Part of the reason scoliosis is so often described as complex is not just because of the condition’s wide severity-level range, but also because there are multiple types of scoliosis a person can develop. While 80 percent of known diagnosed cases are classified as idiopathic, the remaining 20 percent are condition types associated with known causes. Keep reading for a better understanding of the condition’s etiology, and the specifics of what it means to be diagnosed with adolescent idiopathic scoliosis.
While there are different types of scoliosis, adolescent idiopathic scoliosis (AIS) is the most prevalent. It’s diagnosed in adolescents between the ages of 10 and 18, and the idiopathic classification means it is not associated with a single-known cause and is considered to be multifactorial.
Let’s start our discussion of adolescent idiopathic scoliosis by first breaking down the term and what it means.
As mentioned, 80 percent of known diagnosed scoliosis cases are classified as idiopathic, but what does that mean?
Idiopathic is a medical term that means no single-known cause, meaning that despite efforts made to fully understand the causation of idiopathic scoliosis, a single causative source has yet to be identified.
Instead, idiopathic scoliosis is thought to be multifactorial, meaning caused by multiple variables that can vary from one person to the next. So idiopathic is not the same as a complete absence of cause, but instead is regarded as having multiple potential causative sources.
As 80 percent of known diagnosed scoliosis cases are idiopathic, the remaining 20 percent is made up of condition types associated with known causes: neuromuscular, congenital, degenerative, and traumatic.
With an adolescent idiopathic scoliosis diagnosis, this means that an adolescent between the ages of 10 and 18 has been diagnosed with idiopathic scoliosis: the condition’s most prevalent form.
When I give patients an AIS diagnosis, I’m met with some common questions, one of which is asking how much worse a condition can get. This is a difficult question to answer because while scoliosis is highly manageable through proactive treatment, it’s impossible to predict, with 100-percent accuracy, how much worse a patient’s condition will get, as well as how their spine will respond to treatment.
One of the defining characteristics of scoliosis is its progressive nature. When a condition is classified as progressive, this means it’s in its nature to worsen over time, especially if left untreated, or not treated proactively.
So, does idiopathic scoliosis get worse? Yes. While different patient and condition characteristics such as age, condition type (cause, if known), curvature location/pattern, and condition severity factor into a patient’s progressive rate, at some point, virtually all cases of scoliosis are going to get worse, which is why being proactive is key when it comes to managing the condition effectively.
In addition to the condition’s progressive nature, it’s also important to understand what triggers a patient’s condition to progress, and while we don’t fully understand idiopathic scoliosis causation, we do understand it’s number one progressive trigger: growth.
So for adolescents who are in, or are entering into, the stage of puberty characterized by rapid and unpredictable growth spurts, this age group is at risk for rapid-phase progression, which is why proactive treatment is so important, particularly for AIS.
I should also mention that while idiopathic scoliosis is far more prevalent amongst adolescents, adults can be affected by it too, but in cases of idiopathic scoliosis in adults, these are instances of AIS that went undiagnosed and untreated during adolescence, and progressed into maturity.
In fact, idiopathic scoliosis is the most common type to be diagnosed in adults, followed by degenerative scoliosis.
In these cases, AIS didn’t produce noticeable symptoms during adolescence, which is quite common, and it’s not until reaching skeletal maturity that the condition became compressive and started to cause more noticeable symptoms, such as pain and postural changes.
Adolescent idiopathic scoliosis isn’t commonly described as painful, and this is because while the body is still growing, the spine is experiencing a lengthening motion, and this counteracts the condition-related compression, known to be the main cause of pain.
Once a person reaches skeletal maturity, the condition becomes compressive, and this can be felt by the spine itself, as well as its surrounding muscles and nerves.
After explaining the condition’s progressive nature, one thing I do comfort AIS patients with is the knowledge that proactive treatment can counteract that progressive tendency and be managed effectively.
