Not only is there a wide range of scoliosis severity levels, there are also different types of the condition that can develop, some with unknown causes, and some whose causation is clearly understood. While we might not fully understand the causative source of idiopathic scoliosis, we know how to respond to its development: with proactive treatment that works towards reducing the abnormal spinal curvature on a structural level and stabilizing the spine.
‘Idiopathic’ means a condition’s cause is unknown, so idiopathic scoliosis is not clearly associated with a single-known cause; this is the condition’s most prevalent form. Idiopathic scoliosis is, instead, considered to be multifactorial and requires a proactive and customized treatment approach.
Let’s start our discussion of idiopathic scoliosis, and related treatment options, by first touching on condition types with known causes, plus addressing some common condition-related questions.
As mentioned, there are different types of scoliosis a person can develop, and while patients recently diagnosed want to know what the condition’s main cause is, the answer will vary depending on the condition form in question.
While 80 percent of known diagnosed scoliosis cases are classified as ‘idiopathic’, the remaining 20 percent have known causes, and for a better overall understanding of scoliosis causation, let’s start our discussion of idiopathic scoliosis by first exploring the forms with known causes: neuromuscular, congenital, degenerative, and traumatic.
Neuromuscular scoliosis (NMS) is a condition form that can be particularly challenging to treat; this is because its underlying cause is a neuromuscular disease.
Not everyone with a neuromuscular condition will automatically develop NMS, but it is a common complication, and while there are many neuromuscular conditions and diseases that could lead to the development of neuromuscular scoliosis, some common ones include cerebral palsy, muscular dystrophy, and myelodysplasia.
Neuromuscular conditions can affect the brain-body connection, the muscles, and/or connective tissues that provide the spine with support and stabilization.
According to the American Academy of Orthopaedic Surgeons, NMS causation is understood as a result of the underlying neuromuscular condition that can affect the neurological system, the muscular system, or both.
The severity of NMS can range greatly, but is thought to be driven by the amount of muscle and nerve involvement characteristic of the underlying neurological condition.
I said earlier that this form can be challenging to treat, and this is because it's the neuromuscular condition that has to drive the treatment approach as it’s the underlying cause of the scoliosis development, and this complicates the treatment process.
So we know that the development of NMS is a secondary complication of a more-serious underlying neuromuscular condition.
Congenital scoliosis is a rare form that infants are born with as it develops in utero. Congenital scoliosis affects approximately 1 in 10,000 and is caused by bone malformations within the spine itself.
These malformations can involve the vertebrae (bones of the spine) being misshapen, which can affect the spine’s alignment as it develops, or certain vertebrae failing to form into separate bones and, instead, become fused together.
So in cases of congenital scoliosis, we know the cause is a structural abnormality within the spine itself, related to bone malformations that develop in utero.
In cases of degenerative scoliosis, those affected tend to be adults over the age of 40 who are facing spinal degeneration.
Most commonly, it’s the spine’s intervertebral discs that first start to deteriorate, and while degenerative changes can be a natural part of aging, they can also be related to certain lifestyle choices such as not maintaining a healthy weight, leading a sedentary lifestyle, chronic bad posture, and/or repeatedly lifting heavy objects incorrectly and straining the spine.
When the intervertebral discs start to deteriorate, the spine’s strength, flexibility, structure, and ability to distribute stress is affected, and its capacity to maintain its natural and healthy curvatures is impaired.
So in cases of degenerative scoliosis, we know the condition develops due to the spine facing degenerative changes that impacts its overall health and function.
Traumatic scoliosis completes our discussion of the types of scoliosis with known causes as these cases involve patients whose spines have been exposed to trauma, such as in a car accident or fall.
In these cases, the spine has been injured, impacting its ability to remain aligned, and this can lead to the development of a scoliotic curve.
In addition, the presence of tumors pressing on the spine and exposing it to uneven pressure can also cause the development of traumatic scoliosis.
