Understanding Spine Structure
The spine, or backbone, naturally has a slight curve toward the front and back. This S-curve provides optimal support to the body while creating space around organs for unhindered function. From the front, however, the spine should appear perfectly straight. A healthy spine does not bend to either side, maintaining the body’s physical symmetry.
What Is Scoliosis?
Scoliosis is a type of spinal deformity that causes the spine to curve to the side. It may curve to one side, creating a slight C-shape, or it might bend both ways to create an S. While most scoliosis is mild, the condition worsens as time goes on. For this reason, seeking treatment is imperative. Medical care from an experienced physician is the best way to avoid pain, lost mobility, and other complications that might arise as scoliosis progresses to its most severe stages.
Most scoliosis is diagnosed during childhood. In some cases, however, mild scoliosis may go undetected for years. In others, the spinal deformity develops due to a degenerative or muscular condition. This can result in patients being diagnosed as adults. Adult scoliosis presents unique challenges, requiring a different approach to treatment.
Who Gets Scoliosis?
Scoliosis can affect everyone. Certain health factors, however, have been associated with more severe symptoms or higher rates of occurrence. Risk factors for scoliosis include:
- Age: Though many types of scoliosis are congenital, meaning that they develop before birth, symptoms most often develop between the ages of 10 and 20.
- Gender: Both men and women are equally likely to develop scoliosis. Women, however, are likely to experience more extreme deformity and a greater need for treatment.
- Genetics: Like other skeletal deformities, scoliosis can run in families. People with a family history of scoliosis may be slightly more likely to develop it themselves.
- Health: Underlying health conditions and injuries, especially ones that affect the spine or nerves, may put a person at higher risk of developing scoliosis.
These factors are not a guarantee that a person will develop scoliosis, nor should people with risk factors be worried about developing it. Patients with multiple risk factors, however, may wish to speak with their primary care physician about medical imaging to rule out a possible deformity. Early detection and treatment are key to preventing serious complications.
What Causes Scoliosis in Adults?
Types of scoliosis are categorized by their cause. Most cases are called idiopathic scoliosis. This means that physicians are not sure why scoliosis develops, though it may have a genetic link. Other types of scoliosis that may be diagnosed in adults include:
Degenerative Scoliosis
Degenerative scoliosis is the most common cause of scoliosis in adults. This type is caused by wear and tear in spinal joints, causing the discs and vertebrae to break down. This may create a side-to-side curve associated with scoliosis. Degenerative scoliosis starts mild but worsens over time as spinal structures continue to degenerate.
Congenital Scoliosis
In some cases, scoliosis in adults is congenital. This type is caused by incorrect spine development before birth. Congenital scoliosis is often identified at birth. Some patients, however, are born with only mild scoliosis. Their condition may go unnoticed until their aging body displays increased symptoms, resulting in a late diagnosis.
Neuromuscular Scoliosis
Certain neurological and muscular diseases may also cause scoliosis. Cerebral palsy, spinal cord traumas, spinal muscular atrophy, and Chiari malformation may all be responsible for what physicians call neuromuscular scoliosis. Depending on the underlying cause, neuromuscular scoliosis may develop before birth, or it may be diagnosed in adulthood.
Syndromic Scoliosis
Finally, scoliosis may occur as part of a syndromic disease. A syndrome is a condition with no known cause, characterized by a set of symptoms that often appear together. Scoliosis is associated with muscular dystrophy, arthrogryposis, spina bifida, Marfan syndrome, Ehlers-Danlos syndrome, and others, where it is known as syndromic scoliosis.
Symptoms of Scoliosis
Mild cases of scoliosis may not be detectable without medical imaging. As scoliosis increases in severity, however, it begins to create visible deformity. Common signifiers of scoliosis include:
- Off-center head
- Uneven shoulders
- Uneven or elevated hips
- One shoulder blade appears larger than the other
- One leg appears longer than the other
- Constant leaning to one side
- Changes in skin texture over part of the back
- Height loss
In addition to the side-to-side curvature, scoliosis can also cause the spine to rotate or twist. This may cause the ribs or muscles on one side of the body to jut out. This jut may be amplified by other abnormalities in a person’s posture, such as uneven hips or shoulders.
Most scoliosis does not cause any symptoms. Over time, however, the deformity becomes more extreme. Severe cases may begin to interfere with how the body functions, resulting in discomfort and reduced mobility. The following are some symptoms of severe scoliosis:
- Back pain
- Balance issues
- Difficulty walking upright
- Core muscle weakness
- Muscle fatigue
- Leg pain or numbness
- Chest pain
- Shortness of breath
- Bowel or bladder incontinence
Like the deformity itself, symptoms of scoliosis also get worse with time. The sooner treatment begins, therefore, the better chance a person has of avoiding serious pain and other complications.
Potential Complications of Scoliosis
Scoliosis is a mild condition by itself. If left untreated, however, it may lead to serious health complications. While these are rare, they can make it difficult to lead an active and fulfilling lifestyle. They include:
- Breathing issues: The bent spine may press against the lungs, making it difficult to breathe. In serious cases, this may even cause lung damage and deformities.
- Back problems: Patients with scoliosis are more likely to suffer from back conditions such as myelopathy, herniated discs, degenerative joint disease, and others.
