Scoliosis

Written by Dr. Jason Ngan, DC

What is Scoliosis?

Scoliosis is an abnormal lateral curvature of the spine greater than 10 degrees. The term scoliosis is derived from the Greek word skolios meaning twisted. There are two types of scolioses, functional and structural. Functional scoliosis is the result of abnormal soft tissues (muscles, ligaments, tendons) pulling on the spine. Structural scoliosis is the result of abnormal bones in the spine. Functional scoliosis is temporary as long as the imbalance is fixed, but it can lead to structural scoliosis if left untreated.

What Causes Scoliosis?

Functional scoliosis is caused by abnormal soft tissue patterns.

  • Muscle imbalance: use one side of the body more causing tightness on one side

  • Awkward sleeping positions

  • Poor posture

  • Nerve root irritation causes muscle spasm

  • Leg length discrepancies causes scoliosis in the lumbar spine

    • One leg is shorter due to abnormal stance or gait (walking pattern)

Structural scoliosis is caused by abnormal bony structures of the spine. There are two subtypes of structural scoliosis, developmental and acquired.

  • Developmental structural scoliosis is a congenital defect in the bones (born with it)

    • Hemivertebra: half of the vertebra (spine bone) does not form. A normal vertebra is rectangle but a hemivertebra is triangular shaped. This shape creates an angle at that part of the spine.

    • Spinal bifida: birth defect where the spinal column does not form properly and the spinal cord and nerves are exposed.

  • Acquired structural scoliosis (acquired after birth)

    • Idiopathic (most common cause of scoliosis): cause is unknown.

    • Trauma can fracture vertebra.

    • Infection can deform the vertebra. Examples include tuberculosis and bone infections.

    • Virus can also deform the vertebra. Example include polio.

    • Degenerative scoliosis occurs with elderly patients. The bones are degenerating (losing bone mass) and causes scoliosis.

    • Genetic defects such as neurofibromatosis causes spinal deformity.

    • Neuromuscular disorders such as cerebral palsy.

    • Tumors such as osteoid osteoma and osteoblastoma. Creates abnormal growths in the bones.

    • Radiation such as from radiation treatment of cancer.

What are the Signs and Symptoms?

  • Back pain

  • Back stiffness

  • Pain, numbness, tingling in legs due to pinched nerves

  • Muscle spasm

  • Uneven shoulders/hips

  • Ribs sticking out

  • Severe scoliosis can compromise internal organs such as breathing

How is Scoliosis Diagnosed?

Scoliosis is diagnosed with a medical history, physical examination, orthopedic testing, x-ray diagnostic imaging, CT scan, and MRI.

  • Palpation of the spine

  • X-ray imaging

    • Angle and severity of the scoliosis is measured with methods such as Cobb Lippman, Nash and Moe, and Risser-Ferguson

  • CT scan and MRI can also visualize a curvature of the spine

What are the Treatment Options?

For patients under 25-years-old where bones are not fully formed yet, the goal is to prevent progression of the curve. For patients over 25-years-old, since the bones are fully formed, the goal is to decrease discomfort.

For patients under 25-years-old the treatment depends on the severity of the curvature angle.

  • Under 20 degrees: chiropractic care to prevent progression of the scoliosis

  • 21-40 degrees: consult with orthopedist for bracing (Boston and Milwaukee)

  • Over 40 degrees: consult for surgery (Harrington’s Rod are inserted into the spine to straighten the curve)

  • Over 50 degrees: can compromise heart and lungs

Types of treatments we offer at Ngan Chiropractic include:

  • Chiropractic manipulation and mobilization

  • Flexion-distraction

  • Spinal traction

  • Soft tissue therapies

  • Gua-sha

  • Cupping

  • E-stim

  • Ultrasound

  • Ergonomic/postural counseling

  • Rehabilitative exercises and stretches

Other treatments that patients may seek (not provided at Ngan Chiropractic) include pain medications, spinal injections, custom bracing, and surgery if severe.

References

  1. El-Hawary R, Akbarnia BA. Early onset scoliosis - time for consensus. Spine Deform 2015; 3:105–106. doi: 10.1016/j.jspd.2015.01.003.

  2. Karimi MT, Rabczuk T. Scoliosis conservative treatment: A review of literature. J Craniovertebr Junction Spine. 2018 Jan-Mar;9(1):3-8. doi: 10.4103/jcvjs.JCVJS_39_17. PMID: 29755230; PMCID: PMC5934961.

  3. Lenz, M., Oikonomidis, S., Harland, A. et al. Scoliosis and Prognosis—a systematic review regarding patient-specific and radiological predictive factors for curve progression. Eur Spine J 30, 1813–1822 (2021). https://doi.org/10.1007/s00586-021-06817-0

  4. Menger RP, Sin AH. Adolescent and Idiopathic Scoliosis. [Updated 2022 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499908/

  5. Morningstar MW. Outcomes for adult scoliosis patients receiving chiropractic rehabilitation: a 24-month retrospective analysis. J Chiropr Med. 2011 Sep;10(3):179-84. doi: 10.1016/j.jcm.2011.01.006. Epub 2011 Aug 6. PMID: 22014907; PMCID: PMC3259989.