Scoliosis

I believe that the term scoliosis is within the average americans medical lexicon. But, just incase you are not aware, scoliosis is when our spine curves to the side. Our spines are supposed to have curvature but the normal curvature is from front to back creating something of an S curve. Some may call any lateral curvature a scoliosis but most medical providers use 10 degrees of lateral curvature as the over/under for diagnosing scoliosis. As a chiropractor, any amount of lateral curvature is important to me and I often use 'the S word' to describe minor curves in practice. I am careful how I phrase this to my patients because a minor scoliosis generally does not represent a major health problem or disease process..

Diagnosing Scoliosis

The diagnosis begins, as most do, with a visual inspection. As a chiropractor I am always looking for asymmetries from the moment a patient walks into the clinic. I might notice one shoulder higher than the other, a rib hump more prominent on one side or another, or the characteristic walk of somebody with a leg length difference. Once we are doing an exam an Adams test will generally reveal any curvature that is present. The adams test is simply a forward bend from the waist with attention paid to the shoulders, ribs and hips. Differences in any of these indicate the possibility of a scoliosis.

The gold standard for diagnosing scoliosis is an old fashioned X-ray. A scoliosis series (x-ray to detect scoliosis) is performed with the patient standing and includes the entire spine. This gives me a look and allows me to properly measure the curve with something called the Cobb method.

Chiropractic evaluation of scoliosis of the spine

Types of Scoliosis

There are several types of scoliosis with the biggest difference being age of onset. A few types are due to malformations of a vertebra or two and a another has to do with severe degenerative changes within the lumbar spine and almost exclusively affects folks over 50 years of age.

Idiopathic Scoliosis (most common) - This type starts in our youth and may improve, get worse or remain unchanged. We simply do not know exactly what causes this type of scoliosis but genetics plays a big role.
1. It is subdivided by age of onset
  1. Infantile 0y - 3y
  2. Juvenile 4y - 10y
  3. Adolescent (most common) 11y - 18y
Congenital Scoliosis - This is where a vertebra fails to develop properly and leads to an abnormal spinal curvature.
Neuromuscular Scoliosis - In conditions like cerebral palsy, the muscles that support the spine and our normal curves are not able to function properly and lead to abnormal curvatures of the spine.
Functional Scoliosis - This is usually minor and comes about for various reasons. The most common reason for this type is a difference in leg length from side to side which is in itself very common.
Degenerative scoliosis - This type occurs in older folks with severe degenerative changes in the lumbar spine.

Treatment of Scoliosis

The treatment of scoliosis depends on a few things, but first and foremost, the type and cause. In the cases of both Congenital and Neuromuscular variants the underlying disease must be treated. With idiopathic scoliosis treatment depends on the severity with 40 degrees typically being the threshold for bracing and/or surgical interventions. Although, the vast majority of idiopathic scoliosis do not require intervention and may resolve spontaneously. With minor idiopathic scoliosis, I typically see these patients twice a year for monitoring and, of course, adjustments. The functional scoliosis type is one that I see on a day to day basis and is almost always minor in severity but does lead to some uneven wear and tear of the discs and joints in the spine often causing low back pain. Degenerative scoliosis may seem inevitable but some spinal hygiene can significantly reduce the likelihood that this develops in old age.

I have to be careful here not to over promise but most scoliosis is benign and once the patient is an adult is relatively static. Several have proclaimed to be able to reverse scoliosis in adults with varied approaches but none have been able to demonstrate, reproducible results. At the end of the day, we are treating the wear and tear that the scoliosis makes more likely and not the curvature directly.

See ya soon,

Dr Malone