How is it diagnosed?
In visual terms, scoliosis is fairly easy to diagnose: the lateral curve in the spine is often very noticeable. If the condition is present in the thoracic spine, the rib cage will also rotate; as a result, the ribs on the inside of the curve will stick out at the front, and those on the outside will stick out at the back. In addition to this, the ribs on the inside of the curve are squashed together, whilst those on the outside display increased separation:
Providing a full diagnosis, however, is slightly more complex. For example, the primary (or structural) scoliotic curve is often accompanied by secondary curves. These are usually developed by the patient to compensate for the distribution of weight over the primary curve (without a secondary curve, they might fall over). Primary and secondary curves can be distinguished by asking the patient to bend over to the side. Structural curves are largely unchanged, but secondary curves straighten significantly in order to maintain balance.
In addition to this, one needs to determine the severity of the condition. This is defined by an angle referred to as the Cobb angle (the same angle that is used to measure Kyphosis); this time, however, the angle is used to measure a side-to-side curve as opposed to one that goes from back-to-front. X-rays are used to measure the Cobb angle; a normal, healthy spine should display an angle of 0° although angles of less than 25° are considered relatively small.
What are the consequences for back pain?
Irrespective of the cause, scoliosis can be very painful.
In general terms, however, the pain is roughly proportional to the size of the curve (measured by the Cobb angle). As the primary angle increases, so does the size of any secondary curve. In turn, this leads to increased muscle fatigue and pain. In addition to this, nerve root compression is relatively common: as the primary curve increases, the vertebrae are pushed closer together (on the inside of both the primary and secondary curves); as a result, the spinal nerves become compressed. This can lead to intense pain, in addition to (other) sensory and motor symptoms. For example, in severe cases of lumbar scoliosis, the patient may experience partial, or complete, paralysis of the feet and/or legs; patients with thoracic scoliosis may develop heart and/or lung problems as one side of the rib cage becomes compressed.
In addition to this, the increased pressure, on the inside of both the primary and secondary curves, can lead to Bulging or herniated discs; scoliosis will also accelerate the degenerative changes in the spine and lead to secondary conditions (such as Osteoarthritis).
What are the risk factors?
To reiterate: idiopathic, genetic scoliosis accounts for about 80% of all cases, and is far more common in girls (88%) than boys (12%). For most people, hereditary factors, and sex, are therefore primary risk factors. For adults with idiopathic scoliosis, the risk factors are similar, but they also include the type of treatment (if any) they were given as children.
Degenerative scoliosis is largely caused by Osteoporosis; as a result, overweight, post-menopausal women tend to be most at risk.
Can it be treated?
The classical approach to treatment includes observation, bracing, and, in extreme cases, Surgery. In our opinion, however, the only conditions that require surgery are vertebral fractures, and cancer of the spine; instead, we believe that scoliosis can be treated by non-invasive decompression of the spine (either by using the Backrack™ or, for larger curves, by visiting a specialist trained in Orthopaedic Medicine).
Irrespective of the treatment, however, there are a number of observations that appear to hold true:
- Adolescent curves > 40° are difficult to control with braces.
- Adult curves > 50° will continue to progress at a rate of 1% per year.
- Children with large curves are more at risk from deterioration, than adults with small curves.
Taken together, the goal of treatment is to keep adolescent curves at < 50°. However, it should be noted that bracing is only temporarily effective; curves generally return to their previous angle, soon after the brace is removed.
The surgeon’s approach to scoliosis, is to correct the curve using instrumentation (rods and screws), and then to fuse the vertebrae together. This prevents them from moving back to their original positions, but it also prevents all other forms of movement. Our views on Surgery are well documented on this website.
For cases of degenerative scoliosis, the best possible form of treatment lies in prevention. For example, if osteoporosis can be prevented (generally by eating well, and taking regular, weight bearing exercise) then the chances of developing osteoporotic scoliosis are vastly reduced.