Scoliosis

Scoliosis is a condition involving a sideways curvature of the spine that typically arises during the growth spurt just before puberty. Unlike normal spinal alignment, scoliosis causes the spine to curve abnormally, which can impact posture, mobility, and in more severe cases, organ function. The severity of scoliosis can range from mild to debilitating, with some individuals requiring lifelong care.

Although scoliosis is more prevalent in adolescents, it can occur at any age due to various underlying causes. The earlier scoliosis is diagnosed, the better the outcomes in terms of managing the condition and preventing complications. This guide aims to educate patients, families, and caregivers on scoliosis by providing simple, comprehensive, and accurate information.

Scoliosis is a musculoskeletal disorder where the spine curves sideways in an “S” or “C” shape. It’s not merely poor posture but a medical condition involving structural changes in the vertebrae. The curvature can be mild, moderate, or severe, and may worsen over time if left untreated.

It can be detected by visible signs such as uneven shoulders, an asymmetrical waist, or a prominent ribcage. While many cases are mild and require minimal intervention, others may need bracing or surgery. The condition affects both children and adults, and it can significantly influence quality of life if not addressed properly.

Global Prevalence

Scoliosis affects approximately 2–3% of the global population. According to the Scoliosis Research Society, adolescent idiopathic scoliosis (AIS) is the most common form, accounting for 80–85% of all cases. Girls are up to eight times more likely than boys to have curves that progress to the point of requiring treatment.

Prevalence in India

In India, scoliosis is often underdiagnosed due to lack of awareness and limited access to orthopaedic care in rural areas. However, studies indicate that the prevalence is similar to global rates. A 2020 study published in the Indian Spine Journal found idiopathic scoliosis to be the most prevalent form in Indian children.

Scoliosis is categorised based on its cause and age of onset:

1. Idiopathic Scoliosis: The most common type, with no identifiable cause. It typically emerges during adolescence.
   
   • Infantile (birth to 3 years)
   • Juvenile (4 to 10 years)
   • Adolescent (11 to 18 years)
2. Congenital Scoliosis: Caused by spinal abnormalities present at birth, such as vertebrae that are incompletely formed or fused.
3. Neuromuscular Scoliosis: Occurs in individuals with neuromuscular conditions such as cerebral palsy, muscular dystrophy, or spinal cord injury.
4. Degenerative Scoliosis: Develops in older adults due to wear and tear of spinal discs and joints, often linked to osteoporosis.
5. Syndromic Scoliosis: Occurs as part of broader syndromes like Marfan syndrome or neurofibromatosis.

The cause of scoliosis varies depending on the type:

• Idiopathic: The exact cause is unknown, but genetic predisposition plays a significant role.
• Congenital: Result of improper development of the vertebrae during embryonic growth.
• Neuromuscular: Arises from disorders that impair muscles and nerves.
• Degenerative: Caused by age-related spinal deterioration.
• Traumatic or Postural: Rare cases may result from injury or poor biomechanics.

Risk factors include family history, gender (females more prone), and underlying neurological or muscular diseases.

Symptoms vary based on the degree of curvature and age of onset:

• Uneven shoulders
• Asymmetrical waist or hips
• One shoulder blade more prominent
• Leaning to one side
• Prominent ribs or shoulder when bending forward
• Back pain or discomfort
• Fatigue due to muscle strain
• Limited mobility in advanced cases

In severe cases, scoliosis can impair lung or heart function due to reduced chest space.

Early and accurate diagnosis is key to effective management:

1. Physical Examination: Involves posture analysis and the Adams Forward Bend Test to check for spinal abnormalities.
2. X-rays: Essential for confirming scoliosis and measuring the Cobb angle.
3. MRI or CT Scan: Used to detect underlying causes or nerve involvement.
4. Scoliometer: A device used in schools and clinics to screen children.

• Family History and Growth Assessment: Helps identify high-risk individuals.
   

Treatment depends on curve severity, progression, and age of the patient:

Non-Surgical Options:

• Observation: For mild cases (curves <20 degrees), especially in growing children.
• Bracing: Common for adolescents with curves between 25–40 degrees. Braces prevent further curvature.
• Physical Therapy: Customised exercises to strengthen back muscles, improve posture, and reduce pain.
• Chiropractic Adjustments: May offer temporary relief.
• Pain Management: Medications or heat therapy. (Brand: Voberan SR Tablet)

Surgical Options:

• Spinal Fusion: Most common surgery; fuses curved vertebrae using rods and screws.
• Growing Rods: Used in children to accommodate growth.
• Vertebral Body Tethering (VBT): A newer, less invasive surgery allowing spinal growth.

Recovery from surgery can take 3–6 months and includes physical therapy.

While not a substitute for medical treatment, alternative therapies may enhance quality of life:

• Yoga and Pilates: Improve flexibility, alignment, and core strength.
• Massage Therapy: Alleviates muscle tension and promotes relaxation.
• Acupuncture: May relieve chronic back pain.
• Mindfulness and Meditation: Support emotional wellbeing.

Always consult a healthcare provider before beginning any alternative therapy.

Major risk factors for scoliosis include:

• Female gender
• Adolescence (growth spurts)
• Genetic history
• Neurological disorders
• Muscular imbalances
• Previous spinal injuries

Environmental factors such as poor nutrition and lack of access to healthcare may worsen outcomes.

If untreated or improperly managed, scoliosis can lead to:

• Chronic pain and stiffness
• Spinal arthritis (spondylosis)
• Respiratory issues due to reduced lung capacity
• Deformity and imbalance
• Psychological distress and low self-esteem
• Postural instability

• Stay Physically Active: Walking, swimming, and yoga are beneficial.
• Use Supportive Furniture: Ergonomic chairs and beds reduce strain.
• Prioritise Mental Health: Seek counselling or join support group.
• Follow Medical Advice: Wear braces consistently and attend check-ups.
• Customised Exercise Plans: Focus on strength, mobility, and balance.

• Myth: Scoliosis is caused by carrying heavy bags.
   Fact: No evidence supports this; scoliosis is structural.
• Myth: It always requires surgery.
   Fact: Most cases are mild and managed without surgery.
• Myth: Scoliosis leads to paralysis.
   Fact: Rarely, and only in extremely severe or neglected cases.
• Myth: Adults can't develop scoliosis.
   Fact: Degenerative scoliosis is common in the elderly.

Consult a doctor if:

• You notice visible spinal curvature
• Your child complains of back pain or fatigue
• There is uneven posture or clothing fitting oddly
• There’s a family history of scoliosis
• You experience respiratory difficulties

Early intervention improves long-term outcomes.

• What type of scoliosis do I have?
• How severe is my spinal curve?
• Is bracing or surgery necessary?
• What are the non-surgical treatment options?
• Can I continue regular physical activities?
• How often will I need monitoring?
• Are there any long-term effects?

• Offer Encouragement: Support treatment decisions.
• Promote Self-Confidence: Compliment strengths, not looks.
• Help with Logistics: Accompany them to appointments.
• Educate Yourself: Learn about the condition.
• Adapt Daily Life: Modify school, work, or home environments.
   

Scoliosis, while complex, is a manageable condition with early detection and appropriate care. From mild curvatures to more severe cases requiring surgery, timely diagnosis and a personalised approach can greatly improve quality of life. With the right blend of medical treatment, lifestyle changes, and emotional support, people with scoliosis can lead fulfilling, active lives.

Understanding scoliosis empowers patients and families to make informed decisions. Greater awareness and education are key to ensuring timely intervention and avoiding complications.