Scoliosis: diagnosis and treatment
Scoliosis, a common spinal abnormality, presents a variety of challenges and considerations in both diagnosis and treatment. When considering the impact of scoliosis on pain, understanding the type of scoliosis one has is crucial.
Congenital scoliosis:
Congenital scoliosis is due to skeletal abnormalities of the spine that are present at birth. These anomalies, which can include multiple spinal levels, are the result of a failure of formation or a failure of segmentation during vertebral development. Because these spinal deformities are present in utero, they are often first identified on fetal ultrasound. Treatment is based on the age of the patient, progression of the curve, and the location and type of anomaly.
Neuromuscular conditions:
Certain neuromuscular conditions that can be associated with scoliosis are listed below:
Cerebral palsy
Charcot-Marie-Tooth disease
Spinal muscular atrophy
Duchenne Muscular Dystrophy
Ehlers-Danlos Syndrome
Marfan Syndrome.
While this is an abbreviated list, most of the signs and symptoms are present before the scoliosis is even detected.
Idiopathic scoliosis:
Idiopathic scoliosis is a diagnosis of exclusion meaning there is no specific cause of the scoliosis. This type of scoliosis is the most common type of spinal deformity and is divided into the age at which the scoliosis presents - infantile idiopathic scoliosis, juvenile idiopathic scoliosis, and adolescent idiopathic scoliosis (89% of scoliosis is adolescent idiopathic scoliosis).
How to detect if you have scoliosis:
There are two types of scoliosis to test for, Structural and Functional. Adam’s Test is a great test to do at home to determine if you have scoliosis. For this test, have someone behind you and observe your spine while you bend down and try to touch your toes. If there is an apparent bump (usually by the shoulder blade) then that test is positive for structural scoliosis. If the spine straightens out, then it is positive for functional scoliosis.
What can be done about idiopathic scoliosis?
Surgery is rarely needed for idiopathic scoliosis. A general goal is to keep curves under 50 degrees at maturity. Typically, only observation and monitoring is recommended for immature (under 20 years of age) patients with curves less than 25 degrees. Orthotic management with specific braces is recommended for immature patients with progressing curves between 25-50 degrees. Surgical intervention of idiopathic scoliosis is considered only for curves greater than 45 degrees in immature patients and 50 degrees in mature patients.
It is important to note that any curves 10 degrees or more to the left must be closely watched due to the positioning of the heart and other internal organs.
Does idiopathic scoliosis cause pain?
It is rare that idiopathic scoliosis causes pain in mature adults unless the curve is significant and visible. The condition does not usually cause significant pain or any other health problems and tends to stay the same after you stop growing. If you do notice your scoliosis curve getting worse, it would be wise to see a healthcare provider as soon as possible.
Treatment strategies:
Treatment strategies for idiopathic scoliosis are diverse. Back bracing for idiopathic scoliosis is not recommended for adults since the bones are already fused and there is nothing that can be done. There is a small amount of evidence that suggests any specific exercise regime for scoliosis. Although it is not clear whether back exercises help improve scoliosis, general exercise is good for overall health and should not be avoided unless advised by a trusted healthcare practitioner
