IDIOPATHIC SCOLIOSIS

Approximately 90 percent of scoliosis cases are idiopathic, making it the most common type. Idiopathic means that doctors can’t pinpoint the cause of the spinal curvature.
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Idiopathic Scoliosis

The word “idiopathic” means that the cause of this form of scoliosis is unknown. Adolescent idiopathic scoliosis affects children between 10 and 18 years old. This form of scoliosis affects girls more than boys. In fact, girls are treated 10 times more often than boys. There are many theories as to why this type of scoliosis develops, but the root of the condition has yet to be discovered.

Idiopathic Causes Include

  • Genetics – Scoliosis appears to run in certain families. It may be hereditary. Significant research is ongoing in the field of genetics.
  • Growth – Curves progress rapidly during growth spurts, perhaps showing a tie to hormonal causes.
  • Structural and Biomechanical Changes – Some studies have shown increased muscular activity around the spinal curves. Differences in leg lengths have also been noted in adolescents with idiopathic scoliosis. But there is no clear evidence that this type of change causes scoliosis. It may simply be a secondary result.
  • Central Nervous System Changes – Some forms of scoliosis are associated with central nervous system disorders. A lot of research has been focused on this topic. But so far such disorders have not been proven as the root of idiopathic scoliosis.
  • Equilibrium and Postural Mechanisms – Idiopathic scoliosis could be related to factors that affect body alignment. If a child has problems with posture, balance, and body symmetry, it could affect the way the spine is positioned. If the problems are chronic, it may disrupt the way the spine and muscles develop.

Idiopathic scoliosis is classified by the age at which it occurs, falling into one of four categories:

Young daughter with Idiopathic Scoliosis
  • Infantile idiopathic scoliosis – Also known as early-onset scoliosis. Develops in children, mostly boys, under the age of 3.
  • Juvenile Idiopathic scoliosis – More common in girls, this kind of scoliosis occurs between the ages of 3 and 10.
  • Adolescent Idiopathic scoliosis – This type of scoliosis makes up the majority of idiopathic cases. It’s most common in girls between the ages of 11 and 17. Adolescent idiopathic scoliosis is the most common diagnosis in children, representing nearly 90 percent of cases.
  • Adult idiopathic scoliosis – This type is seen in adults 18 years and older.

The curvature of idiopathic scoliosis (Infantile, Juvenile, and Adolescent) varies from person to person, with mild curves being more common than severe curves. In children and adolescents who are still growing, the curve can worsen rapidly during a growth spurt. While this type of scoliosis can develop in younger children, it most often begins during puberty. Both boys and girls can be affected, however, girls are more likely to develop severe curves that require medical care.

Likelihood of Progression

Once scoliosis is diagnosed, the concern may arise whether the curves will continue to grow bigger. There is no absolute way to tell, but this much is known:

  • Curves in the thoracic spine are more likely to progress than lumbar curves.
  • The likelihood of progression is linked to the size of the curve. Larger curves are more likely to get bigger.
  • If the curves start at a young age or before a girl begins her period, they are more likely to progress.
  • The higher the child’s Risser sign is at diagnosis, the less chance there is of progression. The Risser sign also measures skeletal maturity. It is based on a 0 to 5 scale, with 5 being full skeletal maturity. This measurement is based on the iliac apophysis-a layer of cartilage on the flared part of the hip bone that turns to the bone with age and maturity.

Symptoms of Idiopathic Scoliosis

In children and adolescents, small curves often go unnoticed until they hit a growth spurt during puberty and there are more obvious signs, such as:

  • Tilted, uneven shoulders, with one shoulder blade protruding more than the other
  • The prominence of the ribs on one side
  • Uneven waistline
  • One hip higher than the other
  • Back pain
  • Difficulty breathing

Adult Idiopathic Scoliosis

Adult idiopathic scoliosis is a continuation of the disease from childhood. Scoliosis may have started during your teenage years and gone unnoticed, not progressing until you reached adulthood. This form of scoliosis can affect both the thoracic and lumbar portions of the spine.

In adults, the symptoms are often more severe and may include:

  • Spinal stenosis, an abnormal narrowing of the spinal canal that can cause back pain that’s worse when standing or walking.
  • Nerves can sometimes become compressed and may cause radiating pain in the mid to lower back, as well as numbness, tingling, or weakness in the legs.
  • In severe cases (generally in curves more than 90 degrees), scoliosis can result in diminished lung function.

Diagnosing

Idiopathic scoliosis is usually diagnosed through a combination of physical examinations and specialized X-ray images. During the physical examination, Richard Hostin, MD, Shyam Kishan, MD, or Kathryn Wiesman, MD will examine the curvature of the spine, looking closely at the degree of rotation in the spine. They will also note any secondary changes in other parts of the body.

X-ray images are important to pinpoint the shape and location of the curves, as well as for measuring the degree of the curvature so it can be classified. Southwest Scoliosis Institute uses the revolutionary EOS 2D/3D X-ray imaging system, which allows us to quickly take full-body images of patients in standing or seated positions in just a few seconds while delivering the lowest possible dose of radiation.

Treating Idiopathic Scoliosis

In many cases, idiopathic scoliosis treatment can be addressed through a combination of observation and a brace. However, in cases where the patient’s curve has progressed to the point that they are in pain or having difficulty breathing, surgery may be the best option.

Observation
The physicians at Southwest Scoliosis Institute typically recommend observation for younger patients whose curves are not severe. Using our advanced in-house imaging system, X-ray images of the spine can be taken every 4 to 6 months to determine if the curve is progressing or not while delivering an extremely low dose of radiation. This low-dose imaging system is especially beneficial for children, as they are more susceptible to the cumulative effects of radiation than adults.

Scoliosis brace
In (primarily adolescent) patients whose curve has progressed past 20-25 degrees, the physicians often prescribe a back brace to be worn until the patient reaches full skeletal maturity. Though bracing cannot correct the curvature, in many cases it can stop it from progressing. For this reason, bracing is most effective when it is started early and when braces are worn as prescribed.

Scoliosis surgery
If the curve progresses beyond 40-50 degrees, the physician may recommend surgery. The most common type of surgery to address idiopathic scoliosis is called spinal fusion, which involves inserting rods and screws (known as instrumentation) into the vertebrae to prevent the spinal curvature from progressing any further.

Surgeries to correct idiopathic scoliosis are complex, and multi-step procedures, but doctors Richard Hostin, Shyam Kishan, and Kathryn Wiesman, are specially trained and have years of experience performing these types of complex spine surgeries.

“Adolescent Idiopathic Scoliosis is the most common form of scoliosis that we see in teenagers. The most common symptoms we see are curvature of the spine, unevenness of the shoulders, and unevenness of the hips. The treatment is based on the size of the curve. Research tells us that if your curve is 50 degrees or more, it will continue to progress throughout your lifetime. After surgery people can return to most physical activities 6 months after surgery.” Richard Hostin, MD

If you or your loved one is suffering from scoliosis, there is hope. We can help. Call Southwest Scoliosis Institute at 214-556-0555 to make an appointment.