Scoliosis - Causes and Treatment

What is scoliosis?

What is meant by scoliosis?

Scoliosis, also known as spinal curvature, is a three-dimensional curvature of the spine. This means the spine deviates from its natural shape. The natural shape of the spine, when viewed from the side, is a double S-shape. When viewed from the back, however, in a healthy person, the spine forms a straight line. In scolioses, the spine exhibits both a lateral curvature as well as a twisting and deformation of the individual vertebral bodies. Scolioses are usually referred to as growth deformities, as they primarily occur in children and adolescents during puberty, a time of increased body growth. The curvature of the spine due to scolioses is very rare and the manifestation varies greatly. The Mister Sandman guide explains why:

Causes of scoliosis

Scolioses can be classified according to their causes, the time of onset, and the form of curvature. The causes of scolioses are unknown in about 90 percent of cases; the most important cases are shown in our Mister Sandman guide in the following section.

Idiopathic scoliosis

The so-called idiopathic scoliosis accounts for about 90 percent of all scolioses. Idiopathic means that the causes of the condition are unknown and cannot be determined. Idiopathic scoliosis develops spontaneously without an identifiable cause. It is suspected that an irregular growth of the back muscles and the vertebrae is the cause of idiopathic scoliosis. This suspicion is reinforced by the fact that scoliosis occurs during periods of physical growth, or becomes more pronounced. Girls, especially during puberty, are more frequently affected than boys. Depending on the time of onset, idiopathic scoliosis is classified into three subgroups:

Infantile idiopathic scoliosis (onset up to age 3)
Juvenile idiopathic scoliosis (onset between ages 4 and 10)
Idiopathic adolescent scoliosis (onset from the age of 11)

Symptomatic scoliosis (Secondary scoliosis)

If the causes of scoliosis can be determined, it is referred to in medicine as symptomatic or secondary scoliosis. Causes can be identified in about 10 percent of scoliosis patients. Identifiable causes:

congenital spinal deformities (Deformity scoliosis)
Nerve and muscle diseases (Neuropathic scoliosis)
Muscular dystrophies or arthrogryposis (Myopathic scoliosis)
Systemic diseases
Medical treatment measures, such as radiation or post-surgery due to scarring (iatrogenic scoliosis)
Trauma, amputations, or tumor surgeries in the area of the spine (post-traumatic scoliosis)
Leg length differences (static scoliosis)

Classification by appearance of scoliosis

Depending on where the main curvature (primary curvature) of the spine is located, the following forms of scoliosis are distinguished:

Thoracic scoliosis (curvature in the area of the thoracic spine)
Lumbar scoliosis (curvature in the area of the lumbar spine)
Thoracolumbar scoliosis (main curvature in the transition area between the thoracic spine and lumbar spine)
Thoracic and lumbar (double-curve) scoliosis (primary curvature in the area of the thoracic spine and lumbar spine)

Classification by severity of scoliosis

The severity of scoliosis is classified according to the curvature angle (so-called angle measurement according to Cobb):

Mild Scoliosis: angles of more than 10, but a maximum of 40 degrees Cobb
Moderate Scoliosis: from 40 to 50 degrees Cobb
Severe Scoliosis: over 50 degrees Cobb

In the case of malformations of the spine with a curvature of less than 10 degrees Cobb, one does not speak of scoliosis, but rather of a scoliotic posture. These malformations and slight curvatures are relatively common, but usually go unnoticed by the naked eye and do not cause any discomfort.

Scoliosis - Frequency and Distribution

The frequency of scoliosis varies greatly depending on its severity. Considering all forms, from the mildest severity to the most severe form of scoliosis, about 3 to 5 percent of people suffer from scoliosis. For the diagnosis of scoliosis and the recognition of the need for therapy, a curvature angle of at least 10 degrees Cobb is required. About one percent suffer from scoliosis between 10 to 20 degrees Cobb, and only about 0.5 percent of the population suffer from scoliosis over 20 degrees Cobb. The more severe the curvature, the more often girls are affected compared to boys. The causes of this distribution are unknown. It is assumed that genetic markers are involved.

