Spinal Deformities

Scoliosis

What is scoliosis?

A normal spine, when viewed from behind, looks straight. But a spine affected by scoliosis shows a side-to-side curvature, with the spine looking like an S or C. The back bones (vertebrae) may also be rotated. This makes it look like the person is leaning to 1 side. Scoliosis is defined as a curvature of the spine measuring 10° or greater.

Scoliosis is not due to poor posture.

Spinal curvature from scoliosis may occur on the right, left, or both sides of the spine. Both the middle (thoracic) and lower (lumbar) spine may be affected by scoliosis.

What causes scoliosis?

In most cases, the cause of scoliosis is not known. This is called idiopathic scoliosis. In other cases, scoliosis may be caused by a breakdown of the spinal discs. This can occur with arthritis or osteoporosis. Or it may be a hereditary condition that runs in families.

The abnormal curves of the spine are defined according to their cause:

• Nonstructural scoliosis. This is also called functional scoliosis. In this condition, a normal spine is curved due to 1 or more problems. For example, the leg lengths may be different. Or there may be an inflammatory problem. This type of scoliosis is often short-term. It goes away when the underlying problem is treated.

• Structural scoliosis. The possible causes of structural scoliosis include:

  • Unknown (idiopathic scoliosis)
  • Disease that is neuromuscular, metabolic, rheumatoid, or other type
  • Birth defect
  • Injury
  • Infection
  • Abnormal growth

   

What are the symptoms of scoliosis?

These are the most common symptoms of scoliosis:

• Difference in shoulder height
• Head is off-center from the rest of the body
• Difference in hip height or position
• Difference in shoulder blade height or position
• When standing straight, difference in the way the arms hang beside the body
• When bending forward, the sides of the back look different in height

Get medical care right away if you have back pain, leg pain, or changes in bowel and bladder habits. These are not often seen with idiopathic scoliosis.

The symptoms of scoliosis may look like other health problems. Always see your healthcare provider for a diagnosis.

How is scoliosis diagnosed?

A healthcare provider will ask about your health history. They will give you a physical exam. You will have X-rays. These are the main tool for diagnosing scoliosis. The healthcare provider measures the degree of spinal curvature on the X-ray.

Other tests may be done for nonidiopathic curvatures, abnormal curve patterns, or congenital scoliosis. These include:

• MRI. MRI uses a combination of large magnets and a computer to produce detailed images of organs and structures within the body.
• CT scan. A CT scan uses X-rays and computer technology to make detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

Early detection of scoliosis is most important for successful treatment.

How is scoliosis treated?

The goal of treatment is to stop the progression of the curve and prevent deformity. Treatment may include:

• Observation and repeated exams. This may be needed to determine if the spine is continuing to curve. It's used when a person has a curve less than 25° that is still growing.
• Bracing. Bracing may be used when the curve measures more than 25° to 30° on an X-ray, but skeletal growth remains. It may also be needed if a person is growing and has a curve between 20° and 29° that isn't improving or that is advancing. The type of brace and the amount of time spent in the brace will depend on the severity of the condition.
• Surgery. Surgery may be advised when the curve measures 45° or more on an X-ray and bracing isn't successful in slowing down the progression of the curve when a person is still growing. Certain symptoms, such as loss of bladder or bowel control, may also need surgery.

There's no scientific evidence to show that other methods for treating scoliosis (for example, chiropractic manipulation, electrical stimulation, nutritional supplementation, or exercise) prevent the progression of the disease. Talk with your healthcare provider before starting, or paying for, a nontraditional treatment for scoliosis.

Key points about scoliosis

• Scoliosis is a sideways curvature of the spine measuring 10° or greater.
• In most cases, the cause of scoliosis is not known. In some cases, scoliosis may be caused by a breakdown of the spinal discs. This can occur with arthritis, osteoporosis, or as a hereditary condition that runs in families.
• Symptoms include a difference in shoulder height, difference in hip height or position, and the head being off-center from the rest of the body.
• In addition to a full health history and physical exam, X-rays are the main tool for diagnosing scoliosis.
• Treatment may include observation and repeated exams, bracing, and surgery.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new directions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is advised and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.

Kyphosis

What is kyphosis?

A normal spine, when viewed from behind, appears straight. However, a spine affected by kyphosis has a forward curvature of the back bones (vertebrae) in the upper back area, giving an abnormally rounded or humpback appearance. This is sometimes known as roundback or a dowager's hump.

