What is Scoliosis?
Written by Neil Badlani, M.D., Chief Medical Officer, North American Spine

Scoliosis or spinal curvature is a side-to-side curvature of the spine. The spine is made up of 33 small vertebrae that are interlocked with each other to form the spinal column. The spine is the body’s main support and allows you to stand, twist, and bend. When viewed from the side, a healthy spine should have an S-shaped curve with the cervical or neck region and lower back or lumbar region having a slightly concave curve and the sacral and thoracic regions having a convex curve. These curves absorb shock, allow range of motion, and maintain balance. Scoliosis can range from mild scoliosis to severe.

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More About Scoliosis

lumbar foraminotomyThis condition may be caused by other conditions like cerebral palsy, but the cause is usually unknown and it typically occurs during the growth spurts before puberty. For some people, spinal curvature is mild but some develop severe spinal deformities. When severe, spinal curvature can be disabling and lead to intense back pain. It can even reduce the space inside the chest and make it difficult to breathe.

3 or 4 out of every 1,000 children develop sideways spinal curvature that requires treatment. While most common in children and adolescents, this condition can develop at any time. Some people are born with a sideways curvature as a congenital defect, others develop it as a young child in the early onset of the disease. It can also develop in adulthood due to a degenerative spinal condition.

What Are The Symptoms?

Spinal curvature can be very obvious or it can be subtle, depending on the severity.

Common symptoms of scoliosis include:

  • Uneven shoulders, waist or one shoulder and/or hip that appears higher or more prominent than the other.
  • Ribs may appear to stick out of the body farther on one side than the other.
  • Spine becomes visibly curved.
  • Scoliosis pain as the abnormal curvature of the spine can irritate and pinch nerves.

How is Scoliosis Diagnosed?

Because spinal curvature is a complex disorder, it must be diagnosed by a professional and treated quickly to prevent the curvature from worsening.

  • Medical History: Physician checks for a family history of spinal issues.
  • Physical Examination: A physician will conduct a physical exam that includes a test in which you bend forward with your arms loose but palms touching. In this position, the physician can check if the ribs and back are out of alignment.
  • Diagnostic Imaging: If a significant curve is detected, an X-ray will be used to determine the amount of curvature. A scoliometer can also be used to test if the spine is rotated.

What are the Causes of Scoliosis?

low back pain

While it is known that spinal curvature tends to run in families and a hereditary factor is suspected, the cause of most causes of side-to-side spinal curvature are unknown. There are less common forms of spinal curvature that can be the result of spinal infection, injury to the spine, a birth defect that affects bone development of the spine, or certain neuromuscular conditions like muscular dystrophy and cerebral palsy. Sometimes it’s even present at birth. Sideways curvature of the spine usually affects girls more than boys and it’s most likely to develop between 10 and 12 years old or the teen years.

How is Scoliosis Treated?

Conservative Options

Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator–or STIM–which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes.

Decompression

Minimally invasive decompression surgery aims to relieve pressure on the nerves of the spine. This pressure is often caused by stenosis, bulging or herniated discs, and more. Relieving this pressure can be achieved by reducing or removing soft tissue (disc material or scar tissue) or bone (bone spurs, a section of the lamina or foramina) to decompress the affected nerve. When the compression is caused by soft tissue material, a surgical laser may be used to shrink the impinging material.

Fusion/Stabilization

Fusion surgeries are similar in goal–to remove damaged disc tissue and fuse the bones together–but differ in approach, including the use of specialized hardware to reinforce stability, and the location used to gain access to the spine. A related procedure is an artificial disc replacement, in which a damaged cervical disc is replaced with a synthetic disc, and the vertebrae are not fused.

How Much Does Treatment Cost?

Treatment cost depends on several factors, especially what insurance you have and how much of your deductible has been met. IN the last two years, 90% of our patients have paid less than $2000 out-of-pocket. Some have paid literally nothing, and other have paid much more than that. It depends. The good news is: our Patient Care Managers will handle as much as they can directly with your insurance company, and all your costs will be known up-front.

Important note: spine surgery often pays for itself within a year or two. Many people actually spend more money trying to live with the pain than they do getting the pain fixed. The following calculator is intended to give you a sense of what you spend on managing—rather than eradicating—your pain.

 

Calculate how much you've spent on back pain this year.
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This past year you have spent on your pain treatment:

Get surgery now. Getting surgery now is the smartest financial move. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. You’ve spent that much or more this year to manage your back pain than you could to fix it.

Get surgery soon. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. At your current rate, you will spend that much or more within the next two years. The sooner you get treatment, the sooner it will pay for itself.

Keep an eye on your spending. Currently, you are managing your pain efficiently from a financial perspective but over time, your expenses could add up. Surgery should be strongly considered if you start missing more work or spending more on treatment medication.

Great job! You are spending very little on your back pain. Keep it up!

Equipment Used to Diagnosis and Treat Scoliosis

One of the most important diagnostic tools to detect spinal curvature is a regular X-ray which can confirm the diagnosis of spinal curvature and indicate the severity of the curvature. Another important diagnostic tool used during an exam is the scoliometer, which is combined with the Adams forward bend test to detect rotation of the spine when the scoliometer reads 7 degrees or more.

Bracing and casting are the two most common forms of medical equipment used to treat the condition. Casting is used to partially correct deformities before a brace is used or to reverse curvature in infants. A cast is like a full-time brace that can’t be removed. Braces are used for progressive curves in which a child is still growing. There are many types of braces, including custom-molded hard plastic braces and braces that use straps over the shoulder to bend the child in the opposite direction of the curvature.

How Does Scoliosis Compare to Other Spine Conditions?

A side-to-side curvature is not the only type of abnormal spinal curvature. A sway back or lordosis refers to an abnormal curvature of the lumbar spine while a hunchback or kyphosis refers to an abnormal curve of the thoracic spine.

Lordosis happens when the lumbar spine has an excessive inward curve or sometimes the cervical spine in the neck. When it happens in the lumbar spine, the patient has more prominent buttocks and an exaggerated posture. It can also cause back pain and limit movement.

Kyphosis is an excessive outward curvature of the thoracic spine, forcing the lower back to compensate for the imbalance in the high area of the spine. A hunchback can be structural or postural. Poor posture eventually leads to an excessive rounding of the upper area of the back.

Like sideways curvature of the spine, lordosis and kyphosis can be caused by a birth defect, another condition, or the cause can be unknown. For example, kyphosis is sometimes the result of Scheuermann’s disease, connective tissue disorder, or interrupted bone growth in which a vertebra is not formed correctly.

Analogy: A Drinking Straw

All healthy, strong spines have a slight curve. Like a slightly curved straw, our spines allow for strength and stability while also providing a conduit for material to pass in and out. People with scoliosis, however, have curves where they don’t belong. This causes the spine to function improperly, and the result is pain.

Good Drinking Straw

Bad Drinking Straw

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