Scoliosis - Symptoms and Complaints

A mild scoliosis usually does not cause any particular discomfort. If scoliosis, especially when it occurs in children, is not adequately treated, it can lead to discomfort over time. This is because the deformity and curvature cause the spine to wear differently than in healthy individuals. Thus, scoliosis patients often experience subsequent complaints, especially in advanced age, such as (back-)pain, for example, when getting up from mattresses in the morning. The psychological burden on those affected is often a topic as well, since the curvature of the spine can be quite visible and may be perceived as visually disturbing. Therefore, a good mattress is the basic requirement to support people with scoliosis and to prevent sleep disorders in the long term, which can accompany the condition.

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shoulders are not at the same height
pelvic tilt
waist triangles (triangles formed by the arm hanging down sideways and the waist) differ significantly in their shape
a straight line drawn from the head to the pelvis does not end in the middle of the pelvis, but to the left or right of it
one shoulder blade protrudes more than the other

Scoliosis - Diagnosis

Depending on the severity of the scoliosis, the diagnosis is relatively easy and clear in most cases. A doctor usually recognizes a moderate scoliosis with the naked eye during an examination. In cases of particularly mild scoliosis, a diagnosis may sometimes not be made through a simple examination. A commonly used initial examination method by the consulted doctors when scoliosis is suspected is the so-called Adams test or forward-bending test. In this test, the patient bends forward about 90 degrees with straight legs and lets their arms hang. When looking at the back from behind, one side in scoliosis is usually higher than the other. A noticeable feature is a type of hump (rib hump) or the pronounced protrusion of the lumbar muscles on one side (lumbar bulge). To obtain certainty about the diagnosis of scoliosis and to determine the exact curvature angle, large-scale X-ray images are necessary.

Therapy of scoliosis

Most scolioses can be treated conventionally through special physical therapy. Depending on the severity of the scolioses and the prognosis based on the time of onset, bracing therapy or surgery may also be considered as treatment options. Often, the various therapy methods are also combined with each other. Early diagnosis by a doctor is particularly important in the treatment of scoliosis, as scolioses can only be successfully treated while the patient is still growing. Especially when parents notice a curvature of the spine in their children, it should be diagnosed and treated by a doctor immediately. Since scolioses can often worsen significantly during phases of rapid physical growth, even a initially mild scoliosis should not be downplayed at an early age.

Treatment of scoliosis through physical therapy (physiotherapy)

Physical therapy is always an essential part of the treatment of scoliosis, regardless of the severity of the curvature. The goal is an active erection of the spine and a strengthening of the back muscles. This is intended to counteract the curvature and rotation. The patient's body awareness and mobility can also be improved in this way, as these are often restricted in scoliosis. The exercises are possible at almost any age and can usually be well integrated into the daily routine by those affected. In the case of mild scoliosis, physiotherapy is usually sufficient.

Treatment of Scoliosis using Brace Therapy (Orthotic Therapy)

The use of an individually tailored corset is primarily applied in cases of scoliosis with a curvature of over 20 degrees Cobb, when the patient still has a certain growth potential. The corset is intended to direct growth in a specific, desired direction that counteracts the rotation of the vertebrae. For the success of the corset application, it must be worn as much as possible, even at night. This is often a significant psychological burden for children. In these cases, additional support from a child and adolescent psychiatrist is recommended.

Surgery for Scoliosis

Surgery is only considered for scoliosis when all conventional methods have been exhausted and do not bring the hoped-for success, or when extreme complaints are present. This can include, for example, impairment of heart and lung function due to the rotation of the body. Surgery is generally indicated only for scoliosis with a curvature of over 50 degrees Cobb. Depending on the severity of the curvature, a doctor has various possible procedures for surgery that may be considered. In principle, the goal of surgery is always to eliminate the curvature and rotation as much as possible and to subsequently stabilize the spine with implants. Surgery can be performed through the anterior approach along the ribs or through the posterior approach on the back. Surgery through the anterior approach usually provides better cosmetic results. In special cases, both methods can also be combined during surgery.