As the main type of scoliosis is idiopathic, and this type accounts for 80 percent of known diagnosed cases, the cause of the condition’s main form remains unknown; that being said, there are some factors related to idiopathic scoliosis development that we do understand.
For example, idiopathic scoliosis is most commonly diagnosed in adolescents between the ages of 10 and 18, which suggests that its causation could be related to growth and development.
In addition, while there aren’t a lot of differences in how female and male adolescents experience their condition, in terms of prevalence, females are more likely to develop scoliosis; in fact, for every 4 females that develop scoliosis, only one male will.
Also, in cases of 30+ degree curvatures, females are 10 times more likely than males to experience progression.
While the cause of adolescent idiopathic scoliosis, both in female and male adolescents, is unknown, one theory attempts to account for the higher condition prevalence in females in relation to growth.
Adolescent females tend to reach the start of puberty faster than males, meaning their growth spurts also tend to start earlier and are more rapid in nature, and as we know that growth is the condition’s number-one trigger for progression, this theory is generally accepted.
While adolescent idiopathic scoliosis is the condition’s most common form, which is why scoliosis is so commonly regarded as a child and adolescent condition, it also affects adults.
In cases of adult idiopathic scoliosis, we know the condition doesn’t develop fresh in adulthood with no prior history; instead, these cases are continuations of AIS that were undiagnosed and untreated during adolescence, and it wasn’t until skeletal maturity had been reached that the conditions started to produce more noticeable symptoms that led to a diagnosis.
Whether scoliosis is genetic or not is another common causation-related question, but despite the prevalence of the condition, plus the amount of research and studies done in search of that ‘scoliosis gene’, or genetic mutation, that can account for its development, it has yet to be clearly identified.
In general, scoliosis is considered ‘familial’ as having a family history does increase the likelihood of developing scoliosis, but this is not the same as a ‘genetic’ classification, and remember, families share a lot more than just their genes; they share common lifestyles, posture, diet, responses to stress, socioeconomic factors, geographical locations, and more.
There have also been multiple links found between the development of idiopathic scoliosis and body mass, certain vitamin deficiencies (vitamin D), issues of bone formation, and more, but the majority of these links are more indirect than direct, and study findings reveal the need for more conclusive research.
Despite the many current theories of AIS causation, we still have not clearly identified a single-known source that accounts for its initial development.
So to clearly answer the question, what is the main cause of scoliosis, quite simply, as its most prevalent form is idiopathic, we have yet to clearly identify a single causative source.
What we do know, however, is how to respond once the condition has developed, and as scoliosis is progressive, meaning it will get worse over time, especially if left untreated, how a condition is addressed is crucial.
Another common question I’m asked is, “Can adolescent idiopathic scoliosis be prevented?”
When a patient is first diagnosed, they understandably have a lot of questions. One of the first questions I hear is from a lot of parents wanting to know if their child’s AIS could have been prevented.
One of the reasons so much time and effort is expended in the search for pinpointing a condition’s causative source is in the interest of prevention. If we clearly know what factors lead to a condition’s development, it’s likely that more can be done in terms of controlling those factors in the interest of prevention.
Unfortunately, as is the case with idiopathic scoliosis, we don’t have those answers, so I can’t give guidance on how to prevent the condition, but I can most certainly lead the charge when it comes to responding proactively to the condition’s development.
Another common question I’m asked is if idiopathic scoliosis can be cured.
It’s hard to explain that we simply don’t know why idiopathic scoliosis develops, and it’s equally difficult to explain that it also can’t be cured; however, that doesn’t mean it can’t be treated and managed effectively so patients can continue living their best lives.
Scoliosis is a structural and progressive condition, meaning the spine has a structural abnormality that needs to be addressed with treatment. While we can work towards reducing the abnormal spinal curvature, its natural tendency will be to increase in size over time, at rates that differ from one patient to the next.
One of the goals of treatment is to counteract the condition’s progressive tendency, and even when treatment is successful in terms of staying ahead of a patient’s progressive line and impacting the condition on a structural level, work will still need to be done to sustain those results.
