Scoliosis is a complex spinal condition, not only because it ranges greatly in severity from one patient to the next, but also because there are different types of the condition that can develop; some forms are associated with known causes, but the majority are not. When it comes to idiopathic scoliosis, the most prevalent condition form, it’s thought to be multifactorial and more ‘familial’ than ‘genetic’.
While a lot of time has been spent trying to pinpoint the cause of idiopathic scoliosis, the general consensus is that it is multifactorial, meaning its onset is the result of multiple factors. When it comes to genetics, a single gene, or genetic mutation, has yet to be found as a causative source.
Before we get into the difference between a condition that’s classified as ‘genetic’ and one that’s considered ‘familial’, let’s first take a look at the different types of scoliosis that can develop, as they have different causative sources that shed light on the complexities of the condition.
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Part of the reason scoliosis is so often coined ‘complex and mysterious’ is because of its etiology, meaning the reasons behind its development.
Not only can scoliosis range in severity from mild to moderate, severe to very severe, it can develop at any age, and there are many different types of the condition with different causation.
The majority of scoliosis cases are idiopathic, meaning there is no clear single source identified that accounts for its development.
Conditions are classified based on a number of important patient and condition characteristics; scoliosis is classified based on patient age, condition cause (if known), condition severity, and curvature location.
Cause, when known, can be important as it guides the treatment process and helps determine whether a case is considered ‘typical’ or ‘atypical’. In the most prevalent form of scoliosis, however, 80 percent of known diagnosed cases are idiopathic, meaning the cause is unknown.
As idiopathic scoliosis is the most prevalent form of the condition, when it comes to understanding the nature of scoliosis, understanding what ‘idiopathic’ means is important.
Put simply, idiopathic means there is no known cause, but it’s a little more complex than that. While idiopathic scoliosis doesn’t have one single known cause to account for its onset, that doesn’t mean there is an absence of a causative source, or that there aren’t several.
In general, idiopathic scoliosis is considered to be ‘multifactorial’, meaning its causation is understood as the result of multiple variables, or how certain variables interact, that can vary from person to person.
This is why there are so many theories attempting to explain the onset of idiopathic scoliosis. Some theories consider idiopathic scoliosis to have neurological components, neuromuscular, musculoskeletal, hormone-related, bone-density related, body-mass related, genetic components, and more.
The bottom line is that despite all the time, effort, studies, and research conducted on the subject of idiopathic scoliosis causation, we have yet to find a clear definitive causative link.
So in the condition’s main form (idiopathic), its multifactorial nature necessitates an integrative treatment approach that crafts a fully-customized treatment plan capable of addressing the specifics of each patient and their individual condition.
Before we move on to the debate of whether or not idiopathic scoliosis is genetic, and what exactly that classification means, let’s first explore the other forms of scoliosis that have known causes, and whether these forms have genetic components.
Types of scoliosis that are associated with known causes include congenital, neuromuscular, degenerative, and traumatic, and some of these represent atypical forms of the condition.
In cases of congenital scoliosis, infants are born with the condition that develops in utero due to a bone malformation in the spine.
Bone malformations can involve a ‘hemivertebrae’, meaning a vertebra (individual bone of the spine) is malformed and causes a sharp angle, disrupting the spine’s natural alignment, or vertebrae not forming into separate bones and becoming fused together.
Some cases are a combination of these two issues, and congenital scoliosis is a rare form, affecting approximately 1 in 10,000 newborns.
Congenital scoliosis is an example of a condition form whose onset is understood as we know the condition develops due to a malformation of the spinal vertebrae in utero, but is there a genetic component that explains why those malformations occur initially?
There is mixed data on the topic of congenital scoliosis etiology as it seems to have links to both genetic and environmental factors.
Cases of neuromuscular scoliosis develop because there is a larger neuromuscular condition/disease, such as cerebral palsy or muscular dystrophy, that causes the development of an abnormal scoliotic curve.
In these types of cases, there is a disconnect between the brain and the muscles and/or connective tissues that support the spine. Neuromuscular scoliosis is not a typical form of scoliosis as there is a larger issue at the root of its development; however, neuromuscular scoliosis is the second most common spinal deformity, after idiopathic scoliosis.
My neuromuscular scoliosis patients are atypical and are among the most challenging to treat because its underlying cause, the neuromuscular condition, has to be the guiding force of treatment, and this complicates the treatment process.
