Scoliosis is a highly-prevalent spinal condition currently affecting approximately 7 million Americans. There are multiple types of scoliosis, and causation will depend on the type in question; however, 80 percent of known scoliosis cases are idiopathic, meaning there is no single known cause.
The term ‘scoliosis’ is Greek for ‘crooked’, but scoliosis is more complex than just a crooked spine; it’s an abnormal sideways spinal curve, with rotation, and a minimum Cobb angle measurement of 10 degrees. The majority of scoliosis cases are idiopathic, meaning there is no single-known cause.
Part of the reason scoliosis is often described as a ‘mysterious’ condition is because its causation is not fully understood, at least not in the condition’s most prevalent form. Before we move on to what ‘idiopathic’ means and answer some common questions, let’s discuss what parameters must be met to reach a scoliosis diagnosis.
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For a person to be diagnosed with scoliosis, certain parameters have to be met. Scoliosis is more than just a crooked spine; it’s an abnormal sideways curvature of the spine that also rotates and is of a certain size.
The size of a scoliotic curve is determined by a measurement known as ‘Cobb angle’ and is taken during X-ray as needed.
A patient’s Cobb angle tells me how far out of alignment a scoliotic spine has become, and is determined by drawing intersecting lines from the tops and bottoms of the curvature’s most-tilted vertebrae (bones of the spine). This involves multiple vertebrae and places a condition on its severity on a scale ranging from mild, moderate, severe, or very severe.
From the wide range of Cobb angle measurements, you can see what a highly-variable condition scoliosis is, which is why fully customizing treatment plans is so important.
The fact that a scoliotic curve doesn’t just bend to the side, but also twists, is the rotational component that makes it a 3-dimensional condition, and effective treatment has to address the condition’s 3-dimensional nature.
One of the hardest things about giving patients a scoliosis diagnosis is explaining that, in many cases, we simply don’t know why the condition initially develops, so let’s talk about the different types of scoliosis with unknown, and known, causes.
When I diagnose an individual with scoliosis, one of the most common questions I’m asked is what caused the condition, and the answer varies based on the form of scoliosis diagnosed.
The most prevalent type of scoliosis is ‘idiopathic’, meaning the condition is not associated with a single-known cause. 80% percent of known diagnosed cases are idiopathic, and this includes adolescent idiopathic scoliosis (AIS), which is the condition’s most-prevalent form, and also idiopathic scoliosis in adults.
Idiopathic scoliosis is considered to be ‘multifactorial’, meaning caused by multiple variables that can vary from one person to the next.
So in the condition’s main form (AIS), its causation is not fully understood, although there is no shortage of theories attempting to explain its etiology; these theories claim connections between idiopathic scoliosis and genetics, body mass, bone formation, vitamin D deficiency, and many more.
Although studies have found links between the development of idiopathic scoliosis and the aforementioned variables, they are more indirect than direct, and have also revealed the need for further research and more-conclusive evidence.
So if idiopathic scoliosis accounts for 80 percent of cases, what makes up the other 20 percent?
As mentioned, there are different types of scoliosis that can develop, and while the majority of scoliosis cases are idiopathic, there are some with known causes: neuromuscular, congenital, degenerative, and traumatic.
My neuromuscular scoliosis (NMS) patients are among the most challenging to treat, and this is because the scoliosis develops as a secondary complication of a larger neuromuscular condition, and it's the underlying neuromuscular condition that has to guide the treatment approach.
While there are many neuromuscular conditions/diseases that can lead to the development of neuromuscular scoliosis, cerebral palsy, muscular dystrophy, and myelodysplasia are common ones. These types of neuromuscular conditions can affect the brain-body connection and/or the muscular system and tissues that affect the spine.
While not every neuromuscular condition will lead to scoliosis, it is a common complication.
In cases of congenital scoliosis, we know the condition’s cause is a malformation within the spine itself that develops in utero as infants are born with the condition.
