There is no known cause of idiopathic scoliosis because any condition classed as ‘idiopathic’ means it has no known single cause. That’s not to say that idiopathic means not having multiple causes, and this is the case with idiopathic scoliosis and its multifactorial causation.
When someone gets diagnosed with any disease or condition, or their loved one does, it’s already a challenging time. Facing a condition that is idiopathic and has no known single cause only adds to that stress.
Many people associate unknown causation with limited treatment options. I am here to say that when it comes to scoliosis, this is not the case. While a large majority of scoliosis cases are idiopathic, that does not mean there are no known causes, just that there is no known ‘single’ cause.
What that means is that the condition developed from multiple causes, or a unique combination of causes, and those factors contributed to its development and progression.
When I’m explaining the nature of idiopathic scoliosis to my patients and their caregivers, I like to use the example of a fever. A fever is a symptom of another cause, or a combination of causes.
While the first response is to give medication to lower the fever and reduce the risk of related complications, the next step is to determine what the underlying cause, or causes, of the fever is; then the underlying cause itself and the larger issue can be dealt with, rather than merely treating the symptoms.
Another fascinating aspect of idiopathic scoliosis is that it does seem to resolve itself over time, otherwise a spinal curvature would just keep progressing and never stop.
There are constant advancements made in the medical industry. Breakthroughs in medicine and treatments happen every day. The more the medical community understands about the human body, the more likely it is that underlying causes of conditions and diseases will be discovered.
Despite the prevalence of scoliosis cases and the number of theories regarding its causality - right down to someone getting braces too early - there are still many unanswered questions. Considering that there were more than four million diagnosed cases of scoliosis in the United States alone in 2018, the lack of concrete answers regarding the condition’s cause is not due to any lack of effort made by the medical community.
A staggering 80 percent of diagnosed scoliosis cases are classed as idiopathic. The remaining 20 percent with known causes include neuromuscular scoliosis, congenital scoliosis, and traumatic scoliosis.
Some people have theorized that scoliosis is hereditary or that it has a genetic predisposition. Let’s discuss the difference between the two.
Genetically speaking, when a condition is described as hereditary, that means there is a particular defective gene known to cause the condition that is passed down from one generation to the next.
In truth, there are very few conditions and diseases that are hereditary, but there are more that carry genetic predispositions.
A genetic predisposition means there might be a higher chance of developing a certain condition or disease because it is in the family; that doesn’t mean it’s in the family because of a defective gene as families share a lot more than just genes. Families share environmental and socioeconomic factors, important traits such as diet, lifestyle, shared responses to stress, and even posture.
Most experts agree that there is likely a genetic predisposition to idiopathic scoliosis, but that is very different from saying the condition is hereditary, and there is a lot of support that debunks the hereditary theory.
Let’s look at twin studies, for example. There are numerous cases where one twin develops the condition while the other doesn’t. If a genetic mutation was the single cause, then twins that share identical genetic makeup, in theory, should both develop the condition. There are also cases where twins develop distinctly different spinal curvatures in terms of severity or location.
While there is still some ambiguity surrounding the hereditary theory, the common consensus is that scoliosis is not hereditary but likely carries a genetic predisposition. The bottom line is that some people who have a genetic predisposition within a family will develop the condition while others won’t, and someone with no genetic predisposition can still develop the condition.
What seems most likely is that if there is a genetic predisposition within a family, there might be higher chances of developing the condition, but certainly lifestyle choices and a number of other factors can combine to cause or prevent that gene from being expressed.
With the vast majority of diagnosed scoliosis cases being idiopathic, it’s natural for people to wonder if knowing the actual cause would change the chosen course of treatment or its efficacy.
That concern is why so many people feel the need to look to their family tree or elsewhere in search of an answer to where their condition, or the condition of a loved one, comes from. It’s natural to equate understanding with control, and let’s face it, one of the hardest aspects of being diagnosed with any condition or disease is that feeling of a loss of control. For parents and caregivers dealing with a loved one’s idiopathic scoliosis diagnosis, that feeling of having no control is especially challenging.
