We do not generally spend much time examining others’ spines. It’s one of the parts of the human body consistently covered by clothing. Yet that ingrained modesty can cause problems when it comes to one of the most common spinal deformities: scoliosis.
According to the American Association of Neurological Surgeons, “Scoliosis affects 2-3 percent of the population, or an estimated six to nine million people in the United States.” Medical professionals do not consider scoliosis a rare condition, but the factors that cause it may remain shrouded in mystery.
Scoliosis delineates into several general categories: congenital, neuromuscular, degenerative, and idiopathic. Among this trio of types, idiopathic (i.e., arising spontaneously) accounts for more than three-quarters of all scoliosis cases. Congenital scoliosis arises when embryonic abnormalities lead to malformations in the spine, and such cases usually get detected early as scoliosis symptoms in children arise. Neuromuscular scoliosis occurs concomitantly with other conditions such as spina bifida, cerebral palsy, and various other syndromes. Degenerative scoliosis occurs when professionals notice scoliosis symptoms in adults, and U.S. News & World Report points out “that 40 to 60 percent of adults will develop degenerative scoliosis by age 65.”
So what can lead people to believe that they might suffer from this disease? Well, the best clue lies in the name or, rather, the Greek word from which it originates: σκολιός (skolios). It means “curved, bent” or “winding (of rivers and paths).” That’s exactly what a spine afflicted with scoliosis will look like.
WebMD correctly notes, “If you look at someone’s back, you’ll see that the spine runs straight down the middle. When a person has scoliosis, their backbone curves to the side.” Where a normal spine has no side-to-side angle, lumbar scoliosis symptoms may have the spine shifting in an “S” or “C” shape with angles ranging from 10 degrees to 45 degrees or more.
This has very distinct and visible effects on patients’ outward appearances. In addition to spinal changes, patients may have uneven shoulders or canted hips. A patient’s head may not center above the pelvis as it normally does. One side of the rib cage may appear higher than the other, and the waist may have an uneven appearance. The skin near the spine may even show multiple abnormalities, such as dimpling, patchy hair, or unusual coloration. Eventually, the patient may develop kyphosis, an extreme rounding of the back.
If you or a loved one have any of these symptoms, you may have scoliosis.
Family History of Scoliosis
When considering whether or not you or loved one may have scoliosis, does taking a family history of the disorder into account matter? Yes, it does. Though most cases of scoliosis arise spontaneously, relatively recent research confirms that the condition definitely has a genetic component. Orthopedic surgeon Dr. Han Jo Kim explains why.
“In 2003, the Human Genome Project was completed and promised the possibility for identifying genes associated with each individual person and his or her phenotypes. The project, however, is ongoing, since the sequencing of the genome is one thing, and identifying individual genes responsible for a disease state is another,” he told U.S. News & World Report.
Kim added, “Such is the issue with genetic studies that have been done on scoliosis. Familial studies on scoliosis have associated the X chromosome — as well as regions on chromosomes 6, 9, 16 and 17 — with a strong linkage to scoliosis. In addition, familial studies on relatives have also identified a higher incidence of scoliosis in first-degree relatives compared to second- and third-degree relatives. These relationships confirm the genetic etiology of scoliosis. However, genetics alone is not the only culprit. It is likely that scoliosis is a result of a combination of genetics and neurological, environmental and behavioral factors.”
That’s an evaluation that the National Institutes of Health’s Genetics Home Reference seconds. Its entry on adolescent idiopathic scoliosis states, “Adolescent idiopathic scoliosis can be sporadic, which means it occurs in people without a family history of the condition, or it can cluster in families. The inheritance pattern of adolescent idiopathic scoliosis is unclear because many genetic and environmental factors appear to be involved. However, having a close relative (such as a parent or sibling) with adolescent idiopathic scoliosis increases a child’s risk of developing the condition.”