This form is rare and affects approximately 1 in 10,000 infants. We know the cause is a structural abnormality within the spine with congenital scoliosis, such as misshapen vertebrae or multiple vertebrae that become fused together instead of forming separate and distinct bones.
After idiopathic scoliosis in the adult, which is a continuation of AIS that remained undiagnosed and untreated in adolescence, degenerative scoliosis is the most common type to affect adults.
Degenerative scoliosis is caused by degenerative changes to the spine that compromise its ability to maintain its natural and healthy curvatures and alignment.
While spinal degeneration can be a natural part of aging, the cumulative effect of certain negative lifestyle choices can also contribute to it. Not maintaining a healthy weight, leading a sedentary lifestyle, chronic poor posture, and repeatedly lifting heavy objects incorrectly are a few of the most common spinal degeneration causes.
It’s most commonly the spine’s intervertebral discs that start to deteriorate first. The discs perform many important functions, including giving the spine structure, providing cushioning between adjacent vertebrae, and acting as shock absorbers: absorbing and distributing mechanical stress that’s incurred during movement.
When the discs start to deteriorate, they can become dehydrated and lose height, and this change can impact the spine’s structure and cause it to become misaligned and develop a scoliotic curve.
As the name indicates, traumatic scoliosis is caused by a trauma experienced by the spine, such as a car accident or fall.
In addition, the presence of spinal tumors pressing on the spine can force it out of alignment and cause the development of a scoliotic curve.
So now that we have touched on the different causes associated with the different types of scoliosis, let’s address a common condition-related question: “Why is scoliosis bad?”
As you may or may not know, scoliosis isn’t always easy to diagnose. This is because there is such a range of severity levels. Although scoliosis is progressive, meaning it will naturally worsen over time, mild cases aren’t known to produce a lot of noticeable symptoms and/or functional deficits.
In addition, in the condition’s most common form (AIS), it’s not known to be painful, and while no one wants to experience any form of condition-related pain, it does serve a purpose: it signals that something is wrong inside the body, and pain commonly leads to a diagnosis and treatment.
So why exactly is scoliosis bad, especially if mild cases can go unnoticed for so many years?
The spine is an important part of human anatomy; it provides the body with structure, allows us to stand upright, practice good posture, balance, and move. The spine also works in tandem with the brain to form the body’s central nervous system (CNS).
If a healthy spine is viewed from the side, it appears to have a soft ‘S’ shape, and when viewed from the front and back, it appears straight.
The spine’s natural curves make it stronger, more flexible and facilitate its ability to distribute mechanical stress evenly so no one section of the spine is exposed to uneven wear.
The development of scoliosis means there is a loss of the spine’s healthy curves as an unnatural curvature develops, and this disrupts the spine’s overall biomechanics.
In a healthy spine, its vertebrae are rectangular in shape and stacked on top of one another in a healthy and neutral alignment; as a scoliotic curve develops, the spine becomes misaligned, and this can cause postural changes, pain (more common in adults), and introduces a lot of uneven forces to the body.
In addition, as scoliosis is progressive, the abnormal curvature is virtually guaranteed to increase in size over time, especially if left untreated or not treated proactively. As every patient will have their own progressive rate, based on a number of important patient and condition characteristics, proactive treatment has to stay ahead of a patient’s progressive line and counteract that progressive nature.
So why is scoliosis bad? Because if left untreated, the unnatural curvature can increase in size, and this can affect the body in numerous ways: disrupting balance, coordination, causing headaches, changes to gait, postural deviation, and in severe cases, lung impairment, digestive issues, mobility issues, and more complications can arise.
As scoliosis introduces uneven forces to the body, this is why it can cause so many postural changes related to the body’s overall symmetry, including uneven shoulders and hips, and as a condition worsens, its symptoms tend to get more noticeable.
A scoliotic curve doesn’t just affect the spine, but also its surrounding muscles and nerves, and compression of the spine and its surroundings can cause varying levels of pain in adults who have reached skeletal maturity; children and adolescents are still growing, so their spines are not as vulnerable to the compressive force of the curvature, which is why the condition isn’t commonly painful for children and adolescents.
