What is scoliosis?
Scoliosis is a sideways curve of the spine that shows up as an “S” or “C” shape rather than a straight line down the back. This back condition can occur in children, adolescents and adults. According to the American Academy of Orthopedic Surgeons, approximately 2% of the population has scoliosis.
Scoliosis symptoms vary with age and severity of the curvature. Many people have some degree of curvature of the spine, yet experience little or no discomfort. Those with more severe scoliosis may experience back pain, disfigurement and nerve compression that can cause numbness, weakness and leg pain, especially upon standing or walking.
Watch a brief video to learn more about what scoliosis is from expert Dr. Ioannis Avramis
Scoliosis can be a hidden disorder with no obvious symptoms, or it can cause severe disfigurement, pain and disability. Some patients can live with undetected scoliosis for many years until their curve starts to increase, often resulting in pain. Some common scoliosis symptoms include:
- Idiopathic scoliosis—This literally means “of undetermined cause.” This type of scoliosis is thought to be genetic, involving involves multiple genes and a concept called variable penetrance meaning. This means that in each generation, there is variability in how severe the spine curve is.
- Infantile idiopathic scoliosis—Scoliosis that occurs from birth to 3 years of age.
- Juvenile idiopathic scoliosis—Scoliosis that occurs from 3 to 10 years of age.
- Adolescent idiopathic scoliosis—Scoliosis that occurs from 10 to 18 years of age. This is the most common scoliosis diagnosis in children, representing nearly 90% of scoliosis cases.
- Adult idiopathic scoliosis—Scoliosis that occurs at 18 years and older.
Many physicians don't know what causes the most common type of scoliosis, although hereditary factors and environmental factors, like injuries such as spinal cord injuries, may come into play.
Scoliosis is thought to be genetic and tends to run in families. However, with each generation, there is a variability of how strongly the genes that cause scoliosis are expressed, which determines how severe the spine curve may be. For example, a mother may have a mild curve, but her daughter may have a very severe curve, or a mother may have a severe curve, and her grandchildren may develop scoliosis, but their parents did not.
While the incidence of a scoliosis diagnosis in men and women is approximately the same, the progression rate is seven to eight times more common in females who were diagnosed with scoliosis as an adolescent or young adult than among boys who were diagnosed at the same age.
Most people typically think of scoliosis as a childhood disease. In fact, scoliosis is commonly diagnosed in the juvenile and adolescent stages—ages 9, 10, 11 or 12. There is, however, adult onset or degenerative scoliosis, which develops as a result of disc degeneration and is different from adolescent idiopathic scoliosis.
Polio was once one of the most common neurological causes of scoliosis. During the polio epidemic in the 1930s through the 1950s, it was very common for children to develop scoliosis. We see many of those patients as adults at the Baylor Scott & White Scoliosis Centers.
Research into the environmental causes of scoliosis is ongoing, and, while there have been some findings, a clear connection has not been established between scoliosis and medications or environmental factors yet.
The vast majority of patients with scoliosis fall under the category of what’s called idiopathic scoliosis. This simply means that we don't know what causes it as opposed to cases that are due to neurological causes, congenital abnormalities, developmental issues or as the result of a traumatic injury to the spinal cord. In some cases, either the vertebrae in the spine are congenitally malformed or congenitally fused together, or the spinal cord developed incorrectly from birth, leading to very severe curves.
Typically, there is an environmental cause for this, such as drug abuse during pregnancy, or complications from medications and other environmental causes, which put children at risk while they are developing during pregnancy.
A scoliosis diagnosis usually happens during a physical examination when a physician looks for the degree of rotation in the curvature of the spine, as well as secondary changes in other parts of the body that may include:
- Uneven shoulders
- Rib hump or asymmetry
- Low back hump or asymmetry
- A change in the shape of the waist
- Uneven pelvic bones or hips
Frequently, these changes are not visible in a person while they are standing, but they become noticeable when the person bends forward.
X-rays are important for pinpointing the shape and location of the curvature, as well as for measuring the degree of the curvature, so it can be classified.
Scoliosis treatment decisions are based upon a combination of factors: The degree of curvature, curvature location, risk of progression, spinal imbalance, underlying disease progression and degree of pain the patient is experiencing.
