Scoliosis has been around for centuries and is a highly-prevalent spinal condition with approximately close to seven million people living with it in the United States alone. In addition, it is the leading spinal condition in school-aged children. When it comes to treatment, patients have two main approaches to choose between; continue reading to learn more.
Scoliosis of the spine is an unnatural sideways spinal curve, with rotation. It ranges greatly in severity, and the main symptom in adolescents is postural deviation, while the main symptom in adults is pain. There are multiple condition types, and treatment needs will be case-specific.
Let’s start our comprehensive exploration of scoliosis by first defining the condition and the parameters that have to be met to reach a diagnosis.
What is Scoliosis?
Scoliosis involves the development of an unnatural sideways spinal curve, with rotation, and a minimum Cobb angle measurement of 10 degrees.
A patient’s Cobb angle is taken during X-ray and involves the drawing of lines from the tops and bottoms of the most-tilted vertebrae at the apex of the curve; the intersecting angle is expressed in degrees and places conditions on a severity scale:
- Mild scoliosis: Cobb angle measurement of between 10 and 25 degrees
- Moderate scoliosis: Cobb angle measurement of between 25 and 40 degrees
- Severe scoliosis: Cobb angle measurement of 40+ degrees
- Very-severe scoliosis: Cobb angle measurement of 80+ degrees
As you can see from the range of Cobb angle measurements, the condition is highly variable, which is one of the reasons a customized treatment approach is necessary.
So when degrees scoliosis is mentioned, this is most often referring to condition severity as a patient’s Cobb angle measurement determines it.
The rotational component of scoliosis means that not only does the spine bend unnaturally to the side, but it also twists from front to back, back to front, making it a 3-dimensional condition.
It should also be said that as a progressive condition, scoliosis has, in its very nature to worsen over time, particularly if left untreated or not treated proactively; a patient’s progressive rate is an important factor in treatment.
Where a scoliosis is at the time of diagnosis is not indicative of where it will stay, and only effective treatment can prevent a mild condition from becoming moderate, severe, or very severe.
We want to prevent progression because that means the unnatural spinal curve is getting bigger, the spine is getting more rigid and less responsive to treatment, condition severity is increasing, symptoms are likely to escalate, and the body is getting more and more used to the unnatural spinal curve’s presence; put simply, scoliosis is far easier to treat when it’s mild.
The Spine’s Natural Curves
If the spine develops an unnatural spinal curve, it can cause a myriad of effects felt throughout the body.
The human spine allows us to stand upright, practice good posture, and move and bend, and it also works in tandem with the brain to form the body’s central nervous system (CNS).
When a healthy spine is viewed from the sides, it will have a soft ‘S’ shape, and when viewed from the front or back, it will appear straight; this is due to the spine’s natural curves that make it more flexible, stronger, and able to absorb stress, like a coiled spring.
The spine has three main spinal sections: cervical (neck), thoracic (middle/upper back), and lumbar (lower back).
Each of the spine’s main sections has its own characteristic curvature type, known as lordosis and kyphosis; lordotic curves bend inwards, towards the body’s center, at the cervical and lumbar sections, while the thoracic spine features a kyphotic curve that bends outwards, away from the body’s center.
There is a natural range of curvature degree at each spinal section, but if that range falls beyond a normal level, or a condition like scoliosis has disrupted one or more of the spine’s natural curves, problems can occur.
So now that we’ve talked generally about the condition and what makes scoliosis, scoliosis, let’s talk about the different types, determined by causation.
Different Types of Scoliosis
Part of the reason scoliosis is so often referred to as a difficult condition to treat is because it has multiple condition types, each with its own unique symptoms and treatment needs.
The most prevalent type of scoliosis is adolescent idiopathic scoliosis (AIS), diagnosed between the ages of 10 and 18.
