What is Scoliosis? And How is it Diagnosed?
Scoliosis is a sideways curvature of the spine, usually described as a “C” or “S” curve, but is really a spiral deformity like a spiral staircase. Scoliosis most often affects the thoracic and lumbar vertebrae. It is possible to have a slight curvature of the spine but not have scoliosis; doctors use a 10-degree curve as the benchmark for a scoliosis diagnosis. Scoliosis is progressive, meaning it advances over time. Surgical intervention is usually recommended once the curve progresses to 45-50 degrees.
Scoliosis is usually diagnosed in the teenage years or younger. Your doctor will diagnose you by having you bend forward at the waist. This allows them to see the path of your spine, so they’re able to spot the misalignment. Scoliosis diagnoses are confirmed with X-rays. Curves may happen to the right (dextroscoliosis) or, less often, to the left (levoscoliosis). There are 4 types of curves a doctor might see on a scoliosis-positive X-ray:
- Double Major Curve: This is a compound curve, usually to the right near the top of the spine, and to the left near the bottom.
- Lumbar Curve: A curve that starts and ends in the lower back.
- Thoracolumbar Curve: A curve that starts in the upper back and ends in the lower back.
- Thoracic Curve: A curve that starts and ends in the upper back.
These aren’t the only types of curves an X-ray might show; rare cases of idiopathic scoliosis have revealed triple curves.
What Causes Scoliosis?
Most of the time, there is no identifiable cause for a patient’s scoliosis. This is referred to as idiopathic scoliosis. While there is no obvious genetic link, idiopathic scoliosis seems to have a hereditary component. There are 3 types, separated by the age group in which the patient was diagnosed. 80% of idiopathic scoliosis diagnoses are in adolescents. Diagnosis at any age requires consistent monitoring to track the progression of the curve.
There are two bodies of scoliosis: nonstructural and structural. Nonstructural scoliosis means that the spine is functioning correctly, it’s just misshapen. Structural scoliosis, on the other hand, means the spine and its curve are rigid, limiting function and mobility. Structural scoliosis is often caused by conditions like muscular dystrophy, Down syndrome, tumor growth or birth defects.
Dr. Blatman has shown that scoliosis in a developing and growing child is related to fascia through their body that restricts vertical growth of the spine. Every child is different because every child is bound by their fascia in a different way, and every child has a different growth rate. Faster growth will often result in more significant curve. Dr. Blatman has shown that releasing the tight fascia that binds the child and prevents vertical growth can actually reverse progression of a scoliosis. Scoliosis is an ‘inside’ job, which is why braces and muscle therapies are less effective. You can’t win a tug a war against tightening fascia. You have to release the fascia from the inside.
Are There Different Types of Scoliosis?
There are several other kinds of scoliosis besides idiopathic:
- Congenital scoliosis develops in-utero, and may cause vertebrae to develop incorrectly or fail to separate fully.
- Degenerative scoliosis develops in adulthood, and is a result of the wear and tear a lifetime of micro-injuries to your vertebrae and discs. Wear, damage and misalignment can cause part of the spine to curve. Degenerative scoliosis most often presents as lumbar curves.
- Neuromuscular scoliosis is the most debilitating type of scoliosis, as the curve results from a kind of collapsing, making the problem of how to treat the scoliosis difficult, if not impossible. Neuromuscular scoliosis can be caused by injuries or neurological conditions that damage the muscles that support your spine, causing it to curve because it’s not properly supported.
What are the Symptoms of Scoliosis?
Often, scoliosis doesn’t have symptoms in the early stages. Symptoms of progressive scoliosis can include:
- Visual signs like uneven hips, shoulders and/or rib protrusion
- Lower back pain and/or stiffness
- Radiating pain from suspected pinched nerves
- Muscle strain
- Feeling slanted when standing
How is Scoliosis Treated?
Because scoliosis is a progressive condition, there is no common treatment for scoliosis that cures the curvature. The earlier scoliosis is treated, the better, as you can slow, and in some cases partially correct, the spinal curve. Sometimes, childhood scoliosis simply goes away and never needs treatment. The goal of all types of scoliosis treatment is to halt the progression of the curve.
Surgical Treatment for Scoliosis
Almost 90% of patients with scoliosis never need surgery. It’s considered in progressive curves that haven’t responded to physical therapy or bracing. There are a few types of surgical interventions for scoliosis your doctor might recommend:
- Rods might be installed on the spine or ribs of a child with moderate to severe scoliosis. As the child grows, further operations allow the doctor to adjust the rods, guiding the ribs and spine towards a more correct alignment.
- Spinal fusion surgery is often used to treat lumbar curves. With spinal fusion surgery, soft tissue joints are replaced with a bone-like material, and over time the vertebrae grow together, limiting the severity of a curve.
- There’s also a newer surgery for scoliosis that can instantly reduce a major curve down to 10-15 degrees. A rod is placed where the spine should be, and fibers are anchored to each vertebrae in the curve, as well as the rod. Then, via the fibers, the doctor pulls the spine towards the rod. The recovery is difficult and long, but the correction is immediate and permanent.
Holistic Medicine and Physical Therapy for Scoliosis
There are non-invasive treatments for scoliosis doctors will try before recommending surgery; surgery is definitely the last resort of scoliosis treatments. If a curve is less than 20 degrees or so, your doctor will probably just observe it via X-rays every 6 months or so. They may also recommend a regimen of physical therapy and regular exercise; yoga has proven a popular holistic scoliosis therapy. Physical manipulation is another non-invasive treatment option for scoliosis, though evidence it’s effective is entirely anecdotal.
Once a curve reaches 20-25 degrees, or if its progression starts to speed up, a physician will recommend a brace. These braces hold the spine straight by holding the torso in a rigid upright position. This scoliosis treatment is reserved for adolescents who haven’t yet reached skeletal maturity. Nighttime braces require extreme position changes that make them impossible to wear during the day. There are also daytime braces, which can be worn under clothes and are meant to be worn all day and night.
The effect of braces is limited because the cause of a developing scoliosis is usually tight fascia inside the body that the brace can’t change.
Who is at Risk for Developing Progressive Scoliosis that needs Treatment?
There are several risk factors that increase your chances of needing your scoliosis treated after diagnosis:
- Girls are 7x more likely than boys to develop idiopathic scoliosis.
- Larger lateral curves are more likely to progress, regardless of comparative skeletal development.
- Curve progression that requires treatment is more likely the younger the patient was at diagnosis.
- Thoracic curves are more likely to progress than lumbar curves.
- People suffering from genetic musculoskeletal conditions are more at risk for progressive scoliosis that requires intervention.
There is no magic key for determining whether someone will develop scoliosis, and if they do, how progressive the scoliosis will be. That’s why early diagnosis and consistent observation of the curve are vital to knowing when it’s time to implement a treatment like physical therapy or bracing.
Or better yet, arrange a consult with Dr. Blatman and learn how the tight fascia can be released and progression of the curve reversed. This is best done before the vertebral bodies deform into the double trapezoid like stairs of a spiral staircase.