Types of Scoliosis
Scoliosis, curvature of the spine, can occur at any time in life, but it’s usually first diagnosed in adolescents and teens. Currently, about 6 to 9 million people in the United States have scoliosis; every year, 3 million new cases are diagnosed.
Scoliosis isn’t the same in everyone. Different types of scoliosis have different types of curves: some have one curve that may look like a “C,” while others have two curves, which may look like an “S.” A curve up to 20 degrees is considered mild, up to 40 degrees is moderate, and more than 50 degrees is severe. Here’s how doctors define types of scoliosis and how they approach treatment.
The word “idiopathic” means a condition that occurs spontaneously or unexpectedly with no apparent cause. Idiopathic scoliosis is the most common type of scoliosis.
Infantile idiopathic scoliosis
This form of scoliosis is diagnosed in about 1% of children with scoliosis overall, ranging in age from newborn to 3 years old. Generally, more girls than boys are diagnosed with scoliosis, but infantile idiopathic scoliosis affects more boys (60%).
Doctors don’t know what causes infantile idiopathic scoliosis. It may be genetic, or it may result from a bend in the spine when the baby is born that worsens into scoliosis as the child gets older.
Juvenile idiopathic scoliosis
Juvenile idiopathic scoliosis is diagnosed among children ages 4 to 9 and is the most common type of scoliosis, accounting for up to 20% of all cases. As with the infant type, doctors don’t know what causes juvenile idiopathic scoliosis, but it is often associated with other conditions, such as Arnold-Chiari syndrome, syringomyelia, and others. Up to 70% of children with this type of scoliosis will need treatment to prevent complications. Both infantile and juvenile scoliosis can be referred to as early-onset scoliosis.
Adolescent idiopathic scoliosis
This type of scoliosis is diagnosed in children from 10 to 18 years old, usually triggered by the adolescent growth spurt. They might have had some curvature earlier, but it can become more pronounced as they get older.
Adult idiopathic scoliosis
Adult idiopathic scoliosis could be scoliosis that has always been present but never detected. It can also occur as you age and your spine deteriorates, causing a curve or curves, but this would not be called idiopathic because the cause is known.
Congenital scoliosis is diagnosed in about 1 in 10,000 newborns and is present at birth. It may not be noticed until the children are older, however. There a few possible causes for congenital scoliosis:
- Vertebra (bones that make up the spine) don’t form properly in utero
- One or more vertebra may be missing
- Vertebra that normally join together do not join properly or at all
Children with congenital scoliosis often have other back problems too, such as an outward or inward curvature of the spine.
Neuromuscular Scoliosis and Syndromic Scoliosis
Scoliosis can also be caused by muscular or neurological deterioration, or by a syndrome that affects the connective tissue. Because these conditions are progressive diseases, the damage to the spine is also progressive, often causing the curve or curves to become more severe.
These types of scoliosis can be caused by several conditions, such as:
- Cerebral palsy
- Muscular dystrophy
- Spina bifida
- Osteochondrodystrophy (dwarfism)
Trauma to the spinal cord may also cause scoliosis.
Scoliosis treatment depends on the severity and the cause. At first, a pediatric spine surgeon may choose to watch and wait, to see how the spine develops. Some cases stay stable, while others progress and the curve or curves worsen. If the curve does worsen, the first step in treatment may be bracing. A full body brace keeps the body in position. The goal is to prevent the curve from progressing, but it won’t reverse or cure the curve. The brace should be worn full-time and needs to be changed as your child grows, usually once a year or so. It is no longer used after growth stops, usually around puberty.
If the curve or curves continue to worsen or there is no improvement, your doctor may suggest a body cast instead of a brace. Unlike a brace, a cast cannot be removed for bathing or special occasions. Because the children must be very still when the cast is applied, it is usually done under anesthesia. Like the brace, however, it must be replaced regularly as the children grow, usually every 2 or 3 months.
Surgery is usually a final option for scoliosis treatment. The surgeon may perform a bone graft and add hardware (screws and wires) to make the spine one solid piece. Another option is to insert rods alongside the spine to try to correct the curve as the spine as it grows. The rods must be lengthened every six months or so (an outpatient procedure). Usually patients must also wear a brace while the rods are in place. Once growth is finished, a surgeon removes hardware and performs a spinal fusion, so the spine keeps its shape.
Outcomes for People With Scoliosis
The earlier scoliosis is diagnosed, generally the easier it is to treat successfully. However, treatment success depends very much on compliance from the patient, which can be challenging, particularly for children, given the uncomfortable nature of braces and other scoliosis treatments. Patients who have surgery must carefully follow all instructions during the healing process so as not to damage the back as it is healing.
Untreated moderate to severe scoliosis could cause serious, sometimes life-threatening complications, including:
- Difficulty breathing as the lungs are compressed
- Heart damage if the rib cage causes pressure
- Back pain
- Physical changes, such as one shoulder and hip being higher than the other
If you notice symptoms of scoliosis in yourself or your child, speak with your doctor. The sooner you can get an accurate diagnosis, the sooner you can start treatment and prevent further damage or complications.