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. So whether you have mild scoliosis, moderate scoliosis, or severe scoliosis, the treatment approach will differ based on the severity.
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, diagnosing scoliosis, including conditions like mild scoliosis and cerebral palsy, isn’t always straightforward due to its range of severity levels. Although scoliosis is progressive, meaning it will naturally worsen over time, mild cases, such as those with mild scoliosis, aren’t known to produce a lot of noticeable symptoms and/or functional deficits. This is particularly relevant when scoliosis is diagnosed in its early stages, where symptoms of scoliosis may not be as evident.
In addition, in the condition’s most common form (AIS), it’s not known to be painful. However, the absence of pain, a common symptom of scoliosis in more severe cases, delays the urgent search for diagnosis and treatment. Pain signals something is wrong inside the body, leading to a diagnosis and treatment. Hence, understanding the symptoms of scoliosis, including those related to cerebral palsy and mild scoliosis, is crucial for early intervention.
The spine, crucial for maintaining our structure and facilitating movement, is adversely affected by scoliosis. This condition disrupts the natural spinal curvature, leading to the development of an abnormal spinal curve or curves. A healthy spine's natural curves make it more resilient, flexible, and capable of distributing mechanical stress. However, scoliosis introduces spinal curves that compromise these functions, highlighting the importance of diagnosing spinal curvature early.
Scoliosis, especially when left untreated, results in the progression of spinal curves, which can have a wide range of impacts on the body. From causing uneven forces that lead to postural changes to introducing symptoms of scoliosis such as pain (more common in adults) and mobility issues, the progression of spinal curvature is a significant concern. Additionally, scoliosis diagnosed in conjunction with conditions like mild scoliosis can further complicate the patient's condition.
So, why is scoliosis bad? Primarily because if left untreated, the unnatural curvature, or spinal curve, can increase in size, affecting the body in numerous ways: disrupting balance, coordination, and causing other symptoms of scoliosis to become more pronounced. This includes headaches, changes to gait, postural deviation, and in severe cases, more significant complications like lung impairment and digestive issues.
Another common condition-related question I’m asked is whether or not scoliosis can be cured.
As we have discussed, scoliosis is a progressive condition. While it is a structural condition that cannot be cured in the traditional sense, effective management through proactive scoliosis treatment efforts is possible. This approach aims to counteract the condition’s tendency to worsen over time. By engaging in treatment that impacts scoliosis on a structural level, it's often possible to reduce scoliotic curves, restore as much of the spine's healthy curvature as possible, and improve spinal health and function.
Treating scoliosis involves hard work and commitment, focusing on the condition's structural nature rather than just alleviating its symptoms. This proactive stance is crucial for managing scoliosis and potentially reducing or eliminating related symptoms, such as postural changes and pain. At the Scoliosis Reduction Center, our approach and results achieved through a conservative, chiropractic-centered treatment methodology underscore the importance of active engagement in scoliosis treatment.
Understanding the available scoliosis treatment options is crucial for aligning treatment expectations with potential outcomes. The choice of how to treat scoliosis—whether through conservative means or traditional methods—significantly influences the patient's journey. Traditional treatment methods often lead towards spinal fusion surgery, a significant intervention aimed at halting the progression of the spinal curve. While spinal fusion can address the progression of scoliosis, it comes with risks and a potential loss of flexibility in the lumbar spine and other affected areas.
Spinal fusion surgery, while effective in stopping further progression of scoliosis treated cases, is invasive and involves fusing the most-tilted vertebrae into a single solid bone. This procedure, often motivated by cosmetic concerns, cannot guarantee a return to the body's pre-scoliosis state and may result in a significant reduction in flexibility. Furthermore, once a spine is fused, the decision is irreversible, and any unsatisfactory outcomes may necessitate additional surgeries.
For individuals seeking a less invasive approach or opting out of surgery, conservative, chiropractic-centered scoliosis treatment offers an alternative. This method prioritizes the spine’s overall health and function, aiming for a different potential outcome that avoids the permanence and risks associated with spinal fusion surgery. Such an approach underscores the importance of considering all scoliosis treatment options and the potential they hold for improving the quality of life for those with scoliosis.
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.