In this form, we know the underlying cause is neuromuscular, and while there is a genetic component tied to certain neuromuscular conditions that can lead to scoliosis, neuromuscular scoliosis itself is not commonly considered a genetic condition, as scoliosis is a secondary complication of the larger medical issue/condition.
Degenerative Scoliosis also has a known cause: spinal degeneration. It commonly affects people as they age and the body and spine face degenerative changes.
In addition to the natural degenerative effects of aging, the cumulative effect of certain lifestyle choices can also lead to the development of degenerative scoliosis by adversely affecting the spine’s health and function: not maintaining a healthy weight, leading a sedentary lifestyle, chronic bad posture, and repeatedly lifting heavy objects incorrectly, exposing the spine to strain.
It’s most commonly the spine’s intervertebral discs that are vulnerable to degeneration. The intervertebral discs sit between adjacent vertebrae, providing them with cushioning that guards against friction. They also enable the spine’s flexibility and even distribution of mechanical stress that’s incurred during movement.
If the discs face degenerative changes, lose height, and/or start to dry out, it impairs the spine’s ability to maintain its healthy curves, leading to the development of an abnormal spinal curvature.
In cases of degenerative scoliosis, the cause is not commonly considered fully genetic as it’s the spine’s degenerative changes that compromise its overall health and function, which can also be lifestyle-related, impairing its ability to maintain its natural curvatures.
Traumatic scoliosis is another atypical form of scoliosis as it is caused by a trauma that has adversely affected the spine. The condition can be caused by surgery, an accident, or the presence of tumors pressing on the spine and disrupting its alignment.
This form of scoliosis is also not commonly considered as genetic (although there is a genetic component to spinal cancer), as it is caused by trauma.
So what does a condition being classified as genetic actually mean, and what exactly is the difference between ‘genetic’ and ‘familial’?
There is a lot of motivation behind trying to find a clear causative source for idiopathic scoliosis because it is such a prevalent condition. According to the Scoliosis Research Society, there are close to 7 million people currently living with scoliosis in the United States alone.
Also, keep in mind, these are only ‘known’ diagnosed cases, and if we were to add to that number, people living with scoliosis throughout the world, it would increase exponentially.
While gaining a more-complete understanding of scoliosis is part of the motivation behind looking to genetics for answers, it’s also natural for people to look to genetics as it clearly explains why a person develops a condition, alleviating concerns that a person’s lifestyle or actions somehow led to the condition.
Although someone perusing the Internet in search of answers will come across different explanations as to why idiopathic scoliosis develops, including those that claim scoliosis is genetic, or has genetic components, it’s important to understand what a condition being officially classified as ‘genetic’ means.
If a condition is genetic, this means that it can be passed down from one generation to the next because of a specific gene, or genetic mutation, but in conditions officially classified as ‘genetic’, that specific gene, or genetic mutation, has been clearly identified, and in scoliosis, that has yet to happen.
Despite the years of debate, studies, and research attempting to isolate a specific ‘scoliosis gene’ to account for the condition’s development, we have not found it, nor do we fully understand the factors that lead to its onset.
What experts generally agree is that scoliosis is instead considered ‘familial’; this means that having a person in the family with scoliosis can increase chances of another family member developing the condition and can be considered a risk factor.
It’s easy to get these two classifications confused as the outcome is similar: more than one person within a family has scoliosis, but there are important distinctions.
Scoliosis is so often deemed a mysterious or complex condition because of multiple factors, etiology being a significant one. While scoliosis does tend to run in families, people have to remember that families share a lot more than just their genes: lifestyle, posture, diet, responses to stress, location, socioeconomic factors, and more.
In addition, twin studies have shown that even in sets of identical twins who share the same genes, one twin can develop scoliosis, while the other does not, or in cases where both develop scoliosis, one can develop a certain curvature pattern, while the other twin has a completely different curvature type and severity.
Ultimately, there is no clear answer, as idiopathic scoliosis twin-study results seem to find that both heritability factors and environmental factors play a role.
While it is still possible that there is a genetic component to scoliosis development, a clear genetic link has yet to be found or identified.
So a person could be carrying the gene, if indeed it exists, but never develop scoliosis, and conversely, a person not carrying the gene could develop scoliosis as the result of other causative factors.
The topic of scoliosis and genetics is, indeed, a controversial one, but considering how long the condition has been around, how prevalent it is, and the amount of research done, I have to wonder why, if there is a specific scoliosis gene in existence, it has not yet been identified.
Especially for parents and caregivers of loved ones recently diagnosed with scoliosis, it’s natural to look to genetics for answers, but clear answers are unlikely to be forthcoming.