I also have to point out that countless individuals have gone on to live extraordinary lives and achieve their dreams, despite living with scoliosis.
Usain Bolt, for example, holder of the Olympic title of the world’s fastest man, has scoliosis but went on to fulfill a dream and achieve something most people, with or without scoliosis, could not.
So while the answers to some of these common condition-related questions are not exactly what patients, and their families, want to hear, having scoliosis doesn’t have to define a person, nor limit their life’s passions or goals, especially if proactive treatment is applied.
When a person receives an idiopathic scoliosis diagnosis, they are facing an important fork in the road along their journey of life with the condition.
Something I always want patients, and their families, to be fully aware of is that there are different treatment options available to them, and that different treatment approaches offer patients different potential outcomes.
While a traditional approach to scoliosis treatment is still a popular choice, it has changed little over the years, despite advancements made in our understanding of the condition, including how to manage the condition proactively without the need for invasive spinal-fusion surgery.
The two main scoliosis treatment approaches are traditional and chiropractic-centered. The former involves mainly watching and waiting while a condition is mild, to monitor its progression, but it does not believe in proactive treatment initiated as close to the time of diagnosis as possible; the latter is also referred to as a ‘conservative’ treatment approach, and this is the approach I offer my Scoliosis Reduction Center patients.
Here at the Center, I believe that being proactive can spare patients a lot of the hardships associated with increasing condition severity and more invasive forms of treatment.
For those interested in trying a more modern and synergistic approach to scoliosis treatment, or who choose to forego a surgical recommendation, my results speak for themselves.
As I value the benefits of an integrative approach to treatment, I combine multiple treatment disciplines to craft the most effective and customized treatment plans possible.
All treatment disciplines are scoliosis-specific and include chiropractic care, in-office therapy, custom-prescribed home exercises, and corrective bracing. Through the combining of these disciplines, I can apportion them accordingly based on how a patient’s spine is responding to treatment.
Especially in cases of AIS, being proactive is crucial because this age group is at risk for rapid-phase progression due to the intense stage of growth and development they are in, or entering into.
When it comes to treating AIS, I want to stabilize the spine and reduce scoliotic curves on a structural level, or hold them where they are throughout the stage of puberty, and once skeletal maturity has been reached, we can adjust the treatment plan as the trigger for rapid progression (growth) has been removed.
As is the case with health in general, being proactive is key. While we can’t always prevent the development of certain conditions, like idiopathic scoliosis, we can certainly respond to them proactively once they have developed.
As ‘idiopathic’ means a condition has no known cause, idiopathic scoliosis is considered, instead, to be multifactorial: caused by several variables that can differ from person to person.
While a lot of effort has been made in the interest of identifying a single-known cause for idiopathic scoliosis, and despite the prevalence of multiple theories involving genetics, body mass, bone formation, and vitamin deficiencies, the links identified are more indirect than direct, and the main condition form remains classified as ‘idiopathic’.
Here at the Center, I work closely with my patients to engage them in the treatment process, not only because this is important in terms of results, but also in terms of mental health; being diagnosed with a progressive and incurable spinal condition can be difficult to process, and feeling a loss of control can be challenging. As patients work towards improvements and see results, those negative emotions can be replaced by feelings of empowerment and motivation.
While no treatment results are guaranteed, together, we can impact conditions on a structural level by working towards reducing the abnormal spinal curvature and increasing core strength so the spine is better supported and stabilized.
The chiropractic-centered treatment approach I offer patients of the Center values the application of multiple treatment disciplines that are combined to complement one another and impact the condition on multiple levels.
Although I don’t fully understand the etiology of idiopathic scoliosis, I most certainly know how to respond to it proactively and manage its progression effectively; in doing so, I can help patients regain feelings of control and mastery over their bodies, their conditions, and their lives moving forward.
For a better understanding of idiopathic scoliosis and related treatment options, don’t hesitate to reach out to the Scoliosis Reduction Center for guidance and support.