While many patients recently diagnosed with scoliosis feel their condition developed suddenly, the reality is that as a progressive condition, it can be difficult to detect when mild; in most cases, by the time it’s diagnosed, the condition has progressed enough to cause noticeable symptoms, meaning its initial development occurred some time before it was diagnosed.
Scoliosis can develop at any age, but is most commonly diagnosed during adolescence. In addition, different types of scoliosis have different causes, and reasons for developing when they do. From idiopathic to neuromuscular, degenerative and congenital, scoliosis is a highly-prevalent.
There are many spinal conditions a person can develop, so let’s start our discussion of scoliosis development with how the condition is first diagnosed.
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If a healthy spine was viewed from the sides it would have a soft ‘S’ shape, and if viewed from the front and/or back, it would appear straight, and this is due to natural and healthy spinal curves.
There are a number of spinal conditions that involve a loss of the spine’s healthy curves, so in order to be considered a true scoliosis, certain guidelines have to be met.
Being diagnosed with scoliosis means an unnatural lateral (side-to-side) spinal curve has developed, but a scoliotic curve doesn’t just bend unnaturally to the side, it also twists, and it’s the condition’s rotational component that makes scoliosis a complex 3-dimensional condition.
In addition, the unnatural spinal curve has to be of a minimum size to be diagnosed as scoliosis: minimum Cobb angle measurement of 10 degrees.
Cobb angle is a key piece of information because it tells me how far out of alignment a scoliotic spine is, and the measurement is taken during X-ray by drawing lines from the tops and bottoms of the curve’s most-tilted vertebrae; the intersecting lines form an angle that’s expressed in degrees:
A patient’s severity level not only shapes the design of effective treatment plans, it indicates likely symptoms and progressive rates, and as a progressive condition, scoliosis has it in its nature to worsen over time, especially if left untreated.
So when it comes to first detecting the presence of scoliosis, severity is a key variable because when mild, it can be difficult for anyone, other than a specialist trained in recognizing early condition indicators, to notice; in other words, when scoliosis is diagnosed isn’t generally indicative of the condition’s initial onset.
Scoliosis being progressive means, the unnatural spinal curve is virtually guaranteed to increase in size over time, and as scoliosis introduces a lot of uneven forces to the body, those forces will also increase over time, as will their effects.
As a progressive condition, where a scoliosis is at the time of diagnosis is not indicative of where it will stay, and while we don’t always understand what causes scoliosis to develop, we most certainly understand what causes it to progress: growth and development.
Now, as mentioned, scoliosis can affect any age, and there are also different condition types with unique etiologies and development scenarios, so for our current purposes, we’ll focus on the condition’s most-prevalent types: idiopathic, degenerative, neuromuscular, and congenital.
Idiopathic scoliosis is the most common, and the most mysterious, type of scoliosis; this is because idiopathic means not clearly associated with a single-known cause.
Idiopathic scoliosis is generally regarded as multifactorial, meaning caused by multiple variables that can vary from patient to patient.
Idiopathic scoliosis is the most common type to affect children and adults, with adolescent idiopathic scoliosis (AIS) being the most prevalent form overall.
When it comes to addressing who is the most likely to develop scoliosis, the answer is adolescents between the ages of 10 and 18.
As growth and development is the condition’s progressive trigger, adolescents in, or entering into, the stage of puberty are at risk for rapid-phase progression, and this is also why scoliosis can seem to develop suddenly if a large growth spurt triggers significant progression.
The reality, however, is that the condition could have developed long before but was undetected until it progressed and caused more-noticeable symptoms; this is very common and is why the majority of my adolescent patients are in the moderate level because it’s often not until a condition progresses from mild to moderate that it starts to become noticeable.
Adolescent Idiopathic Scoliosis Symptoms
The earliest and telltale signs of AIS are often uneven shoulders and hips, and this is part of the condition’s main symptom of postural deviation, caused by the condition’s uneven forces disrupting the body’s overall symmetry.
