Scoliosis
What Is Scoliosis?
A normal spine is straight from the base of your neck to the top of your hip bone. Scoliosis is an abnormal curve in your spine, such as an S-shape (with a top and bottom curve) or C-shape (with just one curve). It may look like you are leaning to one side from the front.
Spine specialists use the Cobb angle to measure scoliosis—10 degrees or higher is scoliosis. This specific measurement indicates the severity of your spine curve and if you need treatment. Scoliosis is classified into the following categories based on the degree of spine curvature:
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Mild scoliosis (between 10 and 30 degrees)
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Moderate scoliosis (between 30 and 50 degrees)
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Severe scoliosis (over 50 degrees)
Types of Scoliosis
There are four different types of scoliosis:
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Adolescent idiopathic scoliosis (AIS) first appears in children and teens ages 10 to 15 who are going through a growth spurt. Idiopathic means doctors do not know what causes this type of scoliosis. You may notice some asymmetry, such as leaning to one side or one shoulder or hip that is higher than the other. The curve stops progressing when you stop growing.
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Congenital scoliosis presents from the time a baby’s spine starts to form. A baby's vertebrate may not form completely or may not divide normally during fetal development. Doctors see this condition after you're born sometimes. However, congenital scoliosis may not be noticeable until you're a teenager.
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Neuromuscular scoliosis occurs when you have damaged muscles that can't support your spine. This condition is often the result of another neuromuscular disorder, such as spina bifida or cerebral palsy.
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Degenerative scoliosis mostly affects older adults. The spine begins to curve from wear and tear on discs and joints in your spine over time. Sports, work-related injuries, or other back problems can contribute to this wear and tear on your spine.
Another way doctors categorize scoliosis is by the area of the spine affected:
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Thoracic scoliosis—Curve in the top half of the spine (thoracic spine)
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Lumbar scoliosis—Curve in the lower half of the spine (lumbar spine)
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Thoracolumbar scoliosis—Curve in the center of the spine between the thoracic and lumbar regions
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Combined scoliosis (double curve)—Two separate curves—one in the thoracic spine and one in the lumbar spine—that go in opposite directions. The curves may balance each other out so the spine curve is not as noticeable.
Scoliosis Symptoms
You may notice the following signs and symptoms of scoliosis:
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Leaning to one side
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Uneven shoulders
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One shoulder blade sticks out more than the other
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Uneven waistline
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One hip that is higher than the other
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One side of your back sticks out when bending over
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One side of your rib cage sticks out farther
Does Scoliosis Hurt?
Most people do not experience pain. However, if scoliosis worsens, it could lead to physical symptoms:
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Difficulty walking from pain
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Nerve compression in the spine
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Difficulty standing up straight
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Difficulty standing or walking for long periods of time
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Posture that stoops forward
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Numbness or tingling in the legs
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Pain down the leg
When to See a Scoliosis Specialist
See your primary care provider first if you think you may have scoliosis. They may recommend seeing a spine specialist if you have symptoms that could be related to scoliosis:
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Back or leg pain
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Numbness
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Difficulty standing up straight
What Causes Scoliosis?
Doctors may not know exactly what causes scoliosis. Adolescent idiopathic scoliosis, which is the most common type of scoliosis, has no known cause.
Other scoliosis causes include the following risk factors and conditions:
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Congenital defects (something present at birth)
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Genetics
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Infections
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Injuries that never healed properly
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Medical conditions, such as one leg that is longer than the other
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Neuromuscular conditions
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Osteoporosis
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Spinal tumor
What to Expect During Your Scoliosis Screening Exam
Your spine specialist will order an X-ray or MRI that shows your full spine from the base of the skull to the hip bone. They may also request additional images to see your spinal alignment from the side. These images show whether your head sits forward, neutral, or behind a line with your hips. You can get this imaging done at U of U Health or bring imaging from another provider. Your provider may order additional images to see how your spinal alignment changes in different positions, such as bending forward or backward. We use these images to measure your curve’s Cobb angle.
Scoliosis Treatment
Your scoliosis treatment depends on the cause and severity of your spinal curve, especially if the curvature worsens over time. Our spine specialists will monitor you and recommend treatment if necessary.
What Degree of Scoliosis Requires Treatment?
Scoliosis with a curve below 50 degrees does not require treatment unless it causes severe pain or impairs your everyday functioning. Our spine specialists will monitor curves between 30 and 50 degrees. We may recommend nonsurgical treatment options, such as physical medicine & rehabilitation or physical therapy. Scoliosis curves over 50 degrees may require spine surgery.
Physical Therapy & Scoliosis Exercises
A physical therapist will use your diagnosis and spine curvature to create a tailored treatment plan:
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Education to understand how scoliosis affects your body
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Range-of-motion exercises to improve overall movement
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Strength training to strengthen the muscles that support your spine
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Functional training to help your body move in the most effective ways
Your scoliosis treatment plan may include physical therapy sessions, at-home exercises, or both.
