Skip To Content

Office Appointments: 303-321-1333 - Physical Therapy: 303-253-7373

Scoliosis

    Scoliosis

    Scoliosis is defined as a persistent lateral curvature of the spine of more than 10 degrees in the standing position, also associated with rotation of the spine.
    What Causes It?
    There are four major categories of scoliosis: congenital, idiopathic, neuromuscular, and degenerative. 
    Congenital scoliosis refers to curvature present at birth due to an abnormality of formation of the spinal column, i.e. a failure of the vertebrae to form individually or separate from each other. 
    Idiopathic scoliosis refers to the most common type of scoliosis, although the cause is unknown. Research points to a probably multifactorial process that includes altered melatonin synthesis, connective tissue disorder, skeletal muscle abnormalities, contractile protein dysfunction or a neural mechanism problem. Idiopathic scoliosis is further subdivided into three age categories based on the age of initial onset: infantile, with onset after birth up to age 2; juvenile, occurring between ages 3 up to 10 years old; and adolescent (the most common type, abbreviated AIS) between ages 11 and 17. Adult idiopathic scoliosis, in addition, refers to scoliosis starting at a younger age, which persists, into adulthood.
    Neuromuscular scoliosis is the result of a wide variety of neuromuscular disorders that include cerebral palsy, muscular dystrophy, and myelomeningocele. These disorders require different treatment interventions than idiopathic scoliosis.
    Degenerative scoliosis refers to a worsening of idiopathic scoliosis later in life or the development of scoliosis not previously present due to degenerative disc disease. The process of loss of fluid and secondary loss of height of intervertebral discs does not always result in a uniform collapse of the disc. If this collapse occurs asymmetrically (more on one side of the disc than the other), a secondary scoliosis occurs.
    AIS is usually a painless condition. A family member, school screening or pediatrician/family doctor typically first identifies it. A fullness or prominence of the spine or shoulder blade, or elevation of one shoulder, is noted, often when the individual bends forward. Three to five percent of the population have curves greater than 10 degrees, but only 0.2-0.3% require treatment. Scoliosis is more common in females than males, and tends more often to progress in females. 3-foot standing x-rays are used to measure the severity of curves and further classify them. The angle of the curve in degrees is called the Cobb angle. The major curve is the curve with the greatest Cobb angle. Since curves progress in AIS only until the completion of skeletal growth, the smaller the curve and more fully-grown the patient, the less likely scoliosis will worsen. X-rays taken over a period of time can determine whether or not a curve or curves are progressive.
    Treatment Options
    Curves less than 20 degrees are observed; curves in the 20-29 degree range are treated with bracing is curve progression is documented over time; and 30-40 degree curves are braced immediately if growth potential remains. Surgery becomes an option for curves over 40 degrees if growth potential remains, although curves less than 50 degrees can still be braced. Surgery is more seriously considered for curves over 50 degrees, given that curves of that magnitude are more likely to continue to progress at a slow rate through adulthood.
    A failure of bracing with curve progression above 40 degrees, and especially above 50 degrees, is an indication for consideration of surgery, involving fusion of the spine using corrective spinal instrumentation. Surgery can be performed from the front of the spine, the back of the spine, or both.