Each case of scoliosis is unique, but the following are some of the most common symptoms of AIS, related to the uneven forces scoliosis introduces and how they can disrupt the body’s overall symmetry:
- Uneven hips
- Uneven shoulders
- Uneven shoulder blades
- The development of a rib arch
- An uneven waistline
- Arms and legs that appear to hang at different lengths
- Ill-fitting clothing
- Changes to balance, coordination, and gait
The idiopathic classification means that its initial cause is unknown, but while we don’t fully understand its etiology, we know how to treat it effectively, plus knowing its causes wouldn’t necessarily change the course of treatment, or its outcome, and we know what triggers its progression: growth and development.
Young patients who have not yet reached skeletal maturity are at risk for rapid-phase progression due to growth and development, which is why monitoring for growth/progression is so important in the management of scoliosis in children and adolescents.
Treatment for AIS involves working to stay ahead of a condition’s progressive line by monitoring patients for growth and progression, applying condition-specific chiropractic care, in-office therapy, custom-prescribed home exercises, and corrective bracing.
The different treatment disciplines complement one another and augment corrective results.
Approximately 80 percent of known diagnosed scoliosis cases are classified as idiopathic, and the remaining 20 percent are associated with known causes: neuromuscular, congenital, degenerative, and traumatic.
Neuromuscular Scoliosis
Neuromuscular scoliosis is the most complex type because the scoliosis was caused by the presence of a larger neuromuscular condition such as cerebral palsy, muscular dystrophy, or spina bifida, to name a few.
In these types of cases, the larger neuromuscular condition has caused a disconnect between the brain and the muscles and connective tissues that support the spine.
There are varying levels of severity related to the degree of nerve involvement; as the spine is part of the CNS, it helps transmit signals and messages throughout the body, and when a condition impairs the spine’s surrounding muscles and nerves, their ability to support the spine and trunk is disrupted, hence the development of an unnatural sideways spinal curve.
While not everyone with a neuromuscular condition is guaranteed to develop scoliosis, it is a common complication, with symptoms varying from patient to patient, but commonly including movement and balance impairment, with the potential of causing patients to become non-ambulatory (wheelchair-bound).
When it comes to neuromuscular scoliosis treatment, the scoliosis developed as a secondary complication of a larger medical issue, so the underlying cause, the neuromuscular condition itself, has to be the focus of treatment.
So, before the scoliosis is even addressed, the neuromuscular condition has to be treated, which complicates the treatment process and is why I can’t offer my NMS patients the same types of outcomes I can with more-typical idiopathic scoliosis cases.
Congenital Scoliosis
Congenital scoliosis is a rare type, affecting approximately 1 in 10,000.
Infants are born with congenital scoliosis, which is caused by a malformation within the spine itself that develops in utero as the spine is forming.
The spine is made up of vertebrae (bones) that are rectangular in shape and stacked on top of one another in a straight and neutral alignment; however, if one or more of those vertebral bodies are misshapen and are more triangular, it can disrupt the positioning of the spine and affect how it develops.
In addition to misshapen vertebrae, congenital scoliosis can also be caused by the failure of multiple vertebrae to separate into distinct bones that, instead, become fused together (bony bar).
Symptoms of congenital scoliosis can include:
- Uneven hips
- Uneven shoulders
- Uneven shoulder blades
- Different arm lengths
- Back asymmetry that’s noticeable when child is in a forward-bend position
- Additional related issues such as bladder or kidney problems
When it comes to the treatment of congenital scoliosis, there are unique challenges related to age so treatment plans are modified to account for those extra challenges, and monitoring for progression during growth is important because once a curve progresses past 25 degrees, it’s likely to continue progressing with growth and into maturity.
Treatment plans for infants are customized to each individual case and often include modified scoliosis-specific therapy or corrective bracing.
Degenerative Scoliosis
Degenerative scoliosis is the second most common type to affect adults; the first is idiopathic scoliosis that are extensions of AIS cases left undiagnosed and untreated during adolescence, so progressed into adulthood.