When it comes to treatment options for adolescent idiopathic scoliosis, this is an important choice that can have far-reaching consequences.
While the fact that there are more treatment options available to scoliosis patients than ever before is a positive thing, it also means putting the onus of fully understanding the different options in the hands of the patients, and their families.
When it comes to deciding on which scoliosis treatment approach to commit to, what I want for every patient is to fully understand not just the different options available to them, but what the different approaches offer in terms of potential results and quality of life.
There are two main scoliosis treatment approaches for patients to choose between: conservative and traditional.
Here at the Scoliosis Reduction Center, I apply a conservative chiropractic-centered approach that prioritizes the spine’s overall health and function throughout treatment and beyond.
I believe in starting proactive treatment as close to the time of diagnosis as possible, especially with my AIS patients, as I know they are likely to face progression due to growth and development.
While early detection and proactive treatment can’t guarantee successful results, it certainly increases the chances of reaching a positive outcome.
As scoliosis is progressive, it’s crucial to understand that where a condition is at the time of diagnosis is not indicative of where it will stay; scoliosis is not a static condition. Part of treatment involves monitoring conditions closely to see just how fast they are progressing, and adjusting the treatment plan accordingly to counteract that progressive rate.
Based on a patient’s Cobb angle, we know how severe a patient’s condition is, but that severity level can change quickly, especially when rapid growth spurts are involved, as they can be with AIS.
Cobb angle is a measurement obtained during X-ray that draws intersecting lines from the tops and bottoms of the curvature’s most-tilted vertebrae (bones of the spine) at the apex of the curve. This involves multiple vertebrae and places a condition on its severity scale:
As you can see, there is a wide range of severity levels, and even conditions that start out as mild can easily move up that natural progressive line and become more severe, especially if treatment isn’t applied.
Here at the Center, I combine multiple scoliosis-specific treatment disciplines for a customized and integrative approach: chiropractic care, in-office therapy, custom-prescribed home exercises, and ultra-corrective bracing.
Throughout the treatment process, I can apportion each discipline accordingly based on the specific needs of the patient, their condition, and how their spine is responding to treatment.
First and foremost, I want to impact the condition on a structural level by reducing the abnormal spinal curve, and I also want to work towards increasing core strength so the muscles surrounding the spine are strengthened, as this means optimal support and stabilization for the scoliotic spine.
As mentioned, there is another scoliosis treatment approach for patients, and their families, to consider: traditional.
It’s important for patients, and their families, to understand that although the traditional approach to scoliosis treatment was the dominant one for many years, it can funnel patients towards spinal-fusion surgery, and this can produce a very different type of treatment outcome and quality of life.
What the traditional approach commonly does, when it comes to AIS, is if a condition is diagnosed as mild, the patient is told to watch and wait to see if/how much it progresses. It’s not until a mild condition progresses into the moderate severity level that a traditional approach will apply treatment, in the form of scoliosis bracing.
With watching and waiting, patients are commonly told to return for assessment at periodic intervals of every 3, 6, or even 12 months, depending on the doctor, and this can be problematic if a patient has a significant growth spurt in between check ups.
Once a condition has progressed, it becomes more complex to treat, the spine tends to become more rigid, and the body has had more time to adjust to the presence of the unhealthy spinal curve.
While there is no harm in reducing a mild curve to smaller, there most certainly is harm associated with allowing a scoliotic curve to progress unimpeded and requiring more invasive treatment.
It’s through this watching-and-waiting approach that many patients are funneled towards spinal fusion: nothing proactive was done to prevent further progression, and then once conditions progress past that surgical-level threshold, they are told that spinal fusion is the best option.
Also commonly called scoliosis surgery, spinal fusion involves fusing the most-tilted vertebrae together to form one solid bone; this is done to address the main goal of traditional treatment, stopping progression, but that is not the same as working towards corrective results.
