Introduction:

Scoliosis is the term given to abnormal lateral (to the side) curvatures of the spine. Although this abnormality of the spine is a rather common deformity (2-3% of the pediatric population, up to 20% of older adults), it rarely requires any form of treatment. Scoliosis may develop due to a number of causes, and thus several types of scoliosis exist.

In children and adolescents, the most common type of scoliosis is called Idiopathic Scoliosis. As its name implies (idiopathic means that no specific or clear origin is identified) the cause of this deformity is not known but may be caused by a combination of factors (possibly hormonal, genetic, and neurologic). In idiopathic scoliosis, a portion of the spine rotates and shifts away from the midline. Seen from the back the spine is thus no longer straight and a "hump" can be noted on the side to which the curved spine has shifted. When this abnormal curvature of the spine is examined by X-ray, the exact degree of curvature can be measured (often called the Cobb angle). Depending upon several factors such as the patient age, sex, degree of curvature and how fast the abnormal curve is developing, a treatment plan is designed. Most patients who have scoliosis do not have severe curves and thus may require no treatment. When a scoliosis with a significant or progressive curvature is noted, then treatment may be necessary. Treatment for scoliosis can involve doing nothing (for mild curves), bracing (for moderate curves), or in some instances performing surgery for severe or progressive (worsening with time) curves. The risks and benefits of each of these approaches for a particular patient must be carefully reviewed. Sometimes there is no one correct treatment. When different options exist the physician must work closely with the family and patient to follow a plan designed for the particular individual. If the decision is not to operate, then X-rays must be obtained at regular intervals to ensure that the scoliosis is being controlled and not progressing too rapidly. If a decision to operate is made, the patient must be aware of the risks involved, the recovery period required, and the limited activities possible during that time. With the new spinal instrumentation systems dramatic corrections of deformity are now possible and patients are often out of bed walking in several days.

Aside from idiopathic scoliosis, there are many other (less common) types of scoliosis seen in children. Other types of scoliosis include congenital scoliosis, neuromuscular scoliosis, metabolic and traumatic scoliosis.

In adults, scoliosis can occur due to a number of different conditions. The most common causes for spinal deformity include a childhood scoliosis which has progressed or become painful in adult life, or a new scoliosis which has developed due to aging. In some cases it is difficult to tell when exactly the spine developed a scoliosis, and sometimes it is even hard to tell that there is a spinal problem just by looking at someone. In severe cases, the spine can become quite hunched and twisted causing problems with posture, walking and even breathing. The exact cause of scoliosis in adults is not clearly understood. We know that aging leads to a gradual collapse of the intervertebral discs along the spine, and that the ligaments that the support the spine lose their strength and elasticity. Furthermore, the bones can become weakened and partially collapse (as in osteoporosis). All of this combined can weaken the structure of the spine so that a gradual deformity occurs that usually combines an increased forward curvature (kyphosis) as well as a lateral deviation of the spine (scoliosis).

Aside from scoliosis due to degeneration, or progression from childhood, there are a number of other causes for spinal deformity in an adult. Some of the less common types include: fractures, metabolic diseases, infections, cancer.

Prior to planning a treatment for scoliosis in an adult it is essential to understand what caused the deformity. The evaluation may include X-rays and possibly other test such as an MRI, blood tests, and a bone density evaluation. The treatment for adult scoliosis is then dependant upon the cause of the deformity as well as the symptoms. In most cases of mild degenerative scoliosis the treatment is directed at muscular rehabilitation and pain control. A focused therapy program and anti-inflammatory and/or pain medication can help most patients in this category. For patients suffering from other specific types of scoliosis the treatment is directed at the underlying cause for spinal collapse.

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