Scoliosis is not a disease but a descriptive term. All normal spines have curves; both the neck and low back bend backwards, called lordosis and the thoracic spine or mid-back bends forward called kyphosis. Some curvature in the neck and back is normal. Humans need these spinal curves to help the upper body maintain proper balance and alignment over the pelvis. Scoliosis is however, a termed used to define abnormal side-to-side (lateral) curves in the spinal column. The vertebrae involved are also usually rotated.
The prevalence of scoliosis varies depending on the severity of the curvature; however, scoliosis affects 2% of women and 0.5% of men in the general population. Scoliosis are broadly divided into structural and non structural types. Structural scoliosis refers to those curvatures that are fixed and cannot be corrected by side bending of the spine. Non-structural or functional scoliosis lessen or disappear with side bending of the spine. There are more than 50 conditions associated with scoliosis. Some of the more common causes of scoliosis include congenital spine deformities, genetic conditions, neuromuscular problems and limb length inequality. Other causes for scoliosis include cerebral palsy, spina bifida, muscular dystrophy, spinal muscular atrophy and tumours. Over 80% of scoliosis cases, however, are idiopathic, which means that there is no known cause. Most idiopathic scoliosis cases are found in otherwise healthy people.
There are number of different “warning signs” to look for to help determine if you or someone you know may have scoliosis.
- Shoulders are different heights.
- Head is not centered directly above the pelvis.
- Rib cages are at different heights.
- Uneven waist.
- Appearance of a raised, prominent hip.
- Changes in look or texture of skin overlying the spine (dimples, hairy patches, color changes).
- Leaning of entire body to one side.
Early detection is vital, if you notice any of the signs mentioned above you should make an appointment with your health care practitioner.
The role of the chiropractor is to recognize and monitor scoliosis. Once suspected, scoliosis can be confirmed with a spinal x-ray. The scoliosis can then be measured and classified in terms of significance. Curves are generally considered significant if they are greater than 25 to 30 degrees. Curves exceeding 45 to 50 degrees are considered severe and often require more aggressive treatment. Adolescents and juveniles with curvatures less than 20 degrees should be monitored for progression every 3-6 months. This is important as progression of the curve will likely require more aggressive treatment options.
Prognosis and Treatment:
Currently, treatments for scoliosis include bracing, electrical stimulation, surgery, chiropractic care or a combination of all of these. Bracing should be considered when curves are between 20 and 40 degrees. Surgery is usually considered when the curvature is beyond 50 degrees. Prognosis for scoliosis varies depending on a number of factors including: age at time of diagnosis (curves below 30 degrees do not usually progress following skeletal maturity), stage of skeletal maturity (scoliosis progress more rapidly in skeletally immature patients), vertebral rotation, and the magnitude and pattern of curvature.