straight line. A physician or medical provider can examine the back to see if it curves towards the right or left, and if the spine curves more than 10 degrees, a diagnosis of scoliosis is made.

Plain X-rays should be done in all cases of scoliosis to evaluate the underlying bones for any abnormalities, including fractures (breaks), spurs (bony prominences), or osteoporosis (thinning of the bones). Metastatic cancer cells originating from a different organ can look like "punched out" lesions on X-rays, like raindrops when they hit a surface and splash.

In addition, standing X-rays are highly recommended to evaluate the degree of spinal curvature.

Plain X-rays only show bones, not soft tissues such as muscles, tendons, and ligaments. Therefore, if an evaluation of those areas is needed, a computerized tomography (CAT or CT) scan or a magnetic resonance imaging (MRI) study can be done. Both produce computer-generated three-dimensional X-ray type images of the bones and soft tissues.

What is the treatment for scoliosis?

For children and adolescents diagnosed with scoliosis, the treatment varies by the number of degrees and if they are still actively growing. For example, in children who are still actively growing, and the scoliosis is 20–50 degrees, it is recommended for them to wear a brace for about 15 hours a day. However, if the growing child has a curve of more than 50 degrees, surgery could be recommended.

For adult scoliosis, braces or surgery are rarely recommended. Instead, most cases are treated conservatively with cardiovascular exercises, stretching, core strengthening, and resistance training — essentially trying to stay active.

Can medicines be used to treat the symptoms?

Yes, you can use medications, including over-the-counter (OTC) pain medications such as acetaminophen (Tylenol); however, it needs to be used carefully as excessive use can lead to liver disease.

Nonsteroidal anti-inflammatory drugs, known as NSAIDs, can help with inflammation, swelling, and chronic pain, and can be taken as prescription or OTC.

Examples of OTC NSAIDs include aspirin, ibuprofen (Advil), and naproxen (Aleve). In addition, prescription NSAIDs are being used today, such as Celebrex, Voltaren (diclofenac), Ansaid, Meloxicam, and many others. However, we recommend caution with NSAIDs since there is a risk of gastrointestinal irritation, causing stomach ulcers and bleeding.

Often, scoliosis leads to fibromyalgia, which involves soreness and pain in several spots within different muscles. For this condition, several antidepressant medications can be helpful.

Are there alternatives to using medications?

Yes, physical therapy and occupational therapy can help correct poor posture caused by scoliosis and help correct the curvature in a growing child or adolescent.

Exercise is usually the best treatment for many musculoskeletal diseases. Combining cardiovascular (aerobic) exercise with weight training (anaerobic exercise) is best. Walking, biking, hiking, and using elliptical machines are excellent activities. For those who cannot tolerate these activities, lap swimming or water aerobics are good alternatives.

Other lifestyle changes can help with scoliotic-caused musculoskeletal pain, such as eating a healthy diet, seeing the doctor regularly, and getting plenty of rest and sleep.

Scoliosis is a common reason for chiropractic visits since it causes shortening and lengthening of the muscles in and around the spine. A chiropractor can fix the spine's misalignment with an instrument or by using their hands.

Many people state that acupuncture helps with musculoskeletal pain from scoliosis.

In addition, hot and cold therapy can be highly effective. The basic idea is to use ice for the first 24 hours and then to use heat. However, every person is different, as some people respond better to ice, and some respond better to heat.

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