In addition, scoliosis development and progression in adolescents can cause:
The aforementioned types of postural deviation can also cause changes to gait, balance, and coordination, as well as clothing suddenly seeming ill-fitting.
AIS also isn’t commonly painful because scoliosis doesn’t become a compressive condition until adulthood, when compression of the spine and its surrounding muscles and nerves can cause varying levels of pain; this is another reason scoliosis in adolescents can develop long before it’s first diagnosed.
Idiopathic Scoliosis Development in Adults
A further testament to the challenge of scoliosis detection is the fact that idiopathic scoliosis is also the main type to affect adults, and these cases are, in fact, cases of AIS that went undiagnosed and untreated all through adolescence, not being diagnosed until the condition became painful in adulthood.
Adults being diagnosed with idiopathic scoliosis in this way is a very-common scenario, and the unfortunate reality is that had these patients been diagnosed and treated during adolescence, their spines would be in far better shape than they are by the time I see them.
So in cases of idiopathic scoliosis in adults, the condition actually developed years before it was finally detected and diagnosed; pain is the main symptom of adult scoliosis, and this is what commonly brings them in for a diagnosis and treatment.
The second most common type to affect adults is degenerative scoliosis, and this condition type develops slowly over time.
Degenerative Scoliosis Development in Adults
When it comes to degenerative scoliosis, we’re talking about scoliosis that affects aging adults and is caused by natural age-related spinal degeneration that occurs over time.
In addition to natural age-related spinal degeneration, certain lifestyle factors can also contribute such as carrying excess weight, low activity levels, chronic poor posture, and repeatedly lifting heavy objects incorrectly.
As the spine starts to degenerate, and it’s often the intervertebral discs that are the first spinal structures to start deteriorating, its ability to maintain its natural curves and alignment is disrupted, causing the development of a scoliotic curve.
Just as the spine degenerates slowly over the years, degenerative scoliosis can also be slow to develop, and once it’s diagnosed, degeneration that’s already occurred can’t necessarily be reversed, but treatment can focus on preserving spinal function and slowing further deterioration.
Neuromuscular Scoliosis
In cases of neuromuscular scoliosis, the scoliosis develops as a secondary complication of a larger neuromuscular condition such as cerebral palsy, spina bifida, or muscular dystrophy.
These patients are complex to treat because the underlying neuromuscular condition has to be the focus of treatment as it’s the underlying cause of the scoliosis.
Scoliosis development in these scenarios is difficult to pinpoint because, again, its development was caused by the presence of another condition.
Neuromuscular scoliosis can affect children, adolescents, and adults.
Congenital Scoliosis
Cases of congenital scoliosis develop quickly as they are caused by a malformation within the spine itself that develops in utero; infants are born with congenital scoliosis.
Spinal malformations can mean one or more vertebrae (bones of the spine) are misshapen and/or vertebral bodies can fail to separate into separate bones, instead becoming fused together.
Congenital scoliosis is a rare form, affecting approximately 1 in 10,000.
When it comes to questions about scoliosis, there are rarely clear-cut answers, and this is because it’s such a complex condition that ranges widely in severity and type.
So when does scoliosis develop? The answer will be case-specific and depend on the patient and condition-type in question.
The reality is that as a progressive condition, it’s extremely common for it to be diagnosed after significant progression has already occurred over time, because in many cases, symptoms of mild scoliosis are difficult to detect.
In the main condition type, adolescent idiopathic scoliosis, the condition isn’t generally painful, nor does it often cause noticeable functional deficits, and when mild, its main symptom of postural deviation can be very subtle.
So in many cases, when scoliosis is first diagnosed isn’t indicative of its initial onset/development.
When diagnosing a patient, a very common question I hear is, “Why do I suddenly have scoliosis?” That answer will vary based on key patient/condition variables, but oftentimes, it didn’t develop suddenly; it just became noticeable suddenly due to progression most often triggered by a growth spurt.
Here at the Scoliosis Reduction Center, I’m proud to work towards increasing scoliosis awareness, particularly regarding its prevalence and early indicators: key to early detection and treatment success.
