Scoliosis is a medical condition characterized by an abnormal sideways curvature of the spine. When viewed from the back, a healthy spine appears straight from the neck to the tailbone. However, in individuals with scoliosis, the spine curves to the side, often in an “S” or “C” shape. While a typical spine naturally has gentle curves when viewed from the side, scoliosis refers to a side-to-side curvature.
Scoliosis is most frequently diagnosed during adolescence. Although it can be associated with conditions like cerebral palsy and muscular dystrophy, the majority of childhood scoliosis cases have no known cause. This is referred to as idiopathic scoliosis.
In most instances, the curvature caused by scoliosis is mild. However, some cases can progress as children grow. Severe scoliosis can be debilitating, and a significant spinal curve can reduce space in the chest cavity, potentially hindering proper lung function.
Children diagnosed with mild scoliosis are typically monitored through regular check-ups and X-rays to observe if the curve is worsening. Many of these cases require no treatment. For some children, a brace may be necessary to prevent the curve from progressing. In more severe cases, surgery might be needed to straighten the spinal curve.
Recognizing Scoliosis: Key Symptoms
Scoliosis symptoms can vary, and in mild cases, they may be subtle and develop gradually. Signs of scoliosis to watch out for include:
- Uneven shoulders: One shoulder may appear higher than the other.
- Prominent shoulder blade: One shoulder blade might stick out more noticeably than the other.
- Uneven waistline: The waist may appear asymmetrical, with one side having a different curve than the other.
- Uneven hips: One hip might be positioned higher than the other.
- Rib cage protrusion: One side of the rib cage may jut out forward.
- Asymmetry when bending forward: When bending forward at the waist, one side of the back may appear higher than the other, forming a rib hump.
In many scoliosis cases, the spine not only curves sideways but also rotates or twists. This rotation can cause the ribs or muscles on one side of the body to protrude further than on the other side, contributing to the visible asymmetry.
When to Seek Medical Advice for Scoliosis
It is important to consult a healthcare provider if you observe any potential signs of scoliosis in a child. Mild scoliosis can develop without causing pain and may go unnoticed by both the child and parents initially. Often, scoliosis is first detected by teachers, friends, or sports coaches who notice postural irregularities. Early detection is key for effective management and monitoring of scoliosis.
Understanding the Causes of Scoliosis
While the exact cause of the most common type of scoliosis, idiopathic scoliosis, remains unknown, it is believed to have a hereditary component, as it sometimes runs in families. Less common types of scoliosis can be attributed to:
- Neuromuscular conditions: Certain conditions like cerebral palsy and muscular dystrophy can increase the risk of scoliosis.
- Congenital disabilities: Birth defects affecting the development of the vertebrae (bones of the spine) can lead to scoliosis.
- Prior chest wall surgery: Surgery on the chest wall during infancy can sometimes contribute to the development of scoliosis.
- Spinal injuries or infections: Trauma or infections affecting the spine can, in rare cases, cause scoliosis.
- Spinal cord abnormalities: Irregularities in the spinal cord can also be associated with scoliosis.
Risk Factors Associated with Scoliosis
Several factors can increase the likelihood of developing the most common type of scoliosis:
- Age: The onset of signs and symptoms typically occurs during adolescence.
- Sex: While both boys and girls can develop mild scoliosis at roughly the same rate, girls have a significantly higher risk of the curve progressing and requiring medical intervention.
- Family History: Scoliosis can have a familial tendency, although most children with scoliosis do not have a family history of the condition.
Potential Complications of Scoliosis
Although most individuals with scoliosis have a mild form, scoliosis can sometimes lead to complications, particularly in more severe or untreated cases:
- Breathing Difficulties: In severe scoliosis, the rib cage can press against the lungs, potentially impairing breathing function.
- Chronic Back Pain: Individuals who had scoliosis as children may have a higher predisposition to chronic back pain as adults, especially if their spinal curves were large and untreated.
- Appearance Concerns: As scoliosis progresses, it can cause more noticeable physical changes, such as uneven hips and shoulders, prominent ribs, and a shift of the waist and trunk to one side. This can lead to self-consciousness about appearance.
It is important to remember that scoliosis is a complex condition, and early diagnosis and appropriate management are crucial for ensuring the best possible outcomes. If you have concerns about scoliosis, consulting a healthcare professional is always recommended.
References:
- Scoliosis in children and teens: In depth. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/scoliosis/advanced. Accessed April 7, 2021.
- Introduction to scoliosis. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases–conditions/introduction-to-scoliosis. Accessed April 7, 2021.
- Kliegman RM, et al. The spine. In: Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed April 7, 2021.
- Scherl SA. Adolescent idiopathic scoliosis: Clinical features, evaluation and diagnosis. https://www.uptodate.com/contents/search. Accessed April 7, 2021.
- Ferri FF. Scoliosis. In: Ferri’s Clinical Advisor 2021. Elsevier; 2021. https://www.clinicalkey.com. Accessed April 7, 2021.
- Scherl SA. Adolescent idiopathic scoliosis: Management and prognosis. https://www.uptodate.com/contents/search. Accessed April 7, 2021.
- Miller MD, et al., eds. The adolescent: Scoliosis. In: Essential Orthopaedics. 2nd ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed April 7, 2021.
- Kim W, et al. Clinical evaluation, imaging and management of adolescent idiopathic and adult degenerative scoliosis. In: Current Problems in Diagnostic Radiology. 2019; doi.org/10.1067/j.cpradiol.2018.08.006.
- Azar FM, et al. Scoliosis and kyphosis. In: Campbell’s Operative Orthopaedics. 14th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed April 7, 2021.
- Surgical treatment for scoliosis. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/treatment/surgical-treatment-for-scoliosis. Accessed April 7, 2021.
- Devlin VJ. Idiopathic scoliosis. In: Spine Secrets. 3rd ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed April 7, 2021.
- Larson AN (expert opinion). Mayo Clinic. April 30, 2021.
- Fedorak GT, et al. Minimum 5-year follow-up of Mehta casting to treat idiopathic early-onset scoliosis. The Journal of Bone and Joint Surgery. 2019; doi:10.2106/JBJS.18.01268.
- Shands AR. End result of the treatment of idiopathic scoliosis. The Journal of Bone and Joint Surgery. 1941;23:963.
- Morrow ES Jr. Allscripts EPSi. Mayo Clinic. Feb. 16, 2021.