When it comes to idiopathic scoliosis, the truth is that we quite simply do not fully understand the ‘why’ or ‘how’ behind its onset.
However, here at the Scoliosis Reduction Center, what I remind patients and their families is that just because I don’t have all the answers as to where idiopathic scoliosis comes from, I do know how to treat it effectively.
In addition, even if we did fully understand its etiology, those answers would be unlikely to change the treatment plan moving forward. Once the condition is structural, it needs to be impacted on a structural level, regardless of the reasons behind its development.
Now that we have discussed the different forms of scoliosis with known and unknown causes, and the difference between what it means for a condition to be classified as ‘genetic’ versus ‘familial’, let’s talk about how to respond once the condition has been diagnosed.
While I understand it can be frustrating to receive an idiopathic scoliosis diagnosis and be told that we simply don’t know why it has developed or where it comes from, having those answers wouldn’t necessarily alter the treatment process and prognosis.
When it comes to scoliosis treatment, choosing the approach to commit to is important and can have far-reaching consequences with the potential to shape a person’s life with the condition, and as scoliosis is progressive and incurable, scoliosis will be part of a patient’s life for life.
There are two main treatment approaches to choose between: traditional and functional.
The traditional scoliosis treatment approach has been in place for many years, but as our understanding of the condition has evolved, this approach has stayed relatively the same. It’s priority is to stop/slow progression, which is important, but the means by which it’s achieved can come at a high cost.
This approach watches and waits while a condition is in its mild progressive stage and doesn’t initiate active treatment until it has progressed to a certain point; the issue I have with that is it is wasting valuable treatment time.
When a condition is diagnosed and treated early on in its progressive line, curvatures tend to be smaller, less complex, less rigid, and the body has not yet fully adjusted to its presence.
Patients following the traditional scoliosis treatment approach are often funneled towards spinal-fusion surgery as little active treatment is applied, other than bracing, prior to a patient’s condition crossing that surgical-level threshold.
While all surgical procedures come with risk, spinal fusion is costly, invasive, and can carry some heavy potential side effects and risk of complications. In addition, a spine that is fused and held in place by artificial means, such as by rods and screws commonly used in the procedure, can adversely affect its overall health and function.
Also, a fused spine is a fused spine. If surgery is unsuccessful or causes complications or unexpected side effects, there is no unfusing it, and there is no recourse other than subsequent surgeries.
Fortunately, there is another approach that has gained in understanding and acceptance over the years: a chiropractic-centered functional approach.
Here at the Scoliosis Reduction Center, I offer patients a chiropractic-centered functional treatment approach that prioritizes correction, curvature reduction, and the spine’s overall health and function.
As discussed, idiopathic scoliosis is considered multifactorial, and its nature necessitates an integrative treatment approach that combines multiple treatment disciplines.
Here at the Center, our patients have access to different scoliosis-specific treatment disciplines under one roof, and the benefits that combining complementary forms of treatment provides: chiropractic care, in-office therapy, custom-prescribed home exercises, and specialized corrective bracing.
An integrative approach allows me to craft effective treatment plans that are fully customized to address the specifics of each patient and their condition. As a scoliosis chiropractor, I know the spine, and I know how scoliosis affects it and needs to be addressed.
Throughout treatment, I monitor how the spine is responding closely and adjust treatment plans as necessary.
In addition, unlike the traditional approach, I start proactive treatment as close to the time of diagnosis as possible. There is no harm in making a small curve smaller, but there is harm in letting a small curve progress unimpeded and then having to treat it more invasively down the road.
So is scoliosis genetic? The answer is as complex as the question itself. While there are theories and studies that support a link between idiopathic scoliosis and genetic components, we have yet to isolate a specific ‘scoliosis gene’, or genetic mutation, that accounts for its development.
Instead, many experts agree that scoliosis is more accurately described as ‘familial’, meaning that the condition can run in families, but not just because of shared genetics, but other related shared factors.
While idiopathic scoliosis is the condition’s most prevalent form, there are types of scoliosis with known causes: congenital, neuromuscular, degenerative, and traumatic.
Despite not having all the answers behind idiopathic scoliosis development, here at the Scoliosis Reduction Center, we know how to respond to its development with proactive and effective treatment.
By combining multiple scoliosis-specific treatment disciplines, our patients benefit from fully-customized treatment plans that impact the condition on a structural level while prioritizing the spine’s overall strength, function, and health.
