Each case of scoliosis is as unique as the patient themselves. Not only does scoliosis affect all ages and is the leading spinal condition amongst school-aged children, there are different types and wide-ranging severity levels. Continue reading to learn more about how scoliosis is classified in terms of severity.
Scoliosis ranges widely in severity from mild to moderate and severe to very severe. Condition severity is determined by a measurement known as Cobb angle, and a diagnosis of severe scoliosis would be given with a Cobb angle measurement of 40+ degrees.
Let’s start our exploration of severe scoliosis by discussing how further classifying conditions based on key patient/condition variables is part of the diagnostic process.
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In order for scoliosis to be diagnosed, certain parameters have to be met that differentiate it from a number of other spinal conditions that cause a loss of healthy spinal curves.
Scoliosis is the development of an unhealthy sideways spinal curve that also rotates (twists), making it a 3-dimensional condition.
In addition, the unnatural spinal curve has to be of a minimum size: Cobb angle measurement of at least 10 degrees.
As mentioned, part of the diagnostic process involves further classifying conditions based on specific key patient/condition variables.
Classifying scoliosis doesn’t just streamline the treatment process, it also shapes the design of effective customized treatment plans.
Important classification points include patient age, curvature location, condition type (cause), and severity.
Condition severity is classified based on an important measurement known as Cobb angle.
A patient’s Cobb angle is taken during X-ray by drawing lines from the tops and bottoms of the curve’s most-tilted vertebrae at its apex, and the intersecting angle is expressed in degrees.
When scoliosis is present, the spine’s biomechanics have been disrupted by the condition’s uneven forces, and the spine is no longer in alignment.
A patient’s Cobb angle tells me how far out of alignment a scoliotic spine is, in addition to classifying conditions based on severity.
The higher a patient’s Cobb angle, the more severe the condition, and the more noticeable its symptoms are likely to be:
As you can see from the range of Cobb angle measurements, scoliosis ranges widely in severity.
Perhaps the most important aspect of scoliosis to understand, however, is its progressive nature, meaning scoliosis is virtually guaranteed to get worse over time.
So where a scoliosis is at the time of diagnosis isn’t indicative of where it will stay, or be in the future; even scoliosis diagnosed as mild can easily progress and become moderate, severe, or very severe, especially if left untreated, or not treated proactively.
Only proactive treatment can work towards counteracting the condition’s progressive nature.
So now that we’ve defined the condition and discussed how it’s classified, let’s discuss the specifics of what it means to have severe scoliosis.
Mild to moderate and severe to very severe are the condition’s severity levels, but they are also the condition’s progressive line.
Being diagnosed with severe scoliosis means that significant progression has already occurred, with a Cobb angle of 40+ degrees.
As mentioned, in addition to being classified based on severity, scoliosis is also classified based on condition type.
The most common type to affect children and adults is idiopathic scoliosis, with adolescent idiopathic scoliosis (AIS), diagnosed between the ages of 10 and 18, being the most prevalent condition type overall.
With AIS, it’s common that in mild forms, it can be difficult to detect, and while there are no treatment guarantees, early detection, when responded to with proactive treatment, does increase chances of treatment success.
If an adolescent is diagnosed with severe scoliosis, its most-noticeable symptoms are likely related to postural deviation, more so than pain, and this is because scoliosis doesn’t become compressive until skeletal maturity has been reached.
So children and adolescents who are still growing don’t commonly find the condition painful, as the constant lengthening motion of growth counteracts the compressive force of the scoliotic curve; compression is the main cause of condition-related pain.
The main symptoms of severe scoliosis in adolescents will be postural deviation:
At the severe level, postural changes are overt, and while most children and adolescents don’t deal with a lot of back and nerve pain due to growth, they do still experience muscle pain.
It’s not just the spine that has to maintain its natural curves and alignment, but also its surrounding muscles that provide it with support/stabilization.
In addition, at the severe level, ill-fitting clothing and changes to gait, balance and coordination are also likely to be overt.
When it comes to adult scoliosis, the two main forms to affect adults are idiopathic and degenerative.
Cases of idiopathic scoliosis in adults are cases of adolescent idiopathic scoliosis that went undiagnosed and untreated during adolescence, and this is a prime example of the dangers of leaving a progressive condition untreated.
As progression occurs, the spine becomes increasingly rigid, making it less responsive to treatment, and more complex to treat, which can lead to a surgical recommendation.