- Nerve damage: Scoliosis may cause nerve compression and potential damage, which can result in long-term loss of mobility and sensation in the legs and feet.
- Body image issues: Changes in a person’s appearance and physical ability may result in insecurity, which, in turn, can create depression or anxiety.
If a person is experiencing breathing problems, persistent back pain, or signs of nerve compression, they should speak with a physician about treatment. Permanent damage can be prevented by an early and appropriate medical intervention.
Screening for Scoliosis
The first step of a scoliosis diagnosis is screening. This is a type of physical exam that focuses on analyzing the shape, structure, and alignment of the spine. It is most often performed by the patient’s primary care provider. Most scoliosis screenings occur during childhood and adolescence. If a person is suspected to have scoliosis, however, they may be screened as an adult.
Before a screening, the patient must remove their shirt to provide clear visibility of their back. They are then asked to stand up straight, bend over forward, or twist from side to side, while the physician looks at their posture and spine curvature. The physician may also test the patient’s reflexes, nerve function, and muscle strength to determine whether these have been impacted by the deformity. If scoliosis is suspected, medical imaging may be requested to confirm the diagnosis and rule out other conditions that may result in spine pain.
Scoliosis Degrees
A scoliosis diagnosis includes both whether scoliosis is present, in addition to its degree. This is a measure of spine curvature to determine the condition’s severity. The scale works as follows:
- No scoliosis: Less than 10 degrees
- Mild scoliosis: 10 to 24 degrees
- Moderate scoliosis: 25 to 39 degrees
- Severe scoliosis: Over 40 degrees
Measuring this degree is helpful for planning an appropriate treatment. The higher the degree, the more severe the scoliosis is. Therefore, more aggressive treatments may be considered.
Conservative Scoliosis Treatments in Adults
Most scoliosis does not require aggressive treatment. If the degree of curvature is low or if the patient does not experience severe symptoms, physicians are likely to begin with a conservative approach. This treatment approach focuses on relieving symptoms rather than on correcting scoliosis directly. Conservative treatment methods include:
- Attending regular appointments to monitor how the condition progresses
- Taking over the counter (OTC) anti-inflammatory medications to relieve pain
- Exercising to increase core strength and flexibility
- Wearing a back brace, which provides additional support around the spine
- Managing underlying conditions related to scoliosis
Healthcare providers may also recommend physical therapy to strengthen muscles, improve mobility, and relieve pain. Physical therapy for scoliosis often features low-impact exercises, such as swimming, along with daily stretches to maintain or enhance flexibility.
Surgical Scoliosis Treatments in Adults
Scoliosis gets worse over time. Eventually, conservative treatments may no longer provide the relief that patients need to maintain a high quality of life. In other cases, the scoliosis may already be too severe to manage effectively with conservative methods. This is especially common for adult patients who are diagnosed late. In this case, the physician may discuss surgery. Spinal reconstruction corrects the spine’s curvature for a long-term solution to pain.
Spinal Fusion
Spinal fusion involves fusing several vertebrae into a single, strong bone. It is performed under general anesthesia, meaning that patients sleep while the surgeon is at work. The procedure follows these steps:
- The surgeon makes an incision over the spine, near the target area.
- Using surgical dilators, the surgeon pulls muscle and soft tissue aside to expose the spine.
- The surgeon cuts away and removes spinal discs as part of a discectomy.
- The surgeon places bone graft material between the vertebrae. A bone graft is either harvested from the patient themselves or sourced from a donor bank.
- The surgeon anchors the vertebrae together using titanium plates, rods, and screws. These implants keep the bones securely in place until the fusion is complete.
- The surgeon closes the incision with stitches.
Most patients can return to normal activities after a few weeks, though full recovery from spinal fusion may take six months or longer. Spinal fusion eliminates incorrect curvature and restores a normal shape to the spine. This effectively addresses any pain and other symptoms caused by scoliosis. It also removes movement between vertebrae. This means that patients live with reduced flexibility after their surgery. In many cases, however, the pain relief is worth the reduced mobility.
Choosing a Scoliosis Surgeon
As with any other spine procedure, choosing the right surgeon is key to a positive outcome. At NU-Spine, surgical procedures are performed by Dr. Branko Skovrlj. He is an award-winning neurosurgeon in New Jersey who focuses exclusively on spine treatments. His special expertise is in complex procedures and minimally invasive spine surgery, which reduces post-surgical stress for faster, easier recoveries. He also contributes to research to improve spine revision surgeries.
Even though Dr. Skovrlj is known worldwide for his expertise, patients find him approachable. Dr. Skovrlj understands that spine conditions, especially deformities, can be difficult to discuss. He treats patients with compassion and respect, getting to know them as individuals and not just diagnoses. This makes it easier for them to talk about their pain.
Find Expert Scoliosis Treatment Near You in New Jersey
Scoliosis can seem inescapable. Fortunately, reliable solutions exist. NU-Spine: The Minimally Invasive Spine Surgery Institute offers treatments for a wide range of spine conditions, including scoliosis, at locations near you throughout New Jersey. We are led by an award-winning neurosurgeon who employs cutting-edge techniques to deliver the best outcomes for patients. To learn more about scoliosis treatments in adults or to set up an appointment, contact us today.