Scoliosis Surgery
Spinal surgery is typically the last line of treatment if other nonsurgical treatments don’t work. Candidates for scoliosis surgery must have a spinal curve over 50 degrees or experience extreme pain that makes everyday activities difficult. Your scoliosis surgery plan will depend on the following factors:
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Diagnostic results of your X-ray or MRI
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Your spinal alignment
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Your personal recovery goals
During surgery, your spine surgeon will place screws at several different spots along your spine to straighten it and anchor it in place. They may remove some spinal bones or joints to make the spine straight.
We commonly treat scoliosis with spinal fusion surgery.
Scoliosis Surgery Risks
Scoliosis surgery is a serious procedure with a high risk of complications:
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Bleeding after surgery
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Blood clot
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Blood transfusion
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Heart attack
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Infection
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Pneumonia
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Urinary tract infection (UTI)
Although it is rare, all surgeries have a risk of death.
Other risks of scoliosis surgery include the following:
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One of the screws may fracture
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Rod placed in your back may break
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Adjacent segment degeneration (an injury or breakdown in your spine that occurs above or below the part of your spine repaired during surgery)
Our spine specialists will only recommend surgery as a last treatment option due to these high risks.
Scoliosis Surgery Recovery Timeline
Hospital Stay
Most people stay in the hospital for 5–7 days to recover. Some people will need to recover in the intensive care unit (ICU), so your care team can monitor your heart and blood pressure closely. Some patients need to have a breathing tube for the first night after surgery. This will assist you with breathing after being on your stomach for several hours during the surgery.
Outpatient Rehab
You will go to outpatient rehabilitation for 3–4 months after you recover. You'll participate in physical therapy and conditioning to get back as much function as possible. Most people do not get the full benefit of surgery to relieve scoliosis pain for at least six months after the procedure. For some people, it takes more than a year.
Home Recovery
Initial recovery at home takes about five weeks. You may have pain in your back and the surrounding areas as your body heals. Your care team will instruct you to walk or move at home about three times a day, increasing how long you stay up each time. You may have painful muscle spasms as your back muscles recover. You can take prescription pain medications or over-the-counter pain medications for relief.
Scoliosis Surgery Scar
Surgery scars depend on where your surgeon made the incision (cut) to access your spine. Most people have a large scar from the middle of their back to the top of their tailbone. You may have another scar on your side or stomach if the surgeon goes in through these areas.
What to Avoid When You Have Scoliosis
There are no specific restrictions on activity for people who have mild to moderate scoliosis. You can continue to participate in all your normal daily activities as long as they do not cause pain or discomfort. However, if you have severe scoliosis or degenerative scoliosis your doctor may tell you to avoid activities that could make the curve worse:
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Bending your neck forward to look at your smartphone or tablet
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Playing high-contact sports like football or rugby
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Sitting or standing in a position with poor ergonomics for long periods of time
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Wearing shoes like high heels that change the way you walk or offer minimal support
Why Choose Ï㽶ÊÓƵ of Utah Health?
U of U Health has a team of exceptional spine surgeons to treat scoliosis. As the largest academic medical center in the Mountain West, the spine team treats patients with complex spine conditions, including severe cases of spine curvature. We perform many high-risk surgeries every year. Studies show that outcomes for these surgeries are often better in a hospital where surgeons have more specialized experience.
We bring together spine surgeons from both the Clinical Neurosciences Center and the Ï㽶ÊÓƵ Orthopaedics Center so you can have the best possible outcome. Our specialists are board-certified, fellowship-trained, and up to date on the latest medical research. We will work with you to review your treatment options and develop a personalized plan for your spine needs.
Find a Scoliosis Specialist
Schedule an Appointment with a Spine Specialist
One of our spine specialists will do a full evaluation and consultation to determine if you need scoliosis surgery. Schedule an evaluation by calling 801-587-2225 or request a spine evaluation online.
Meet Our Patients
For years, Dan Owens suffered excruciating back pain. After many diagnoses, such as previously unidentified scoliosis, and failed treatments for pain management, he grew discouraged. In August 2018, an MRI revealed he had spinal stenosis (severe narrowing caused by arthritis and degenerative disk disease), which exerts pressure on the spinal cord and nerves.
Resources for Our Patients
Straight Facts on Scoliosis
Stand up straight! Scoliosis generally appears in early adolescence and can be treated. Learn about the signs, symptoms, and ways to literally watch your back for this curvature.
Scoliosis: A Common Problem that Can Turn Serious
Scoliosis is common and usually isn't progressive, and, fortunately, those with the condition often can live without much trouble. For some, however, scoliosis can cause pain and even impair function if left untreated. Learn when you should visit your physician for scoliosis and ways to lessen the pain.
What to Expect When Treating Spinal Scoliosis with Surgery
Spinal scoliosis is a degenerative spinal disease that can cause extreme pain or weakness in the legs while walking. In some extreme cases it can even lead to a curvature in the spine that causes further complications. For many patients, physical therapy can help, but for others a surgery may be needed to bring relief.