Sometimes, during human development a lateral (sideways) curvature of the spine develops. If the curvature is larger than 10 degrees, it is called scoliosis. Curves less than 10 degrees are mostly insignificant postural changes.
How is scoliosis evaluated?
Evaluation begins with a thorough history and physical examination, including postural analysis. If a scoliotic curvature is discovered, a more in-depth evaluation is needed. This might include a search for birth defects, tumors, and other factors that can cause structural curves.
Patients with substantial spinal curvatures very often require an x-ray evaluation of the spine. The procedure helps us determine the location and magnitude of the scoliosis, along with an underlying cause not evident on physical examination, other associated curvatures, and the health of other organ systems that might be affected by the scoliosis. In addition, x-rays of the wrist can be performed. These films help determine the skeletal age of the person, to see if it matches an accepted standard, which helps the doctor determine the likelihood of progression. Depending on the scoliosis severity, x-rays may need to be repeated as often as every 3 to 4 months to as little as once every few years.
Is scoliosis progressive?
Generally, it is not. In fact, the vast majority of scolioses remains mild, is not progressive, and requires little treatment. In one group of patients, however, scoliosis is often more progressive. This group is made up of young girls who have scolioses of 25 degrees or larger, but who have not yet had their first menstrual period. Girls generally grow quite quickly during the 12 months before their first period, and, if they have scolioses, the curvatures tend to progress rapidly. In girls who have already had their first periods, the rate of growth is slower, so their curves tend to progress more slowly.
What is the treatment for scoliosis?
There are generally 3 treatment options for scoliosis— careful observation, bracing, and surgery. Careful observation is the most common “treatment,” as most mild scolioses do not progress and cause few, if any, physical problems. Bracing is generally reserved for children who have not reached skeletal maturity (the time when the skeleton stops growing), and who have curves between 25 and 45 degrees. Surgery is generally used in the few cases where the curves are greater than 45 degrees and progressive, and/or when the scoliosis may affect the function of the heart, lungs, or other vital organs.
Spinal manipulation and stability exercises may be helpful for those with scoliosis. No non-surgical therapies have been shown in the scientific literature to either reduce scoliosis or to make the curvatures worse. Yet for patients with pain along with the scoliosis, manipulation and exercise is the treatment of choice. Most people with scoliosis lead normal, happy, and productive lives. Those with scoliosis should remain fit, stay flexible, and avoid smoking.
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