You can’t spell “scoliosis” without an “S” or a “C,” and if you have this condition that’s what your spine looks like.
Scoliosis causes the spine to curve to the left, the right or both. Up to 2 to 3% of Americans—that’s 6 to 9 million people—have scoliosis, and although it can affect people of all ages, children and adolescents are far more likely than adults to be diagnosed with scoliosis.
Symptoms of scoliosis, when they do appear, can range from a purely cosmetic deformity to mild discomfort to life-threatening breathing disruptions. Luckily, most cases are easily correctable. The vast majority of people with scoliosis—with a little knowledge and the help of spine specialists—won’t let the condition even slow them down.
Have you or your child been diagnosed with scoliosis? You’ve come to the right place. Here’s everything you need to know about scoliosis symptoms, causes, diagnosis and treatment.
To understand scoliosis, you first need to know what a healthy spine looks like. There are four regions in your spine:
- Cervical spine: This is your neck, which begins at the base of your skull. It contains seven small spinal bones (called vertebrae), which doctors label C1 to C7 (the "C" means cervical). The numbers one to seven indicate the level of the vertebrae. C1 is closest to your skull, while C7 is closest to your chest.
- Thoracic spine: Your mid-back has 12 vertebrae that are labeled T1 to T12 (the "T" means thoracic). Vertebrae in your thoracic spine connect to your ribs, making this part of your spine relatively stiff and stable. Your thoracic spine doesn't move as much as the other regions of your spine.
- Lumbar spine: In your low back, you have five vertebrae that are labeled L1 to L5 (the "L" means lumbar). These vertebrae are your largest and strongest vertebrae, responsible for carrying a lot of your body's weight. The lumbar vertebrae are also your last "true" vertebrae; down from this region, your vertebrae are fused. In fact, L5 may even be fused with part of your sacrum.
- Sacrum and coccyx: The sacrum has five vertebrae that usually fuse by adulthood to form one bone. The coccyx—commonly known as your tail bone—has four (but sometimes five) fused vertebrae.
Normal Spinal Curves: Lordosis and Kyphosis
When viewed from the side, you can see the spine has both inward and outward curves. Kyphosis refers to the thoracic and sacral spines’ outward curvature toward the back of the body, and lordosis refers to the cervical and lumbar spines’ inward curvature toward the front. These curves help your back carry your weight and are also important for flexibility.
Humans evolved with two types of spinal curves—lordosis and kyphosis—to “allow us to adapt to various movements and forces on us in a way that allows us to stand upright,” He explains, “We evolved from quadruped animals that were on four legs to bipedal animals, so we stand on two feet.”
Although everyone has a little kyphosis and lordosis in their spines, too much of either can cause trouble. Abnormal lordosis is an extreme inward spinal curve. Abnormal kyphosis is a condition that results in a hunchback or slouching posture.
Scoliosis may be diagnosed at any point in life, but the most common age of onset is between 10 and 15 years old and it is the most common spinal deformity in school age children.
There are a variety of types and causes of scoliosis, such as idiopathic, degenerative, congenital, neuromuscular, thoracogenic, and syndromic.
Idiopathic—meaning there is no specific cause—is the most common form, accounting for 80 percent of all pediatric scoliosis cases. Degenerative scoliosis is also fairly common; one recent study found it affects roughly 38% of the population, including as many as eight percent of those over 25 and up to 68 percent of those who are 60 and older. Rarer forms include congenital scoliosis, which affects one in ten thousand newborns
- Infantile idiopathic scoliosis is diagnosed in children ages 0 to 3.
- Juvenile idiopathic scoliosis is diagnosed in children ages 4 to 10.
- Adolescent idiopathic scoliosis (AIS) is diagnosed in young people ages 11 to 18, and account for as many as 85 percent of cases. Girls experience this much more frequently than boys, at a ratio of 10:1
- Adult idiopathic or degenerative scoliosis is diagnosed in people older than 18.
- Degenerative scoliosis results from asymmetrical disc degeneration over time. According to Dr. Lonner, “this type of scoliosis tends to affect the lumbar spine and is milder in magnitude, typically creating a curvature of about 30 to 40 degrees.”
This population tends to walk with “their hip and their waistline shifted and their hips thrust to one side or another.” If you have degenerative scoliosis you may experience difficulty standing fully upright as well as back pain, including sciatica, which is pain and weakness that radiate from your low back down one or both legs and can interfere with walking.
Many cases of adult scoliosis do not need treatment. Your doctor may recommend waiting to see if your curvature progresses over time. Meanwhile, you should do all the “healthy” things you’re supposed to do: exercise regularly, maintain a good diet, avoid smoking, and be mindful of your posture, your gait and your lifting technique to keep your back as healthy as possible.
- Congenital scoliosis occurs when the spine does not develop properly in utero. Malformations may include:
- hemivertebra, where only one side of the vertebral body develops
- failure of segmentation, which happens when parts of the spine are fused
- rib fusion, where ribs are fused together
- Neuromuscular scoliosis is caused by brain, spinal cord, and muscular system disorders. Such conditions include:
- cerebral palsy (CP)
- spinal muscular atrophy (SPA)
- Angelman syndrome
- Arnold-Chiari malformation/syrinx or spinal cord trauma
- Thoracogenic scoliosis is seen in patients whose spinal development has been asymmetric due to radiation treatment of childhood tumors or surgery to address a congenital heart defect.
- Syndromic scoliosis develops as part of an underlying syndrome or disorder such as:
- Muscular system disorders including muscular dystrophy, poliomyelitis, arthrogryposis, or spina bifida
- Connective tissue diseases including Marfan syndrome and Ehlers-Danlos syndrome
Scoliosis symptoms can vary widely, depending on the severity of the curves. In mild cases, symptoms may be purely cosmetic and can include:
- Visible difference in hip and shoulder height
- One or both hips are raised or noticeably high
- Uneven shoulders one or both shoulder blades may stick out
- Head is not centered right above the pelvis
- Asymmetry between rib cage heights on either side.
- Waistline appears uneven
- Changes in the appearance or texture of the skin overlying the spine changes, such as dimples, hairy patches, or color abnormalities.
- The entire body leans toward one side
More serious cases of scoliosis may cause:
- Back pain
- Inability to stand upright
- Leg pain, numbness, and/or weakness due to radiculopathy, or pressure on nerves in the lumbar spine
- Height loss in adults
- Bowel or bladder dysfunction in more severe cases