Degenerative scoliosis affects older adults and most commonly develops after the age of 40.
The body naturally degenerates with age, and the spine is no exception.
In addition, the cumulative effect of certain lifestyle factors can also play a role in the rate of spinal deterioration: carrying excess weight, leading a sedentary life, chronic poor posture, and repeatedly lifting heavy objects incorrectly, and straining the spine unnaturally.
Women are also more likely than men to develop degenerative scoliosis, and this is related to changes in hormones and bone density caused by menopause.
Most often, it’s the spine’s intervertebral discs, which sit between adjacent vertebrae, that are the first spinal structures to feel the effects of degeneration.
The discs give the spine structure (adjacent vertebrae attach to the disc in between), and provide cushioning, so vertebrae don’t rub up against one another, generating friction, and they enable the spine’s flexible movement and act as its shock absorbers.
Considering the many important roles played by the spinal discs, their degeneration is the root cause of many spinal conditions/issues.
Degenerative disc disease, disc desiccation, and bulging or herniated discs are all capable of disrupting the spine’s overall health, function, and ability to maintain its healthy curves and alignment.
Symptoms of degenerative scoliosis will vary based on condition severity/cause but commonly include:
- Loss of vertical height, commonly related to disc desiccation
- Pain, both back and radicular
- Pain in the neck
- Headaches
- Loss of range of motion in the spine = mobility impairment
Treatment for adult degenerative scoliosis (ADS) will vary, of course, based on a variety of factors, and just as it develops slowly over time, reaching treatment success will not be a quick and easy process.
When disc health is at the root of its cause, I work towards improving disc function by providing lifestyle guidance and using chiropractic care to adjust the position of vertebrae that are applying uneven pressure to an affected disc(s).
Through condition-specific exercise and a variety of therapies, I can also increase circulation around an affected disc because, as the spinal discs don’t have their own vascular supply, they absorb fluid and important nutrients needed for repair from their surroundings.
Through combining gentle and precise chiropractic adjustments, in-office therapy, custom-prescribed home exercises, and corrective bracing (helpful for pain management in adults), degenerative scoliosis can be improved by reducing the curve back to where it was prior to becoming painful, increasing core strength so the spine is optimally supported by its surrounding muscles, and introducing a home-rehabilitation program so the spine can be stabilized.
Depending on severity, sometimes work needs to be done before the initial course of treatment to restore a degree of spinal flexibility; if the scoliosis has progressed significantly, the spine can become too rigid to respond to treatment optimally.
Traumatic Scoliosis
Traumatic scoliosis develops because the spine has experienced a significant trauma, such as in a car accident or fall, that has compromised its ability to maintain its natural curves and alignment.
A spinal injury, like a compression fracture, can weaken the bones of the spine, causing them to shift in position and develop an unnatural curve.
In addition, the presence of tumors pressing on the spine can also force the spine out of alignment and lead to the development of traumatic scoliosis.
Treatment for traumatic scoliosis will depend on its underlying cause; treating the injury will be the guiding force of the treatment, and while chemotherapy and radiation can shrink spinal tumors or render them inert, the effects of the treatment itself can also lead to weakened vertebrae and the development of traumatic scoliosis.
So now that we’ve defined scoliosis, explained how it’s diagnosed, and discussed the different types, including symptoms, causes, and treatment, let’s talk about scoliosis treatment options in general; specifically the difference between the two main scoliosis treatment approaches: traditional and conservative.
Traditional Scoliosis Treatment
Traditional scoliosis treatment takes a reactive approach to a diagnosis of mild scoliosis, meaning it doesn’t actually apply any form of treatment, other than monitoring by watching and waiting for further progression, until it becomes moderate or severe.
Remember, as a progressive condition, mild scoliosis won’t stay mild forever, especially if left untreated, and the reason traditional treatment doesn’t respond proactively by treating mild scoliosis is quite simply because it doesn’t include a strategy for treating scoliosis while mild, only once it’s become severe: spinal fusion surgery.