While I would love to be able to tell my patients what exactly their scoliosis is caused by, one comfort I can give is to reaffirm that knowing the cause would not change my chosen course of treatment or its efficacy.
When a patient comes to me with a scoliosis diagnosis or when I diagnose them, the first step is to get accurate measurements of the curvature and assess its severity and location; from there, I work closely with my patients and their caregivers to design a customized treatment plan. That treatment plan really has little, if anything, to do with why the condition developed, and much more to do with the nature of the condition itself, its severity, symptoms, progression, and the individual.
Scoliosis is a complex condition, due largely to its multifactorial causation. Often the way the condition expresses itself is a reflection of the multiple causes that led to its development and governs its progression.
Regardless of the cause or causes of a patient’s idiopathic scoliosis, there are two main treatment approaches to choose between. The first is the traditional approach, still the most common today, and the second is my patient-centered chiropractic approach.
The traditional approach, also known as the orthopedic approach, is characterized by observation, bracing, and often ends in spinal-fusion surgery. This approach would likely advise patients and their caregivers to simply observe the condition to monitor its progression.
Observing, however, is not the same as initiating treatment. X-rays will be done periodically to see if the condition gets worse, and once the curvature reaches a certain severity level, most often over 25 degrees, spinal-fusion surgery is recommended or presented as the patient’s best or only option.
Traditional bracing approaches and spinal-fusion surgery can be successful in making a crooked spine straighter, but the approach is based on holding the spine, either through bracing or the rods and screws inserted during surgery, rather than correcting it.
While this is still a common approach, there is a newer more innovative approach that I have built my career and established the Scoliosis Reduction Center around.
I believe that the traditional approach represents an older way of thinking and is outdated. The scoliosis-specific chiropractic approach that we provide at the Scoliosis Reduction Center offers patients a unique combination of multiple forms of treatment in one convenient and accessible location.
Our goal is to treat the whole patient. Our treatment approach combines scoliosis-specific chiropractic care that works to strengthen the spine in a corrective position and builds up the spine’s surrounding muscles so it is better supported.
Once our treatment plan has tackled the structural issue of the curvature, we add exercise, rehabilitation, diet, therapy, and custom 3-D bracing to further work towards a reduction and slow or stop the condition’s progression.
While a proponent of the traditional approach might say there’s no harm in waiting and simply observing the condition to see if it gets worse, I would say there most certainly is harm in waiting. In fact, as the number-one risk factor for rapid progression is growth, in adolescent scoliosis cases, growth spurts can be very dangerous in terms of just watching and waiting.
The main difference between the traditional approach and my approach is that the former is about observing and surgery, while the latter is about action, initiating treatment right away, and avoiding surgery.
The goal of our treatment approach, here at the Scoliosis Reduction Center, is that patients with scoliosis live their best lives and maintain as much function as possible throughout treatment and beyond. The traditional approach only increases the chances of treatment ending in spinal-fusion surgery as it can involve a lot of watching and waiting while the condition progresses unimpeded.
It is our hope that someday there will more of an understanding around what causes scoliosis. However, we’re simply not there yet. With 80 percent of diagnosed scoliosis cases having no known single cause, the current focus is centered around how to treat the condition as effectively as possible.
Idiopathic scoliosis is understood as a condition that while not hereditary, could have a genetic predisposition. Whether or not the gene expresses itself in an individual is unpredictable and is likely determined by a number of factors.
Here at the Scoliosis Reduction Center, I remind my patients that whether or not we fully understand the nature of how they developed scoliosis, we most certainly know how to treat it, and that’s the most important thing.
My patients have their own scoliosis stories, and what I’m working towards is changing the narrative that surrounds those stories. Just because we don’t fully understand the cause doesn’t mean we can’t help each and every patient come to the most complete understanding of their own condition as possible. Our patients experience great success as we help them cultivate a strategy for moving forward with their condition in a hopeful and positive way.