It is natural for the spine to curve forward and backward to a certain degree; this is what gives the side-view of the spine its "S"-like shape. But occasionally the spine twists and develops curves in the wrong direction-sideways. When the spine twists and develops an "S"-shaped curve that goes from side to side, the condition is known as scoliosis.
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In order to understand your symptoms and treatment choices, it helps to begin with a basic understanding of spinal anatomy. This includes becoming familiar with the various parts that make up the spine and how they work together. Learn more about the anatomy of the spine.
A scoliosis curve can occur in the thoracic spine, the lumbar spine, or both areas at the same time. When the vertebrae in the mid and low back curve to the side, the normal appearance and condition of the spine and its muscles changes. The severity of the scoliosis is measured in degrees by comparing the curves to "normal" angles. Curves can range in size from as little as 10 degrees to severe cases of more than 100 degrees. The amount of curve in the spine helps your doctor decide what treatment to suggest. Conservative (nonsurgical) treatment is usually suggested for curves of less than 40 degrees, while curves over this amount may require surgery.
Scoliosis is divided into categories based on the age the condition is diagnosed:
Scoliosis is most commonly seen in adolescents and adults. Adults can also develop scoliosis as a result of degeneration.
Adolescent Idiopathic Scoliosis
Most cases of scoliosis are first discovered and treated in childhood or adolescence-particularly during puberty when the curvature becomes more noticeable. When an adolescent has scoliosis with no known cause, doctors call the condition adolescent idiopathic scoliosis. This form of scoliosis can affect a child who is healthy and not having nerve, muscle, or other spine problems. It is the most common form of spinal deformity doctors see, affecting about three percent of the general population.
Scoliosis that occurs (or is discovered) after puberty is called "adult scoliosis." Adult scoliosis can be the result of untreated or unrecognized childhood scoliosis, or it can arise during adulthood. The causes of adult scoliosis are usually different from the childhood types.
Degenerative adult scoliosis occurs when the combination of age and deterioration of the spine leads to the development of a scoliosis curve in the spine. Degenerative scoliosis usually starts after the age of 40. In older patients, particularly women, it is also often related to osteoporosis. The osteoporosis weakens the bone, making it more likely to deteriorate. The combination of these changes causes the spine to lose its ability to maintain a normal shape. The spine begins to "sag" and as the condition progresses, a scoliotic curve can slowly develop.
If scoliosis is suspected, a diagnosis must be made before an appropriate treatment plan can be developed.
In order to make a proper diagnosis and rule out other possible conditions, the first step is to take notes. Your doctor will want to know about the following:
You will then be given a physical exam. Your doctor will want to get an understanding of the curve in your back and how it is affecting you. This means first trying to get a "mental picture" of how the spine is curved from examining your back and watching you move. The doctor will look at the flexibility you have by asking you to bend in certain directions.
Usually after the exam, X-rays will be ordered that allow your doctor to see the structure of the spine and measure the curve. You will be asked to hold very still in certain positions. The following images may be taken:
Doctors use the Cobb technique to measure curves in the spine. Lines are drawn on the X-ray to form an angle. The doctor measures the angle formed by the line and assigns the number of degrees to the size of the curve.
Depending on the outcome of your history, physical examination, and initial X-rays, other tests may be ordered to look at specific aspects of the spine. The most common tests that are ordered are: an MRI to look at the nerves and spinal cord; a CT scan to get a better picture of the vertebral bones; and special nerve tests to determine if any nerves are being irritated or pinched.
Learn more about common types of scoliosis.