Curvature of the Spine

Scoliosis | Kyphosis | Scheuermann's Disease

We're all born with natural curves in our back, but take a look at your spine from the back on an x-ray (Read about "X-rays") and you should see a straight line, like the letter "I." According to the American Academy of Orthopaedic Surgeons (AAOS), an x-ray that reveals a spine with a sideways curve, like the letter "C" or "S," could spell trouble. Curvature of the spine is a catch all term for a number of conditions. (Read about "The Spine")

Scoliosis

Scoliosis is an abnormal curve of the spine, with the spine curving to the side, according to the American Academy of Family Physicians (AAFP). Depending on the extent of the curvature, one shoulder may be lower than another and the ribs or hips may stick out more on one side. AAOS says only 2 percent of the population is affected by scoliosis, which tends to be more common in girls, and runs in families.

While scoliosis usually develops during childhood, it can also affect adults, according to AAOS. Actually, adult scoliosis may be the progression of a condition that began in childhood, and was never diagnosed or treated. AAOS says adult scoliosis can be caused by changes in the spine that occur as we age. AAOS says, as more people age in this country, the incidence of adult scoliosis will probably increase.

In most cases, AAFP says scoliosis causes few problems. Usually the curve of the spine is small, and rarely is there any back pain. (Read about "Back Pain") Cosmetics are a prime concern of many patients. However, according to AAOS, there could be some long-term effects if scoliosis is left untreated. AAOS says the condition can worsen during adult life. If the curvature becomes severe, it may result in difficulty breathing. (Read about "Respiratory System")

See diagnosis and treatment options below.

Kyphosis

An exaggerated curve of the back that looks like a rounded or hunched back could be kyphosis, according to AAOS. Kyphosis might develop as a result of slouching. Poor posture can stretch spinal ligaments, and according to AAOS, increase the natural curve in the spine. It is more common among females than males. Luckily, kyphosis is rarely painful and AAOS says strengthening exercises may even help correct the problem. (Read about "Back Tips")

Congenital kyphosis however is more serious. This occurs in some infants whose spinal column does not develop properly. AAOS says this type of kyphosis will worsen as the child grows, but can be helped with surgery. (Read about "Neurosurgery") Kyphosis or round back is also a common problem among those suffering from osteoporosis. (Read about "Osteoporosis") AAOS says, as more people age in this country, the incidence of adult kyphosis will probably increase. Other conditions which can cause curvature include spinal problems - such as arthritis and ankylosing spondylitis - and connective tissue disorders such as Marfan syndrome (Read about "The Spine" "Marfan Syndrome")

See diagnosis and treatment options below.

Scheuermann's Disease

Scheuermann's disease, named for the Danish radiologist who first described it, is a painless deformity. AAOS says the only way to diagnose Scheuermann's is with an x-ray. (Read about "X-rays") While vertebrae and disks look normal among kyphosis patients, they are irregular and wedge-shaped among those who have Scheuermann's disease. Unlike scoliosis and kyphosis, which are more common among girls, Scheuermann's disease is more pronounced among adolescent boys, according to AAOS. The structural changes of the vertebrae usually don't require surgery, and according to the Scoliosis Research Society (SRS), may be treated with a brace. Anti-inflammatory drugs, as well as exercises might be an initial program of treatment. SRS says one type of Scheuermann's disease can be caused by heavy lifting. Stopping such activity is often the only treatment needed.

See diagnosis and treatment options below.

Diagnosis and treatment options

Diagnosing a curvature of the spine usually begins with a physical examination, according to SRS. A physician can access the slope of the spine with the Adam's forward bend test. During this simple test, the patient bends forward with knees straight, and arms extended. X-rays, according to AAOS, will show if there are any bone abnormalities and allow the doctor to examine the degree of the curve. Any curve measuring more than 50 degrees is considered abnormal. Magnetic resonance imaging (MRI's) and CT scans may also be used at the doctor's discretion. (Read about "MRI - Magnetic Resonance Imaging" "CT Scan - Computerized Tomography") Many schools will conduct scoliosis screenings in the fifth or sixth grade. While a physician should be the one making any kind of accurate diagnosis, AAOS says these school screenings can signal parents about potential problems. AAOS says parents should also watch for the following warning signs when their child is about 8-years-old.

• uneven shoulders and/or waist
• leaning to one side
• elevated hips
• pronounced shoulder blade(s)

If a parent notes any of these, a family doctor, pediatrician or orthopaedist should be contacted to check for anything unusual.

If a problem is present, treatment will depend on whether you are diagnosed with scoliosis, kyphosis or Scheuermann's disease. Your physician, according to SRS, will take several factors into account when planning a method of treatment:

• cause
• location
• severity
• age
• family history (Read about "Family Health History")

When it comes to scoliosis in children and young adults, AAOS says there are three different types of treatment your physician may consider:

• Observation - Your doctor will want to check the curve of your spine on a routine basis. This is usually the case, according to AAOS, among patients whose angle of the curve is less than 20 degrees, or if the child is near skeletal maturity. AAOS says most of the scoliosis cases referred through school screenings fall into this category.
• Braces - Newer, more modern braces allow patients to continue routine activities, and are often used to help prevent the curves from getting worse. AAOS believes this is an effective treatment if the child is still growing and has a curve of less than 30 degrees. According to AAFP, braces are barely visible under clothes, and are lightweight.
• Surgery - AAOS says surgery is required in a relatively small percent of cases. Surgery may be considered if the child is still growing, and the curve is more than 50 degrees. AAOS says the surgery requires a bone graft from the ribs, hip or a bone bank. Rods, hooks, wires or screws might be used to straighten the spine. AAOS says patients are usually discharged from the hospital within a week. According to AAOS, exercise programs, electrical muscle stimulation and manipulation have not been found to treat scoliosis effectively. (Read about "Neurosurgery")

Early detection of spinal problems is the key in making sure the curve does not get worse, according to AAOS. In the small number of cases that do need medical attention, advances in medicine have made scoliosis a manageable condition. An orthopaedist is a physician who specializes in diseases of the musculoskeletal system, and will likely be able to diagnose, monitor and treat this condition.

Related Information:

    Calcium and Osteoporosis

    Age and Bone Loss

    Calcium

    Back Pain

    Avoid Back Pain

    Skeletal System

    Marfan Syndrome