What’s the Deal with Scoliosis?
Some of you may remember an experience many of us had in middle school. One day, you got sent to the locker room or gymnasium and a nurse told you to bend over and touch your toes. You just experienced the scoliosis screen, known to doctors as Adam’s test. This test is still being done today, however most likely performed by your pediatrician. Some of you were told that you did, in fact, have scoliosis. And most of you don’t have any memory of it being brought up again.
What is Scoliosis?
It is an abnormal lateral curve of the spine. Your spine naturally has normal curves from front to back. However, scoliosis refers to side-to-side curves. We measure the severity of the curve an an angle in degrees. Check out the image below for a comparison.
Why did I hear about it as a kid and then my doctor never brought it up again? What happened? In most cases, everything went as planned. That’s because scoliosis has various levels of severity, ranging from completely harmless to potentially dangerous, with the vast majority of cases being completely harmless. And for 99.9% of cases, the recommendation is to wait and see if the curve is increasing throughout puberty. If it doesn’t, the recommendation is to typically do nothing, unless there are specific symptoms.
Scoliosis Usually Doesn’t Get Worse in Adulthood
There are several types of scoliosis, but by far the most common type is known as adolescent idiopathic scoliosis, at 90% of cases. That term means it starts occurring in teens and there’s no known reason. Management of scoliosis has everything to do with skeletal maturity. Skeletal maturity is not measured by age. The way skeletal maturity is measured is known by the Risser scale, and it is performed via x-ray on the pelvis.
The scale ranges from 0-5, with 0 meaning no skeletal maturity and 5 means complete skeletal maturity. Typically Risser 5 occurs by age 16 for girls and 18 for boys. That’s why the most critical time to monitor the progression of scoliosis is at the start of puberty. By the time puberty is over, your ability to change the shape of the spine without surgery is over.
Management for Adolescents
So we’ve ruled out that scoliosis is no big deal for 99% of the population. But when do we actually need to do something proactive? From when you’re first measured for scoliosis as an adolescent, we measure the angle of the curve and base our recommendations on that, combined with your level of skeletal maturity.
| Curve | Risser 0 – 2 | Risser 3 | Risser 4 – 5 |
|---|---|---|---|
| < 10° | Clinically insignificant, follow-up only if curve appears to progress. Chiropractic management. | Unlikely to progress. Chiropractic management. | Doubtful to progress. Chiropractic management. |
| 11 – 19° | X-ray every 6-9 months until skeletal maturity. 22% chance of curve reaching > 20°. | Unlikely to progress. Chiropractic management. | Doubtful to progress. Chiropractic management. |
| 20 – 29° | X-ray every 5-6 months until skeletal maturity. 68% chance of curve increasing > 5°. May consider bracing if progression is aggressive. | Unlikely to progress. Chiropractic management. | Doubtful to progress. Chiropractic management. |
| 30 – 39° | Bracing for 23 hours/day. X-ray every 6 months until skeletal maturity. Surgery indicated if rapid progression continues. (≥10° in 1 year) | Follow-up yearly until 1 year after skeletal maturity. Chiropractic management. | Doubtful to progress. Chiropractic management. |
| 40 – 49° | Bracing for 23 hours/day. X-ray every 6 months. Orthopedic consultation is necessary. Surgery indicated if progression continues. | X-ray every 6 months, these patients are beyond bracing, surgical consult if curve reaches 50° before skeletal maturity. | May progress 1° per year, surgery only if thoracic functions worsens or pain worsens |
| 50°+ | Surgery is indicated. | Surgery is indicated. | Surgical consultation is warranted. |
Symptoms of Non-Surgical Scoliosis
For most people, yes, scoliosis is an incidental finding that has no real impact on their lives. For instance, Usain Bolt, Olympic Gold Medalist sprinter and fastest man alive, has a scoliosis curve of more than 40 degrees, which would be considered severe. That doesn’t mean that he never has back pain or didn’t have to work hard to overcome the effects, but he never let it hold him back.
This will also be true for most people who have mild to moderate scoliosis. Occasionally, I will see scoliosis patients who have symptoms such as one-sided back tightness or spasms and they can often be effectively treated with the techniques in our office. Stretching and strengthening exercises can help prevent future flare-ups. Usually, these flare-ups may last a week or two and occur a couple times a year. There are no progressive symptoms of scoliosis and in non-surgical cases, will have little to no impact on your life.
Finally, I’ll Leave You With Some Interesting Scoliosis Facts
Here’s two interesting facts about scoliosis: if you have a severe left-sided scoliosis, the spine may place pressure on the heart, and can affect heart function. This is fairly uncommon unless you have a severe thoracic scoliosis that curves left. Scoliosis has a genetic component: scoliosis is an associated condition with other genetic conditions, and scoliosis in fathers are often passed to their daughters. Pretty interesting!
If you have any questions about scoliosis or how we can help identify if you have scoliosis, please reach out to our office and we’d happy to schedule a consultation.