Kyphosis is a curvature of the spine measuring 50 degrees or greater on an X-ray. The normal spine can bend from 20 to 45 degrees of curvature in the upper back area. Kyphosis is a type of spinal deformity.

What causes kyphosis?

A child can be born with kyphosis (congenital). Or it can be caused by the following conditions:

• Metabolic problems
• Neuromuscular conditions
• Brittle bone disease (osteogenesis imperfecta). A condition that causes bones to fracture with minimal force.
• Spina bifida. A neural tube defect.
• Scheuermann disease. A condition that causes the vertebrae to curve forward in the upper back area. The cause of Scheuermann disease is unknown and is commonly seen in males.
• Postural kyphosis. The most common type of kyphosis. It generally becomes noticeable in adolescence and can be associated with slouching versus a spinal abnormality. Exercise is used to help correct posture.

Kyphosis is more common in people assigned female at birth.

What are the symptoms of kyphosis?

Symptoms may be a bit different for each person. Symptoms may include:

• Difference in shoulder height
• The head bends forward compared to the rest of the body
• Difference in shoulder blade height or position
• When bending forward, the height of the upper back appears higher than normal
• Tight hamstrings (back thigh) muscles

Back pain, pain down the legs, and changes in bowel and bladder habits are not common in people with kyphosis. If you have these types of symptoms, see your healthcare provider.

Some of these can be caused by other spinal conditions or deformities. Or they can happen because of an injury or infection. Always talk with your provider for a diagnosis.

How is kyphosis diagnosed?

The healthcare provider makes the diagnosis of kyphosis with a complete medical history, physical exam, and diagnostic tests. For a child, the provider will want to have a prenatal and birth history of the child. They will also ask if other family members are known to have kyphosis. The provider also will ask about developmental milestones since some types of kyphosis can be linked to other neuromuscular disorders. Developmental delays may need further medical evaluation.

Diagnostic procedures may include the following:

• Blood tests
• X-rays. A diagnostic test that uses invisible electromagnetic energy beams to make images of internal tissues, bones, and organs onto film. This test is used to measure and evaluate the curve. With the use of a full-spine X-ray, the provider measures the angle of the spinal curve. A treatment plan can often be made based on this measurement.
• Radionuclide bone scan. A nuclear imaging method that uses a very small amount of radioactive material, which is injected into the bloodstream to be found by a scanner. This test shows blood flow to the bone and cell activity within the bone.
• MRI. A diagnostic procedure that uses a combination of large magnets and a computer to make detailed images of organs and structures within the body. This test is done to rule out any associated abnormalities of the spinal cord and nerves.
• (CT) scan. This is an imaging test that uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

Finding kyphosis early is important for successful treatment. Healthcare providers, and even some school programs, regularly look for signs of kyphosis in children.

How is kyphosis treated?

Treatment will depend on your child's symptoms, age, and general health. It will also depend on how bad the condition is.

The goal of treatment is to stop the progression of the curve and minimize deformity. Treatment may include:

• Observation and repeated exams. Your child will need observation and repeated exams. Progression of the curve depends on your child's skeletal growth and maturity. Curve progression often slows down or stops after a child reaches puberty.
• Bracing. If your child is still growing, their healthcare provider may prescribe a brace. They will talk with you about the type of brace and the amount of time to be spent in the brace.
• Surgery. In rare instances, surgery is recommended when the curve measures 75 degrees or more on X-ray, and bracing isn't successful in slowing down the progression of the curve.

What are possible complications of kyphosis?

Possible complications of kyphosis depend on the type of kyphosis your child has. With Scheuermann kyphosis, there may be pain with activity or with long periods of sitting or standing. Severe kyphosis can harm how the lungs work and lead to breathing problems.

Key points about kyphosis

• Kyphosis is a type of spinal deformity. Kyphosis is defined as a curvature of the spine measuring 50 degrees or greater on an X-ray.
• A child can be born with it (congenital) or it can be caused by certain conditions.
• It's more common in people assigned female at birth.
• The most common symptoms may include difference in shoulder or shoulder blade height, the head bends forward, and tight hamstring muscles.
• The goal of treatment is to stop the progression of the curve and reduce deformity.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you don't take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions, especially after office hours or on weekends.