While many patients with scoliosis mistakenly believe there is no treatment option available to them or that as an adult their scoliosis cannot be treated, back doctors at Baylor Scott & White Scoliosis Centers across Texas offer new hope. Great advances in the diagnosis and treatment of scoliosis have been made in recent years, offering each scoliosis patient advanced treatment. To date, we have treated more than 3,000 scoliosis patients with a success rate few others can claim.
In most cases, treatment for adult scoliosis begins with a combination of non-operative therapies that may be administered for weeks to months. These scoliosis treatments include:
- Observation—Many individuals we see do not require surgery to correct their spine curve. Pediatric patients, in particular, need to be observed closely before and during their adolescent growth spurt to identify curves that are progressing rapidly and those that remain stable over time.
- Spinal rehabilitation—Physical therapy is often needed to stabilize the spine for patients with scoliosis. Pilates can also be helpful for core strengthening. While physical therapy has not been shown to alter the rate of curvature progression in adults, strengthening and conditioning programs often help reduce back pain symptoms. If surgery should ultimately be required, these physically fit patients often have an easier time recovering.
- Pain management—Anti-inflammatory medications and mild narcotics can be administered via injections to help relieve back pain.
- Epidural steroid injections—These types of injections can be helpful in relieving the leg pain that occurs as a result of scoliosis.
For scoliosis patients who are experiencing an increase in curvature of the spine and are in pain, scoliosis surgery may be needed. Scoliosis surgeries are serious and complex with multi-step procedures and usually take from four to six hours. Sometimes more than one procedure is needed—one performed from the front and one done from the back. Typically, this can be done in one spine operation, but there are times when two operations may be necessary.
The overall goal of spine surgery is to get to the root of the problem, while at the same time causing the least amount of disruption to the patient’s lifestyle. Spine surgery is typically a choice of last resort to treat scoliosis, after all nonsurgical methods have been exhausted, or when problems like severely herniated discs or damaged vertebrae simply will not respond to nonsurgical treatments. While studies show that more than half of back surgeries are unnecessary, there are times when surgery is the answer.
Have you experienced an unsuccessful spine surgery? Have you been told you have to live with the pain and deformity? While many centers are reluctant to try to correct a failed first procedure, Baylor Scott & White specializes in complex or challenging deformities—particularly those resulting from unsuccessful surgeries.
The orthopedic specialists and back surgeons at our Scoliosis Treatment Centers in Dallas, Plano, Lakeway and Round Rock help patients realize positive outcomes and long-lasting, pain-free results—even those who were told nothing could be done.
The most common reason for spine revision surgeries is pseudarthrosis, a condition in which the spine does not heal correctly. Surgical revision may also be needed for proximal junctional kyphosis that occurs when the discs above or below the initial fused area of the spine become worn, shrink or lose their shape. In some cases, individuals require revision surgery because they’ve developed a new deformity that is a secondary outcome of their primary surgery.
Revision surgery is essential to help identify the underlying problem. Every patient is different. That’s why patients at Baylor Scott & White go through a rigorous preoperative regimen to pinpoint the underlying problem, determine the best course of action and identify potential complications.
Scoliosis treatment locations
Baylor Scott & White Health Scoliosis Treatment Centers gives new hope to people suffering from the pain and disfigurement of scoliosis—even those who previously thought their back condition was untreatable.
Baylor University Medical Center, part of Baylor Scott & White Health
The orthopedics department at Baylor University Medical Center provides one of the most comprehensive programs for people with back and neck pain, including scoliosis.
At Baylor Scott & White Medical Center – Plano, orthopedic doctors specialize in treating your back and neck pain. From complex revision surgeries to scoliosis, the orthopedic experts and neurosurgeons in Plano, along with a team of specialists have cared for thousands of patients and have provided surgical and non-surgical solutions to help relieve their pain and achieve a better quality of life.
The team of board-certified, fellowship-trained neurosurgeons at Baylor Scott & White Medical Center – Lakeway specialize in the treatment of spinal disorders using the newest in minimally invasive surgical techniques. Using their extensive skill and experience, the Lakeway neurosurgeons will diagnose and assess if surgery is the best option for your individual condition. They work closely with specialists in physical medicine and rehabilitation to provide you the best care possible for scoliosis treatment.
Baylor Scott & White Medical Center – Round Rock offers sophisticated solutions for back pain. Here, you have access to expert healthcare professionals, such as physical and occupational therapists, as well as physicians on the medical staff. We provide both surgical and non-surgical treatment for a variety of back and spine conditions, including scoliosis.