So what does that mean for those concerned about a family history of scoliosis? Dr. Kim suggests, “Regardless of the specific etiology of scoliosis, if you have it, or suspect you have it, my recommendation would be to see a spine surgeon who specializes in scoliosis as soon as possible in order to get ‘plugged in.’ During my volunteer work in Africa, I too often saw the consequences of scoliosis cases that have progressed without being adequately monitored, leaving individuals with life-threatening spinal deformities and making corrective surgeries for them unnecessarily complex and risky.”
His counsel is exactly what the doctors at The Spine Center would also recommend. As the old adage says, an ounce of prevention is worth a pound of cure. The spinal curvature in most scoliosis cases doesn’t require surgery, but if a specific person ends up needing it, connecting with a surgeon sooner rather than later simply makes sense.
Most Common Scoliosis Symptoms
Often scoliosis cases will manifest no additional issues other than that outward physical signs. The National Institutes of Health’s MedlinePlus database explains, “Most often, there are no symptoms.” When symptoms do manifest themselves, they most often are the following:
- Backache or low-back pain that goes down the legs
- Weakness or tired feeling in the spine after sitting or standing for a long time
- Uneven hips or shoulders (one shoulder may be higher than the other)
- Shoulder pain
These symptoms may sound merely annoying, irritants that impact your daily life but don’t have a permanent effect on your longtime health. Unfortunately, that’s not always true. Because infantile, juvenile, and adolescent scoliosis occur while the spine is still growing, serious conditions may still develop if the spine shifts so severely that it begins to put pressure on internal organs. Similarly, adult scoliosis is usually caused by degenerative spinal conditions, and slipping discs can similarly damage both heart and lungs.
Sometimes such symptoms can indicate the presence of another comorbidity. The American Association of Neurological Surgeons has noted how, “in one study, about 23 percent of patients with idiopathic scoliosis presented with back pain at the time of initial diagnosis. Ten percent of these patients were found to have an underlying associated condition such as spondylolisthesis, syringomyelia, tethered cord, herniated disc or spinal tumor. If a patient with diagnosed idiopathic scoliosis has more than mild back discomfort, a thorough evaluation for another cause of pain is advised.”
When considering whether or not you or a loved one may have scoliosis, know that the symptoms can sometimes become severe. They may involve one or more of the following:
- Lower back pain or back pain that radiates down into the legs
- Breathing problems
- Ongoing pain (which may result from damaged caused by continual pressure on the bones of the spine)
- Nerve damage, which may cause persistent pain, numbness, or a combination of both
- Spinal fluid leakage
If you suspect that you are dealing with a case of scoliosis, try conducting the home-based test in the following section. Additionally, consider making an appointment with a qualified spinal surgeon. While most cases of scoliosis don’t require surgery, a surgeon can monitor the progress (or lack thereof) of the disease in a patient and recommend non-surgical treatments.
How to Rule Out Scoliosis (Home-Based Tests)
There’s a good reason why medical literature and professional medical guides suggest seeing a physician if you suspect that you or someone close to you might have scoliosis. Because severe scoliosis cases can warp the interior of an individual’s bone structure, it’s impossible to determine the severity of a case just by examining someone’s exterior bone structure. However, you can apply one at-home scoliosis screening that may help you determine if you need further medical intervention.
The test is called the Adams Forward Bend Test. It will require two people to perform, one the potential patient and the other an observer. The patient should remove his or shirt. Then the patient should bend forward until he or she is at a 90-degree angle, reaching fingers toward toes with their palms together. The observers should study the patient’s back from behind as he or she bends forward, looking to see if any asymmetrical patterns in the torso or any spinal deformity.
Understand that not only can the Adam’s Forward Bend Test produce false positives, it also cannot determine the severity of any particular scoliosis case. In order to conduct a thorough examination, a patient should undergo tests such as X-rays, MRIs, or CT scans.
If you believe that you or a loved one might have scoliosis, call The Spine Clinic at (847) 628-8147 or reach out through our online form. Our fellowship-trained surgeons pride themselves on patient education and conducting minimally invasive procedures.