Spotlight On: Scoliosis

Scoliosis is a condition where the spine is curved or rotated. Scoliosis affects between 6 and 9 million people across the U.S. It is often diagnosed in the tween and teen years but can develop at any time. Women tend to have scoliosis more than men.

There are four different types of scoliosis curvatures that occur in different areas of the back:

• in the lower back (lumbar),
• between the shoulder blades (thoracic),
• in between the shoulders and lower back (thoraco-lumbar), and
• a combination of two curves going in opposite directions.

There are also three scoliosis classifications:

• Congenital scoliosis develops before birth. It is caused when sections of the spine don’t form or segment correctly. About 1 in 10,000 people are born with congenital scoliosis.
• Idiopathic scoliosis is the most common form of the condition. It’s not clear what causes idiopathic scoliosis, but scientists think that if someone in your family has a history of scoliosis, you may have an increased risk of developing it too.
• Neuromuscular scoliosis develops as a result of underlying conditions such as cerebral palsy or spinal muscular atrophy.

It is important to screen for scoliosis as early as possible. If scoliosis is diagnosed at an early age, preventive treatment can help prevent the curvature from progressing. Taking an X-ray of the back can often identify the type of curvature and curvature degree (how curved the spine is). The curvature degree will determine how scoliosis is treated. For example, a curve of 20 degrees may be treated with a brace, whereas a curve of more than 45 degrees may require corrective surgery

Bracing is often used to treat idiopathic scoliosis in teenagers, as the skeletal system has not yet reached full maturity. Bracing does not correct the initial curve. Instead, by placing pressure on the spine, the brace influences the direction of future growth in a way that minimizes the changing curvature. The brace is typically worn until the teen has reached skeletal maturity, with the goal of keeping the curve to a minimum to prevent the need for corrective surgery.

The most common types of braces are the following:

• Boston brace: The Boston brace is the most common brace for scoliosis. It’s rigid and treats both lumbar and thoracic curves. This brace uses cutouts to apply direct pressure to certain parts of the spine. Because this brace is so common, there are often preexisting molds that correspond to your curve shape.
• Wilmington brace: The Wilmington brace is custom-made from a cast of your individual current curve. It applies pressure to all of the spine to correct the curvature.
• Charleston and Providence braces: Both of these braces are intended for nighttime use as they restrict movement more than daytime braces, making them ideal for wearing while sleeping. The Charleston and Providence braces are used for more severe curves, as they apply more pressure and restriction to the spine.

Bracing is not always an option because sometimes even with the brace you have a high curvature degree or a severe curve. There are three main surgical procedures to correct scoliosis. The type of surgery you may need depends on your age and the location of the curve. They are:

• Spinal fusion surgery fuses multiple vertebrae together to correct curving. The vertebrae are held in place by rods that keep the spine in position, which can permanently limit flexibility and mobility.
• Vertebral body tethering  attaches tethers to the spine with screws, bracing the curve from the inside and forcing it to straighten. This method puts continuous pressure on the spinal curve and is typically used for adolescents so the spine can continue to correct as they continue to grow. It also allows for more flexibility.
• Growing rods are placed above and below the curve and can be adjusted by the surgeon, forcing the spine to straighten gradually with time.

Preventing a curve from progressing helps reduce back pain and potential damage to the heart and lungs caused by the spine pushing on one or both sides of the rib cage. If you experience back pain or think you might have scoliosis, ask your doctor to check during your routine physical exam. While many cases of scoliosis are not serious, it is always good to be well-informed.