Frequently asked questions about scoliosis care
Scoliosis is one of the more common disorders of the spine. Most people experience few symptoms or problems, but for those with a progressive curvature, problems can be severe.
If you or someone you know has been diagnosed with scoliosis, you may have questions. We have provided answers to the most common questions below.
General scoliosis FAQ
Does scoliosis always appear in childhood?
Most people typically think of scoliosis as a childhood disease. In fact, scoliosis is commonly diagnosed in the juvenile and adolescent stages—ages 9, 10, 11 or 12. There is, however, adult-onset or degenerative scoliosis, which develops as a result of disc degeneration that is different from adolescent idiopathic scoliosis.
Is scoliosis hereditary?
Scoliosis is thought to be genetic and tends to run in families. However, with each generation, there is a variability of how strongly the genes that cause scoliosis are expressed, which determines how severe the curve of the spine may be. For example, a mother may have a mild curve, but her daughter may have a very severe curve. Similarly, a mother may have a severe curve, and her grandchildren may develop scoliosis, but their parents did not.
Is scoliosis a progressive disease?
What we know about scoliosis is constantly changing. In the past, the accepted teaching was that once a patient reaches adulthood, their curves become static and do not progress. For many patients, this is true. However, there is a subgroup of individuals whose spinal curves continue to progress during adulthood. Years ago, physicians were taught that a 50-degree thoracic curve typically does not increase in adulthood, but now we know that it can progress in some cases. There has been an evolution in what is known about scoliosis, but many general practitioners, internal medicine specialists and pediatricians do not have access to the latest information, which makes care much more difficult and challenging for their patients.
What is the prognosis for an adult with scoliosis?
With adults, the prognosis can be more complicated. We typically see adult patients, particularly women, who fall into one of several categories:
- Young women with very large curves who have no pain.
In these patients, the probability of the disease progressing is 80 or 90%, and if it goes untreated, they may experience problems in later life. With these women, we discuss their treatment options on a case by case basis.
- Young women with a history of scoliosis who were advised their curves would not progress in adulthood.
These scoliosis patients typically did not experience back pain and were told their curve was stable. However, many of these women go on to experience back pain symptoms during and after their second pregnancy. The primary hormone produced during pregnancy is progesterone, which may cause their scoliosis to progress. Also during pregnancy, the ligaments and joints become loosened in order to allow the pelvis to develop appropriately. During this time, a woman’s curve may start to progress leading her to experience pain from her scoliosis.
- Women with a small curvature of the spine that progresses throughout adulthood.
In these cases, the progression of scoliosis does not seem to be related to pregnancy. Rather, in middle age, the patient experiences some spinal deformities, which causes her clothes to fit differently and alters her physical appearance. The back pain in such cases usually progresses and severely affects the woman’s quality of life.
- Young women with very large curves who have no pain.
For adults in pain, what can you do?
Pain prevention is one of the main reasons your scoliosis should be treated. Back and leg pain can be disruptive and unrelenting. It not only affects an individual’s personal and emotional life, but it can have major effects in many other aspects as well. Our most important job is to find surgical solutions to attempt to remove or alleviate pain caused by scoliosis.
Why do so few doctors say adult scoliosis is treatable?
Scoliosis treatment technology has changed very rapidly, and there are ways to treat patients now that weren’t available in the past. Unfortunately, there is a lack of education, even in the medical community, about concerning the treatment of scoliosis. The orthopedic physicians here are often featured speakers at national conferences and events to help educate pediatricians, primary care physicians and internal medicine specialists to help and to clarify some of the misinformation. The core strength of the Baylor Scott & White Scoliosis Centers is its staff. We have a dedicated group of individuals, including anesthesiologists, nurses, spinal cord monitoring individuals personnel and implant specialists that work with the surgical team. Our operating time, and our time for each case, has decreased, and the benefit to the individual patient is that their outcomes are better. Plus, in an era when a lot of many patients report that their doctors' offices are very impersonal, we have managed to preserve our emphasis on patient care and personal treatment.
When you meet with scoliosis patients, what do you tell them?
Scoliosis patients typically bring two things to their initial office visit: the physical pain their scoliosis is causing and the emotional toll it is taking on them. One of the most rewarding parts for our team is helping patients manage the emotional issues they are enduring: how they feel about themselves and how they feel about their cosmetic appearance. In an effort to help provide our current patients with additional emotional support, we connect new patients with previous patients who are in various stages of their journey.
