Curvature of the Spine (Scoliosis)
If your doctor diagnoses you or your child with scoliosis, it means he is seeing a side-to-side curve in the spine. In most cases it’s probably a mild one, likely not even noticeable to the untrained eye. An X-ray may show some degree of a “C” or “S” curve that may not cause any problems at all.
But you’ll want to explore treatment options if the curve is pronounced and throws the body off kilter, if the condition gets worse, or if it is presenting challenges, such as difficulty standing or walking.
Since the treatment for scoliosis can vary significantly depending upon a number of factors, it is important for patients to seek care from an academic practice like Yale Medicine, where faculty clinicians are up to date on the latest research and treatments.
“We are skilled practitioners who have access to cutting-edge diagnostic technology and are able to provide novel therapeutic options like minimally invasive surgical procedures,” says Peter Whang, MD, a Yale Medicine orthopaedic surgeon.
What causes curvature of the spine?
Out of every 100 people, three have some form of scoliosis. It can affect people ranging in age from young children to older adults, and depending on the type of scoliosis, and can appear at any age.
The most common type is idiopathic scoliosis, which means there is no known cause. (However, 30 percent of people with idiopathic scoliosis have it in their family history, and there is significant research exploring the genetic basis of the condition.) Most cases are discovered around puberty, and the most serious cases are often found in adolescent girls.
There are other types of scoliosis that are less common, including:
Neuromuscular scoliosis: This type of scoliosis is related to a medical condition such as cerebral palsy, muscular dystrophy or another condition that limits ability to control muscles supporting the spine. Children with this condition are usually treated by a team of specialists.
Congenital scoliosis: This type of scoliosis is caused by a birth defect in one out of every 1,000 newborn babies. It is usually identified by the pediatrician at birth, though sometimes doesn’t become apparent until adolescence.
What are the signs and symptoms of scoliosis?
There are often no symptoms—no pain and no limitations to routine activities. In fact, a small curve in the spine can be easy to miss at first, but other signs may emerge:
- Ribs may become more prominent on one side.
- The hips, shoulders or waistline may begin to look uneven.
- One shoulder blade may look higher than the other.
How is scoliosis diagnosed?
Scoliosis is often discovered in a routine checkup with the primary care doctor, who may refer the patient to an orthopaedic surgeon who specializes in scoliosis. The specialist will look for spine curvature and any asymmetry of the shoulder blades, waistline or trunk, among other things.
The doctor may want to see X-rays of the spine from the neck down to the pelvis. On a normal X-ray, the spine should have the shape of a straight line. In a person with scoliosis, the spine’s shape is more like the letter “S” or the letter “C.” While most cases of idiopathic scoliosis are found in the upper back, it also can occur in the lower back or in the entire spine.
If your doctor finds a curve in your spine, he will measure the “Cobb angle”, named after the doctor who first described it, and compare the measurement with that of a spine that does not have excess curvature. If the curve is more than 10 degrees more exaggerated than normal, it’s diagnosed as scoliosis. Any curve greater than 25 degrees is likely to need some form of treatment.
The doctor will also decide whether the curve is temporary and can be corrected, or if it is a fixed curve that could be related to a disease, injury or other problem.
How is scoliosis treated?
If you have a mild case of scoliosis—a Cobb angle of less than 25 degrees—no treatment is necessary, although for children and adolescents who are still growing the doctor may decide on follow-up visits every six months to see if any changes develop. One concern for young people is that their bodies are still growing, and the curve could get worse during growth spurts.
Curves that are more severe can put pressure on the organs, including the heart and the lungs, and cause pain in adulthood. One of the most effective treatments for someone who has a Cobb angle of 20 to 40 is a back brace to prevent the curve from getting worse. Each patient is different, and the type of brace and the length of time it needs to be worn will depend on the patient’s lifestyle and the prominence of the scoliosis.
When is surgery recommended for scoliosis?
Surgery is only used to treat significant cases of scoliosis—if the curve is more than 45 degrees and/or is getting worse despite other measures.
A procedure called spinal fusion straightens the curve using metal implants. These realign the affected bones in the spine and then fuse two or more of those bones together. This stops those bones from growing and halts progression of scoliosis.
Spinal fusion is a serious procedure and it can take six months to a year to fully heal, but it is very successful in stopping scoliosis and also improves appearance. People who have this surgery are usually able to engage in most routine activities and many sports, although their doctor may give them some restrictions.
What is special about Yale Medicine’s care for scoliosis?
Doctors often refer patients with pronounced or complex conditions to Yale Medicine for our deep specialized expertise and access to the most sophisticated diagnostic equipment.
“We have world-renowned orthopaedic surgeons and other medical staff who have a wealth of experience with scoliosis and other complex spinal conditions,” says Dr. Whang. “For this reason, we have access to many innovative diagnostic and therapeutic modalities that simply are not available at other institutions, so that we can provide the best care possible for our patients.”