By the time an adult comes in to see me for a diagnosis of severe idiopathic scoliosis, they’ve experienced significant progression over the years, and as a scoliotic curve gets larger, its effects are also becoming increasingly noticeable, particularly pain.
Had these adults received a diagnosis and treatment during adolescence, their spines would be much healthier than by the time I see them; that being said, it’s never too late to start treatment.
The next most-prevalent condition type to affect adults is degenerative scoliosis, and adults with severe degenerative scoliosis have the added issue of natural age-related spinal degeneration to contend with, and if already severe, the treatment process is more complex and tends to focus on pain management and stabilizing the spine.
By now, you’ve likely noticed a repeat theme to this article, which is to get treatment as close to the time of diagnosis as possible; this might seem obvious in light of the condition’s progressive nature, but depending on the type of treatment approach chosen, this is not always the chosen response.
There are two main scoliosis treatment approaches for patients to choose between: traditional and conservative.
For those on the traditional path of traditional scoliosis treatment, a diagnosis of mild scoliosis is commonly met solely with watching and waiting: waiting to see if the condition progresses.
The problem with this is that it’s wasting valuable treatment time; we know that scoliosis is virtually guaranteed to get worse at some point, so why not be proactive and work towards preventing increasing condition severity?
The truth is that traditional treatment doesn’t have a strategy for treating scoliosis while mild so commonly funnels patients towards spinal fusion surgery because little is done to prevent patients from progressing to severe, and once they do, they become surgical candidates.
Spinal fusion is a costly, lengthy, and invasive procedure that can cost the spine in terms of its natural strength and function.
The fusion process generally involves the removal of intervertebral discs between adjacent vertebrae being fused, then fusing the most-tilted vertebrae of the curve into one solid bone and attaching rods to the spine with screws to hold it in place.
The goal of spinal fusion is to stop progression by eliminating movement in the affected spinal section, but this also means losing a degree of spinal strength, flexibility, and range of motion, which can have a profound impact on quality of life.
A fused spine is a fused spine for life, for better or worse. If, for some reason, spinal fusion is unsuccessful at stopping progression, there is no recourse other than more surgery, and the risks only increase with each subsequent surgery and increasing patient age.
Fortunately, the majority of scoliosis cases can be treated non-surgically, and this is where a proactive conservative treatment approach comes in.
Conservative chiropractic-centered treatment is what patients of the Scoliosis Reduction Center benefit from.
I want to spare my patients the hardships associated with progression, increasing condition severity, escalating symptoms, and the need for surgical treatment in the future.
Although scoliosis is progressive, it is highly treatable, and particularly if caught early and treated proactively, there are few limits to what can be achieved.
Here at the Center, through a combination of condition-specific chiropractic care, physical therapy, corrective bracing, and rehabilitation, conditions can be impacted on every level for the best potential results.
The goal of corrective treatment is not just to manage progression, but to actually correct a scoliosis by reducing the size of the unnatural spinal curve, and this is worked towards through chiropractic care.
As a structural spinal condition, scoliosis has to be primarily impacted on a structural level, and if a series of manual adjustments has achieved structural results, I can shift the focus to increasing core strength through physical therapy so the spine is optimally supported by its surrounding muscles.
Corrective bracing is also known to be particularly effective on growing spines, so when it comes to treating children with scoliosis, bracing can help augment corrective results by pushing the spine into a corrective position; when it comes to adult scoliosis, bracing is more for short-term pain relief and stabilizing the spine, rather than corrective results.
In order to ensure long-term sustainable treatment results, a series of custom-prescribed exercises are recommended for establishing a home-rehabilitation program to further stabilize the spine.
While there are no treatment guarantees, a scoliotic spine that’s corrected through proactive conservative treatment means a spine that has as much of its natural curves, alignment, and function as possible restored.
So when it comes to severe scoliosis, we’re talking about an unnatural spinal curve with a Cobb angle measurement of 40+ degrees.
In severe scoliosis, condition symptoms and effects are overt, and if left untreated, patients are at risk for developing complications such as lung impairment and digestive issues.
In addition, the longer scoliosis is left untreated, the more severe it becomes, and the more likely it is that invasive surgical treatment will be recommended.
While spinal fusion can be successful at stopping progression, the procedure’s potential risks, complications, and side effects should be considered carefully.
For those recently diagnosed, the main message I want to convey is don’t hesitate to reach out for guidance and support because it can be the first step on the road to proactive treatment that can greatly improve quality of life.
When responded to proactively, scoliosis doesn’t have to reach the severe level, and patients won’t have a need for invasive surgical treatment.