Is there much scoliosis research going on? What does the future hold?
There's been a dramatic explosion in the amount of research that is conducted in the field of scoliosis treatment. The goal of this research is to further understand the causes of scoliosis and the most beneficial clinical treatments. We're learning more and more about the fundamental molecular, genetic, and foundational causes of this disease. The future of scoliosis treatment lies in early genetic diagnosis and biopharmaceutical treatment of the growth abnormalities that can lead to the curvature of the spine. Learn more about clinical trials and research activities at the Baylor Scott & White Scoliosis Centers across North and Central Texas in Dallas, Plano, Lakeway and Round Rock.
What are other common spine conditions?
The bones of the spine are arranged to give the spinal column stability. Damage or defects within the supporting structures of the lumbar spine (the lower part of the back) can often be the source of back pain resulting from:
- Herniated disc
- Scheuermann's kyphosis spinal stenosis
- Spondylolysis and spondylolisthesis
How many physicians across the country specialize in scoliosis surgeries?
There are a small number of physicians in the United States who truly specialize in scoliosis surgery. What’s unique about the Baylor Scott & White Scoliosis Centers is that we provide care to patients with complex spinal curvatures and those who have had prior spine procedures.
Is scoliosis surgery covered by insurance?
Scoliosis surgery is an appropriate medical treatment; therefore, it is covered by most insurance. Last year alone, we worked with 106 different insurance companies nationwide. We have significant skill in managing the maze that is the modern health insurance company industry.
How long does recovery take?
If you talk to our patients, what you will hear is that there are milestones of improvement. There is the first week leading up to discharge from the hospital. when a person can walk again and is eating regular food and putting on and taking off their brace, they really feel they've made a great steps forward. Probably the second big milestone is likely to be discharge from rehab, and that's typically about two to two-and-a-half weeks total time from after surgery. The next big milestone patients typically achieve is driving independently—some patients may start to drive as soon as a month following surgery. After that, milestones become harder to define and some patients return to us requesting to transition off of their pain medication. At the three-month mark after scoliosis surgery, many people begin to regain control of their own lives, and they may even return to work in a light-duty capacity about five weeks after surgery. There continue to be long-term gains, so we follow patients for years afterward, and review re-evaluating them at six-month or yearly intervals, depending on their individual situation.
Is scoliosis surgery required for all adults who have it?
Scoliosis surgery is a serious procedure. Before any patient has any a scoliosis operation, the orthopedic physician should explain what the risks and benefits of the back surgery procedure are. The physicians here spend a significant amount of time with patients to discussing the risks, benefits and possibilities of having undergoing scoliosis surgery. Our goal is to give patients a complete understanding of the risks and outcomes.
How long does scoliosis surgery take?
Scoliosis surgeries are complex, and there are many steps to each back operation. The back surgery typically takes four to six hours. If the scoliosis surgery must be performed from the front and back simultaneously, the back surgeon will need additional time.
Are two scoliosis surgeries ever needed?
In some cases, adults need more than one procedure—meaning they need a specific type of back surgery that is performed from the front and back simultaneously. Sometimes this can be accomplished simultaneously in a single combination operation, but other times it is best to separate the process into two scoliosis repair procedures.
What happens after surgery?
Following scoliosis surgery, technology and treatment options have dramatically changed for the better following scoliosis surgery. After surgery, patients are typically admitted to the intensive care unit (ICU) where they receive focused nursing care—one nurse per patient.
A lot of emphasis is placed on patient management during this phase. The pain is treated precisely where it exists. A catheter is placed against the spinal cord and pain medication is pumped directly onto the cord, which reduces drowsiness so that the patient can follow requests or commands.
The day after surgery some patients may actually sit in a chair and take one or two steps. By the third day, the patients will typically stand and walk, and by the fourth day they will often be walking in the hallway.
After the fifth day, they patients are typically discharged and are sent to the rehabilitation hospital to spend another week regaining their abilities to accomplish activities of daily living. During this phase, some patients may need a supportive back brace. Modern braces are made from a light thermo-plastic material so they can easily be taken on and off. Patients do not have to sleep or bathe in the brace, which is a drastic improvement from the casts that patients had to wear years ago following scoliosis surgery.
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