The Greek word “scolios” means crooked or curved and has been used since the time of Hippocrates to describe an abnormal lateral curvature of the spine. (1,2) Today, scoliosis is recognized as more than a simple lateral deviation of the spine but rather one that includes vertebral axial rotation and an alteration of the normal kyphosis/lordosis. (3) The diagnosis of “scoliosis” is best defined as a complex “three-dimensional torsional deformity of the spine and trunk.” (3-7)
Scoliosis can be classified as “congenital” (i.e. vertebral malformation present at birth), “secondary” to another disorder (i.e. spinal muscular atrophy) or “idiopathic.” The latter accounts for 85% of all cases of scoliosis. (8) As its name implies, the etiology of idiopathic scoliosis is not well understood but is likely multifactorial. (9-14) A genetic component is suspected since scoliosis tends to run in families. (15-18) Over 90% of monozygotic twins and 60% of dizygotic twins demonstrate concordance with regard to the presence or absence of scoliosis. (16) Like other genetic disorders, scoliosis is more common in children born to older mothers. (19) Some researchers have connected the etiology of scoliosis to a systemic mucopolysaccharide and protein synthesis disorder resulting in reduced serum melatonin. (20-23)
The prevalence of scoliosis reported in the literature varies widely, depending upon the age of the population studied and the criteria used to define the disease. (24-26) When using the widely accepted definition for scoliosis of a Cobb angle greater than 10 degrees, the prevalence ranges between 1 and 3%- making it the most common spinal deformity requiring orthopedic management. (27-29)
Scoliosis may develop at any time between birth and adulthood but is most common during times of rapid skeletal growth. (6-24 months, 5-8 years, and 11-14 years). (26,30) Scoliosis may be subclassified based upon age of onset (31):
0-5 years of age Congenital scoliosis
6-12 years of age Early onset scoliosis
13-18 years of age Adolescent idiopathic scoliosis
The classification of “congenital scoliosis” (0-5 y/o) includes “infantile idiopathic scoliosis,” which develops within the first two years of life. This condition differs markedly from other types of scoliosis in that it is more common in boys and typically produces a left thoracic curvature. It is thought to have a prevalence of 0.5% in North America. (32) It is more common in those of European descent. Interestingly, ¾ of all infantile idiopathic scoliosis cases resolve spontaneously, while the remainder progress. (33)
“Early onset scoliosis” mimics the adolescent version of the disease, in that it is more common in females and typically demonstrates a right thoracic curve. (34) It is considered by some to be a malignant sub-type of adolescent idiopathic scoliosis due to its high degree of progression (95%) with the majority of patients (64%) requiring spinal fusion. (34-35) Patients with early onset scoliosis frequently demonstrate neural axis abnormalities, including Chiari type malformations. (36)
“Adolescent idiopathic scoliosis” (AIS) represents the most common type of scoliosis overall. The onset of adolescent scoliosis is insidious, and its progression varies somewhere between unnoticed and lethal. (37) Approximately 25-42% of all adolescent idiopathic scoliosis curves will progress. (38,82) The chance of progression increases in relation to the magnitude of the curve and decreases in proportion to skeletal maturity. (38,39) Less severe curves tend to remain stable, while large curves are more likely to progress. (40) Small curves in skeletally mature patients have a low risk of progression (2%), while large curves in immature patients progress much more frequently. (70%) (39) The degree of skeletal maturity is defined by: the Risser sign (0-5), closure of the tri-radiate cartilage, the onset of menarche, and reaching one’s peak height. (39)
Patients with double or multiple curves are more likely to progress than those with a single curve. (78) Curve progression is more common in females. (42,43) The gender discrepancy widens in proportion to the magnitude of the curve. In patients with Cobb angles between 10 and 20 degrees, females are affected only slightly more frequently (1.3:1), increasing to 5.4:1 for Cobb angles between and 20 and 30 degrees and 7:1 when the curve is above 30 degrees. (42,43) Lonstein (38) has proposed and published the following formula for the prediction of progression in idiopathic scoliosis: Progression factor = (Cobb angle – (3 x Risser sign)/Patient age).
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What we do in our office to help this condition:
1. Perform a detailed exam, assessing the alignment of the spine. In some cases we may want to have x-rays taken to know exactly what the scoliotic spine looks like. This depends on the severity of the perceived scoliosis.
2. As indicated, adjust areas of spinal subluxations (misalignments), to restore proper alignment, and nerve system function, which facilitates healing.
3. Apply electrical stimulation and heat to the muscles surrounding the spine. Applying an electrical current helps strengthen muscles, block pain signals, and improve blood circulation.
4. Prescribe stretches and exercises in conjunction with chiropractic care to help realign the spine, and strengthen the soft tissue in the areas where the spine is scoliotic.