So scoliosis is bad because it’s progressive, structural, and can affect the body in multiple ways, and if left untreated, the condition can increase in severity and become more complex to treat.
Another common condition-related question I’m asked is whether or not scoliosis can be cured.
As we have addressed, scoliosis is progressive, but is it curable? Scoliosis is a structural condition that is incurable, thus proactive treatment efforts have to be made to counteract the condition’s nature to worsen over time, but that doesn’t mean it can’t be managed effectively.
With a proactive treatment that impacts the condition on a structural level, scoliotic curves can often be reduced, and as much of the spine’s healthy curvatures as possible can be restored, improving the spine’s overall health and function.
While working towards these changes takes a lot of hard work and commitment, treating the condition itself, and not just its symptoms, means proactively addressing its underlying structural nature, and this is also the best way to work towards reducing/eliminating related symptoms such as postural changes and pain.
While no treatment results can ever be guaranteed, here at the Scoliosis Reduction Center, our results speak for themselves and are achieved through the implementation of a conservative chiropractic-centered treatment approach; however, even when a curvature has been reduced significantly, efforts still have to be made to sustain those results, and this can include at-home exercises and continued chiropractic care.
For idiopathic scoliosis patients, it can be difficult to hear that we don’t fully understand the cause of its initial development, but that doesn’t mean it can’t be managed and treated effectively.
That being said, the choice of how to treat scoliosis is extremely important as different treatment approaches offer patients different potential outcomes. I encourage patients, and their families, to fully research all the treatment options available to them; this is important to ensure the realities of potential treatment results are aligned with treatment expectations.
There are two main scoliosis treatment approaches for patients to choose between: conservative and traditional. While a conservative approach has correction as its end goal, the traditional path of scoliosis treatment focuses on slowing/stopping progression, and the way this end goal is achieved can result in patients being funneled towards spinal-fusion surgery.
While any surgical procedure comes with its share of risks, spinal fusion is a lengthy and invasive procedure that involves fusing the curvature’s most-tilted vertebrae into one solid bone; while this can stop further progression, that result can never be guaranteed, and often, there is a significant loss in the affected area’s level of flexibility.
In addition, it’s often cosmetics that motivate people to undergo the procedure, but many patients are disappointed that the surgery can’t return their body to its natural pre-scoliosis state.
Once a spine is fused, there is no going back, and if surgery is considered unsuccessful, there is no recourse other than subsequent surgeries.
For those interested in a less-invasive and more natural treatment approach, or choose to forgo a surgical recommendation for other reasons, a conservative chiropractic-centered approach can offer a different potential outcome by prioritizing the spine’s overall health and function.
While the term ‘scoliosis’ means ‘crooked’, I feel when most people ask what scoliosis means, they are referring to what it means to have the condition.
As an abnormal sideways spinal curvature, scoliosis means having a spine that is not just crooked, but also rotates, making it a 3-dimensional condition.
Scoliosis is structural and progressive, meaning its very nature is to worsen over time, especially if left untreated, or not treated proactively.
The main cause of scoliosis, in relation to the main form of scoliosis, is idiopathic, meaning that in cases of adolescent idiopathic scoliosis, its etiology is not fully understood.
While idiopathic scoliosis is not associated with a single-known cause, it is, instead, considered to be multifactorial.
Idiopathic scoliosis accounts for 80 percent of known diagnosed cases, and the remaining 20 percent have known causes that are neuromuscular, congenital, degenerative, or traumatic.
While causation guides the crafting of treatment plans with condition types that have known causes, with idiopathic scoliosis, as causation is unknown, once the condition has developed and become structural, knowing its cause wouldn’t necessarily change the course of treatment, or increase chances of treatment success.
Here at the Scoliosis Reduction Center, I integrate multiple scoliosis-specific treatment disciplines so I can craft the most customized and effective treatment plans possible. I use a conservative chiropractic-centered approach to addressing the underlying structural nature of the condition and its related symptoms.