While traditional treatment can include traditional bracing introduced at the moderate or severe level, its efficacy is limited due to its unchanging design over the years, and if progression continues, a patient crosses the surgical-level threshold at 40+ degrees, at which point they become a candidate for spinal fusion surgery.
While all surgical procedures come with their share of risks, spinal fusion is costly, invasive, and carries some heavy potential side effects and risk of complications.
In addition, spinal fusion doesn’t offer corrective results; instead, it has the goal of stopping progression and does this by fusing a curve’s most-tilted vertebrae into one solid bone, and attaching rods to the spine with screws to hold it in place, eliminating movement in the area.
While the surgery can indeed straighten a crooked spine, it does so at the cost of spinal health and function as many patients are disappointed with their loss of spinal flexibility and range of motion post-surgery.
Fortunately, for those who choose to forego a surgical recommendation or simply want to try a less-invasive treatment option first, a conservative chiropractic-centered treatment approach offers a non-surgical treatment option with proven results.
Conservative Chiropractic-Centered Scoliosis Treatment
Here at the Scoliosis Reduction Center®, patients benefit from a conservative chiropractic-centered treatment approach that strives to preserve as much natural spinal function as possible.
Each and every condition will receive a fully-customized treatment plan that addresses patient age and ability, condition type (cause), curvature location, and condition severity.
Once a condition’s underlying cause is determined, I can craft an appropriate treatment plan that integrates different types of treatment, but as a structural spinal condition, scoliosis has to, first and foremost, be impacted on a structural level.
Through condition-specific chiropractic care, I can work towards adjusting the most-tilted vertebrae of the curve back into a healthier alignment with the rest of the spine.
Through the introduction of in-office therapy and custom-prescribed home exercises, I can help patients work towards increasing core strength so the spine is optimally supported by its surrounding muscles, and a custom-prescribed home-rehabilitation program involving the use of scoliosis-specific exercises (SSEs) can work towards strengthening and further stabilizing the spine.
In addition, certain SSEs are known to activate specific areas of the brain for improved brain-body communication, postural remodeling, and more natural body positioning.
When bracing has a place in treatment, particularly the case with young patients, the ultra-corrective ScoliBrace is the Center’s brace of choice, and its modern design addresses many of the shortcomings associated with traditional bracing.
Not only is preserving natural spinal function a leading goal of conservative treatment, but also preventing progression, increasing condition severity, escalating symptoms, and the need for more invasive treatment, like surgery, in the future.
Conclusion
So what is scoliosis of the spine? Scoliosis is the development of an unnatural sideways spinal curve that also twists from back to front, front to back, making it a 3-dimensional structural spinal condition.
In addition, scoliosis is progressive, meaning it will get worse over time, and the only way to prevent that from happening is by applying proactive treatment as close to the time of diagnosis as possible; this is because it’s far simpler to treat scoliosis while mild, and while there are no treatment guarantees, early detection does increase chances of treatment success.
Scoliosis develops across a wide severity spectrum of mild to moderate and severe to very severe, and different condition types have different causes: idiopathic, neuromuscular, congenital, degenerative, and traumatic.
Common symptoms of scoliosis include postural changes that disrupt the body’s overall symmetry and pain (adult scoliosis).
When it comes to scoliosis treatment, traditional and conservative treatment are the two main approaches patients have to choose between.
What I want patients, and their families, to be aware of is that these different treatment approaches offer patients very different potential outcomes, and as an incurable condition, how scoliosis is responded to and managed can have far-reaching effects.
Here at the Center, patients benefit from a conservative approach that responds to a scoliosis diagnosis with proactive treatment integrating multiple treatment modalities, so conditions are impacted on every level.
There’s no reason that people with scoliosis can’t fulfill their life’s dreams and goals; I believe that a less-invasive more-natural treatment approach that helps patients avoid surgery is the best way to help them thrive.