Once the vertebrae are fused, rods are commonly attached to the spine with screws to hold the spine in place. While spinal fusion can be successful in terms of straightening and stabilizing a scoliotic spine, it can come at a high cost.
While no surgical procedure is without its share of risks and side effects, spinal fusion is a costly and lengthy procedure that carries a long list of potential complications and side effects, and I want patients to understand that not every scoliosis journey has to end with surgery.
One of the most noticeable outcomes of spinal fusion is a loss in spinal flexibility. While not all patients who have undergone spinal fusion experience a mobility loss, studies have shown that the more vertebrae involved in the fusion, the more likely it is that a loss of spinal flexibility will occur.
Fusing the most-tilted vertebrae together can eliminate progression, but it does this by eliminating movement, which affects the natural mobility of the spine, and depending on the level of mobility loss, this can greatly impact quality of life.
In addition, people with a fused spine are more prone to injury due to trauma such as in a car accident or fall. Instead of the force of the trauma being transferred to the spine, as it’s supposed to be, it’s transferred to the rigid poles attached to the spine, and this can lead to spinal injury.
So, can spinal fusion treat adolescent idiopathic scoliosis? Yes, it can, but it’s a form of treatment that’s invasive in nature, so can produce different results for different people, and performing spinal fusion on a growing spine is not always ideal.
I want people to be aware that not all forms of treatment are as invasive as surgery, and not all forms of treatment have to come at the expense of the spine’s overall health and function. For those that are interested in a more natural approach to AIS treatment and/or have chosen to forgo a surgical recommendation, there are other effective treatment options available.
Another common question I’m met with, especially for people who are wanting to take a passive approach and not engage in proactive treatment, is whether or not adolescent idiopathic scoliosis goes away on its own.
This is a complicated question with an equally-complex answer. As mentioned, scoliosis is progressive in nature and incurable. When a person is diagnosed with scoliosis, it’s a condition they will have for life, but whether or not a person’s scoliosis takes a leading role, or a minor one, in their life will largely depend on treatment outcome.
If it’s treated proactively by an approach known to preserve the spine’s overall health and function, such as the conservative approach I use at the Center, scoliosis doesn’t have to define a person, or even be a huge part of their life, once it’s been proactively addressed and treated.
However, as scoliosis is progressive and incurable, even if the most intense portion of treatment is completed and achieves corrective results in the form of a curvature reduction and an optimally supported/stabilized spine, work still has to be done to sustain those results.
In addition, the most common form of scoliosis to affect adults is idiopathic, which is a continuation of undiagnosed and untreated cases of AIS, so you can see what happens if cases of AIS are left alone: they tend to get worse over time and as severity increases, so too can related symptoms.
So to clearly answer the question of what is adolescent idiopathic scoliosis, and what does it mean: AIS is an abnormal sideways spinal curvature, with rotation, and a minimum Cobb angle measurement of 10 degrees, diagnosed in adolescents between the ages of 10 and 18, with no single-known cause.
While there are types of scoliosis with known causes that are neuromuscular, congenital, degenerative, and traumatic, this only accounts for 20 percent of known diagnosed cases, while the other 80 percent are classified as idiopathic.
What it means to have adolescent idiopathic scoliosis is that rapid-phase progression can be a factor because although we don’t fully understand the condition’s causation, we most certainly understand what causes it to progress: growth.
As adolescents have a lot of growth and development to go through, part of treatment efficacy has to include counteracting the condition’s natural tendency to progress with growth, and working towards staying ahead of each patient’s progressive line.
While knowing a condition’s causation can help guide the design of treatment plans moving forward, in the case of idiopathic scoliosis, once a condition becomes structural, knowing the cause wouldn’t necessarily change the course of treatment, nor its outcome.
Here at the Scoliosis Reduction Center, our results speak for themselves. I’ve helped numerous young patients make it through the stage of puberty without significant progression and have done so without the need for more-invasive forms of treatment.