By Dr Paul Park
Scoliosis is one of the major spinal disorders which affects normal spinal alignment, and it is the most common spinal disorder in children and adolescents. It is defined by having a lateral curvature of the spine more than 10 degrees, and in some cases, combined with rotation of the vertebrae.
Scoliosis is classified as structural or non-structural scoliosis. Non-structural scoliosis, consisting of a lateral curvature with no vertebral rotation, is easily reversible due to being derived from poor posture, leg length discrepancy, nerve irritation, and more. Whereas structural scoliosis is more common. It consists of a lateral curvature with vertebral rotation and it is further sub-classed into three groups.
This blog will be a brief overview about structural scoliosis and its subgroups, and how these disorders are managed by the medical profession.
Two Major Subgroups
Structural scoliosis is further divided into 2 major subgroups based on the origin of the problem:
- Non-Idiopathic (Neuromuscular & Congenital)
Non-idiopathic Scoliosis makes up about 20% of structural scoliosis. It further divides into Neuromuscular and Congenital Scoliosis. Neuromuscular Scoliosis is caused by insufficient active muscular stabilisers of the spine. It could be from a neurological issue like cerebral palsy, spino-muscular atrophy, spina bifida, or spinal cord injury; or from a muscular issue like muscular dystrophy. Surgery is one of the treatments to correct Neuromuscular Scoliosis; however, it is associated with the highest rate of complications compared to other types of scoliosis. Congenital Scoliosis is caused by spinal deformities that are apparent at birth. These patients have malformed vertebrae such as blocked vertebra, hemi-vertebrae, unilateral bar, or a mixture. It may not be evident at birth but can develop up until adolescence.
Making up 80% of structural scoliosis, Idiopathic Scoliosis is the most common scoliosis. It further divides into classifications based on the age onset.
Infantile Scoliosis develops before the age of 3 with a prevalence of less than 1%. 80-90% of Infantile Scoliosis spontaneously resolves but the remaining 10-20% will progress through childhood to severe deformity if left untreated.
Juvenile Scoliosis develops between 4 to 10 years of age with a prevalence of 10-15% of all idiopathic scoliosis. It has high rate of progression with a result of severe deformity if left untreated.
Adolescent Scoliosis develops between 11 to 18 years and it accounts for approximately 90% of cases of idiopathic scoliosis. It is more common in young females with an overall ratio of 1:3.6. Lastly, adult scoliosis develops after 19 years of age, and it is more common in the older population due to degenerative changes as the spine ages.
Overall, Idiopathic Adolescent Scoliosis is the most common case. Like I mentioned above, the gender prevalence of developing idiopathic scoliosis favours more female than male. This is also true with the prevalence of developing severe scoliosis. Adolescents or children who are starting to develop structurally have the highest prevalence of developing Idiopathic Scoliosis. Based on curve types, thoracic curves are more common with 48% of the Idiopathic Scoliosis cases, followed by thoracolumbar/lumbar curves with 40%. Males are more likely to develop thoracolumbar/lumbar curves, while female are more likely to have thoracic with double curves.
As a Chiropractor, the treatment is different based on the subgroup. Patients with Non-idiopathic Scoliosis are more likely to be referred to a spinal, neuro or orthopaedic surgeon if the symptoms are severe.
Treatment plans for the patients with Idiopathic Scoliosis depends on the age and the severity of the curve. The major key is to monitor their progress through a thorough physical exam and imaging such as X-ray or MRI.
Infantile Scoliosis is monitored because most of the cases spontaneously resolve on their own. For Juvenile and Adolescent Scoliosis, if the Cobb angle (angle measured in a spinal curve) is between 0-20 degrees, then they are closely monitored for the next 3-6 months to see if the curves are worsening. If the angle is between 20-45 degrees, they should be getting manual treatments such as spinal adjustments and exercises to reduce or maintain their curves. Bracings and heel lifts may be recommended by their doctors if the angle is 26-45 degrees as an additional to manual treatments. If the angle is over 45 degrees, the patients will be referred to surgeons. Also, for adults, monitoring is the key and manual treatments will be the best thing to treat any pain related to scoliosis.
Many studies* have shown that spinal adjustments in conjunction with spinal exercises is one of the most beneficial treatments for patients to prevent severe scoliosis. Therefore, it is best to bring young children and adolescents to Chiropractors and other medical professionals to be checked and to seek proper treatment early.
- "Adolescent idiopathic scoliosis treated by spinal manipulation: a case study" by Chen K.C & Chiu E.H 2008
- "Scoliosis treatment using a combination of manipulative and rehabilitative therapy: a retrospective case series" by Morningstar M. W., Woggon D., & Lawrence G. 2004
- "Outcomes for adult scoliosis patients receiving chiropractic rehabilitation: a 24-month retrospective analysis" by Morningstar M. W. 2011
- "Chiropractic and Pilates therapy for treatment of adult scoliosis" by Blum C. L. 2002