A Pain in the Back: Living With Scoliosis

Scoliosis is a common spine condition that affects millions of Americans, many of whom are children and adolescents. Scoliosis affects adults, too, and while some cases are mild, many experience moderate to severe issues from a condition known as degenerative adult scoliosis. 

Over time, this type of scoliosis can lead to severe pain that makes it hard to complete daily tasks. In conjunction with Scoliosis Awareness Month in June, we’re exploring what degenerative scoliosis is, how to tell if you have it and how you can treat it.

What does scoliosis look like?

When looking at a healthy spine from the side, you will see natural curves that form a slight S-shape. These curves allow for flexibility and weight distribution at each section of the spine.

Starting at the top of the spine, the cervical spine curves slightly inward from your neck to your upper back and shoulders. This is known as a lordotic curve and makes a C-shaped curve. From there, the thoracic spine curves outward in a C-shape known as a kyphotic curve. Finally, the lumbar spine has the same curve as the cervical spine, angling slightly inward from your lower back to your sacrum and pelvis.

In certain cases, side-to-side abnormalities or deformities in these curves occur, known as scoliosis. Instead of your spine running down a vertical line when viewing it from behind, scoliosis causes the spine to look more like a “C” or “S.” For a medical diagnosis to occur, the curve must measure at least 10 degrees and can present itself in various areas such as on either side of the spine or at the thoracic or lumbar spine.

Although an X-ray can diagnose scoliosis, several visual clues may appear to indicate you have abnormal spinal curves. Depending on the affected area, your shoulders, hips and rib cage may appear uneven due to the bones twisting or rotating. Your head may also appear off-centered instead of directly over your pelvis. In more severe cases, your body may lean one way.

Regardless of type and location, moderate scoliosis has a curve greater than 25 to 30 degrees. Any spinal curve more than 45 to 50 degrees is severe.

How do you get scoliosis?

In general, degenerative adult scoliosis cases are caused by wear and tear. Child and adolescent scoliosis cases come from either unknown causes or problems present at birth.

More than 80 percent of scoliosis cases have an unknown cause, also known as idiopathic scoliosis. This type of scoliosis begins between the ages of 10 and 15, whereas degenerative scoliosis is more prevalent as you age. You can also develop congenital scoliosis or neuromuscular scoliosis.

Idiopathic scoliosis

Despite its prevalence, medical experts still are unclear what causes this type of scoliosis. What they do know is it’s unrelated to environmental factors, such as poor posture, sitting at a desk too long or repeatedly lifting heavy weights. There is some research that shows genetics play a role, so you’re more likely to develop scoliosis if a family history exists.

Degenerative scoliosis

As you age, the support your spine needs to help you move slowly erodes. More specifically, wear and tear of your spinal discs and joints causes this type of scoliosis (also known as adult-onset scoliosis). It’s the most common type of scoliosis in adults, and curvature typically presents itself after the age of 50 in the lumbar spine.

Congenital scoliosis

Babies can be born with undeveloped spinal bones that can lead to spinal curvature later in life. Sometimes, a pediatrician can diagnose this type of scoliosis early on if there are noticeable physical changes. Other cases aren’t found until a child begins to grow.

Neuromuscular scoliosis

Whereas congenital scoliosis is an issue present at birth, neuromuscular scoliosis is acquired due to related medical conditions that weaken muscles in your back. Cerebral palsy, a disorder that affects movement and muscle tone, can eventually lead to scoliosis due to muscular instability.

What does scoliosis pain feel like?

Children or teens who have scoliosis don’t generally experience pain. However, degenerative adult scoliosis can cause symptoms such as achiness or stiffness in the mid to low back or numbness and weakness in your leg. In more severe cases, scoliosis can impact your sciatic nerve and cause pain to radiate down your leg. Back pain may become worse when standing up and may subside when lying down. You may also have more noticeable symptoms in the morning or at night.

The spine has a series of facet joints that connect vertebrae together. The facet joints help the spine bend and twist — just as a hinge helps a doorway open and close. The joints also allow nerve roots to pass through to various parts of the body. Along with facet joints, the spine has intervertebral discs between each vertebra to help serve as a cushion and to absorb shock. Each disc has a soft gel-like center called the nucleus surrounded by a thick, fibrous outer protective layer called the annulus.

In healthy adults, facet joints and intervertebral discs assist with spinal movement and protection. But, as these joints naturally degenerate over time, the joints and discs don’t offer the same support as they once did. The instability can lead to a side-to-side curvature of the spine that results in spinal imbalance. This imbalance makes it difficult to perform even the most basic movements without pain, such as standing up or walking.

Degenerative scoliosis symptoms generally occur from impaired nerve function, either from the spinal canal narrowing (spinal stenosis) or bone overgrowth where the nerves exit the spine. An impinged or compressed nerve root can cause sharp pain through your hip and down to your upper leg, calf and into your foot.

If you have spinal stenosis, you can also experience neurogenic claudication, a condition in which compression damages the nerve roots that control sensation and movement in your legs and feet. Common symptoms include leg pain or muscle cramps.

Pain tends to be worse when in an upright position — either standing or walking — because it puts more pressure on the nerves. That’s why many patients suffering from this condition lean forward in their chairs or when holding onto a walker or shopping cart. These positions help take pressure off the nerves.

How to treat scoliosis?

Most cases of idiopathic scoliosis are mild and don’t require major treatment. In some instances where scoliosis occurs when the body is still growing, an orthopedic surgeon may recommend wearing a brace or undergoing surgery.

For adults, back braces don’t provide the same effectiveness as the spine is fully developed and won’t benefit from a brace. Plus, relying on a brace for support can actually weaken your muscles and ligaments and make the scoliosis worse.

Physical therapy and other non-surgical treatments

While over-the-counter pain medications or anti-inflammatory injections may help provide acute relief from your symptoms, it’s best to be proactive instead of reactive. 

Physical therapy helps treat your symptoms by strengthening the muscles to better support your back. A strong core will help protect your spine from injury. You can also learn about ways to practice better posture and how to minimize the impact on your spine when doing household chores.

You may also benefit from dry needling or acupuncture. The needles are inserted into pressure points to help release and relax tissue that can create problems with spinal joints and discs.

Scoliosis surgery

If conservative treatments don’t relieve symptoms, your doctor may refer you to an orthopedic surgeon or neurosurgeon who specializes in spine surgery.

The purpose of scoliosis surgery is to both straighten the spine and relieve symptoms. To do so, a surgeon can perform a spinal fusion to stabilize your spine. In this procedure, existing bone is fused together with a bone graft using screws and rods. The surgery is often combined with a laminectomy, a procedure to remove laminae that cover the spinal canal. This helps take pressure off the nerve roots, which helps alleviate symptoms.

If you’re suffering from back pain and think it may be a result of scoliosis, contact INTEGRIS Spine and Neurological Surgery to schedule an appointment with one of our neurosurgeons.