By: Lauren McRae

Scoliosis is a sideways curvature in your spine that can occur both during childhood or adulthood due to different causes.

Scoliosis is found on x-ray when the spinal curvature measures 10 degrees or more, and the curvature can vary in size from very small degrees not even visible in clothes to very large that are visible to the naked eye. Doctors may use the letters “C” and “S” to describe the curve.

Your appearance may be affected by your scoliosis, including:

• Leaning to one side because of the spine curvature
• A visible curve in your back
• Loss of height (stature) – usually in older adults with scoliosis
• Uneven shoulders, waist, or hips that look uneven
• One shoulder blade looks bigger
• Ribs that stick out farther on one side of the body than the other

Having scoliosis can lead to lower back pain, stiffness, numbness in the legs, or fatigue due to muscle strain. The various types of scoliosis are classified by cause and age of onset; the speed of progression also plays a role in determining the specific type of scoliosis.

Though all forms of scoliosis involve some degree of spinal curvature, some are more severe than others. Lukas Peter Zabala, MD, orthopedic and spine surgeon, explains the seven types of scoliosis in greater detail:

Congenital Scoliosis: This is the presence of abnormal curvature of the spine found in newborns or young infants. Children with this condition begin to develop curvature before birth while in the mother's womb. The curvature causes the spinal column to bend left or right in the shape of an “S” or “C”.

Early Onset Scoliosis: This type of scoliosis is present in children before the age of 10. It is important to differentiate between adolescent and early onset scoliosis because children over the age of 10 have already completed most of their spinal growth, while those under 10 are still growing. Because children under 10 are still growing, early-onset scoliosis can affect more than just the spine – it can also lead to malformed ribs, which can affect lung development.

Adolescent Scoliosis: The most common form, this affects children between the ages of 10 and 18. In most cases, adolescent scoliosis patients do not experience any pain or neurologic abnormalities – they may even look normal when viewed from the side. When symptoms do develop, they typically take the form of uneven shoulders, a rib hump, or a leaning torso.

"Treatment of AIS depends on the size of the scoliosis curvature and the child’s remaining growth, and ranges from careful observation with repeat x-rays, brace wearing or in curves over 45 degrees in children with lots of growth remaining, surgical treatment," says Dr. Zebala. 

Degenerative Scoliosis: Also known as adult-onset scoliosis or de novo scoliosis. Degenerative scoliosis most commonly develops in the lumbar spine, or the lower back, and is caused by arthritis that develops in the spine with aging.

"Unlike scoliosis that affects kids, adult scoliosis is often associated with pain due to several causes," says Dr. Zebala. "You can have lower back pain and stiffness from arthritis that causes scoliosis as well muscular pain from your body trying to keep you standing straight. Also, arthritis can cause pressure on your nerves that can cause pain, numbness, tingling and weakness in your legs."

Treatment for adult scoliosis is patient-centered and can range from outpatient surgery to take pressure off the nerves to more involved surgery to straighten out your spine and relieve your arthritis pain.

Neuromuscular Scoliosis: is an irregular spinal curvature caused by disorders of the brain, spinal cord, and muscular system. Some of the underlying conditions known to contribute to neuromuscular scoliosis include myelodysplasia, cerebral palsy, Duchenne muscular dystrophy, Freidrich ataxia, and spinal muscular atrophy.

Scheuermann’s Kyphosis: This condition affects the upper back. It makes the upper back rounded so it looks hunched over. It’s also sometimes called Scheuermann’s disease.

Syndromic Scoliosis: This type of scoliosis develops secondary to some kind of syndrome. Some of the syndromes that are most commonly linked to syndromic scoliosis include Rett’s syndrome, Beale’s syndrome, muscular dystrophy, osteochondrodystrophy, and various connective tissue disorders.

When to Seek Treatment:
Scoliosis treatment varies based on the underlying cause. In adolescent idiopathic scoliosis, brace treatment is often done in curves between 30-45 degrees and surgical treatment may be necessary for larger curves over 45 degrees, especially in kids with lots of growth remaining.

In adult degenerative scoliosis, nonoperative treatment can be done with exercise, medications, injection for patients with small curves, minimal pain or disability from scoliosis, or mild nerve pain. Surgical treatment options for adult scoliosis are recommended based on each patient's symptoms.

According to Dr. Zebala, “I treat the patient and not the x-ray, and when surgery is needed, I work with the patient as a team to figure out what the patient’s main complaints are and what their expectations for treatment are. I create a treatment plan for the patient that is individualized specifically for each patient. Treatment can range from a steroid shot and exercise, to minor outpatient surgery like a nerve decompression, or to more invasive fusion surgeries where we straighten out the spine.”