Severe Scoliosis

Severe Scoliosis Definition

• Spinal curves can occur in infants or children below the age of 4 and are referred to as Infantile Scoliosis.
• When discovered in children and adolescents it is referred to as Pediatric Scoliosis.
• When found after puberty, it is referred to as Adult Scoliosis.

In adolescents, this spinal problem usually affects the upper spine, mostly the thoracic or rib cage portion of the spine. In adults, it appears in the lumbar or lower back part of the spine. Moreover, most cases of spinal curvature seem mild and usually do not progress. When doctors can not ID a cause, they will call it Idiopathic Scoliosis. However, this spinal problem may link to other conditions like Cerebral Palsy and Muscular Dystrophy, injuries or infections that affect the spine, and congenital spinal abnormalities.

The spine usually portrays a natural long S curve running backward. Scoliosis occurs when the spine curves sideways giving an S or C-shaped curved spine. For a diagnosis of scoliosis, the angle of curvature known as the Cobb Angle must exceed 10 degrees. The degree of severity relates to the extent of the curve and resulting pain and discomfort.

During diagnosis, the x-ray of the spine normally confirms curvature. When the Cobb Angle exceeds more than a 40-45 degree curve for adolescents and 50-55 degrees for adults, it is classified as severe and in such cases, the spine becomes highly deformed.  The sideways curvature might include rotation causing the back to bulge to one side. In addition, the doctor will determine the severity by evaluating the spine, body, and the patient’s pain.

Scoliosis Types

The Cobb Angle helps determine the severity of scoliosis and measuring can occur via x-ray images. The higher the Cobb Angle, the more Severe Scoliosis can be.

Mild Scoliosis

Mild Scoliosis exists when the Cobb Angle is more than 10° but lesser than 25°. Most of the time, treatment does not involve surgery and doctors will monitor the patient for signs of progression. It usually does not require any major treatment aside from regular checkups. In children and adolescents, braces or casting appear effective in making quick adjustments to their growing bones.

Moderate Scoliosis

The Cobb Angle in Moderate Scoliosis is between 25° and 40°. This may result from the progression of a mild curve that was poorly managed. Bracing and supportive treatment may help in this stage for children and adolescents depending on the situation and the specialist. Finally, spinal alignment can still definitely continue with growing bones.

Severe Scoliosis

This occurs when the Cobb Angle is greater than 40° – 45° for adolescents and 50° – 55°  for adults. In this state, the spinal curvature is quite prominent alongside postural changes and other complications. Surgery is usually considered at this stage, especially for young people due to cosmetic reasons. The specialist uses this severity scale to determine the course of treatment to follow and how best to help each patient.

Symptoms of Severe Scoliosis

Most Scoliosis diagnoses originate from multiple causes that get found after a thorough body exam.  Obvious Symptoms in adolescents between the ages of 10 and 18 include:

• Uneven Shoulders
• Off-center Head Position
• Uneven Legs
• Unilateral Scapular Prominence
• One Hip higher than the other
• One Side of the Rib Cage jutting forward

Other symptoms include:

• Lower Back Pain in older adults

Symptoms seen in infants include:

• One side of the chest bulging
• Lying with a body curve on one side
• Shortness of breath or chest pain in severe cases

Lower Back Pain in Severe Scoliosis

Lower back pain can occur in adults due to degeneration and other conditions like osteoporosis and arthritis. However, lower back pain occurs with a spinal curve. In adults, spinal degeneration can lead to side-to-side curvature of the spine, called Adult Onset/Adult Degenerative Scoliosis. It involves wear and tear of spinal discs and spinal joints resulting in a shifting and curving of the vertebrae.

Adult spinal curve patients often possess spinal stenosis, a condition where the spinal canal narrows. This leads to a compression of the nerves present in that area of the spine. This compression alongside pressure on the spinal discs, the facet joints, and pain in the muscles typically causes lower back pain. Since Scoliosis affects the spine, it can cause tight muscles, fatigue, and lower back pain. The pain becomes intense and will cause problems in daily activities.

Because Scoliosis by itself does not cause back pain, other causes need identification before determining the treatment approach. The best way to approach lower back pain caused by spine problems is to manage the spine problems properly. Depending on the type of lower back pain, there are several treatment options available.

Treatment

Therapy 

• Hydrotherapy
• Massages
• Stomach and Back Strengthening Exercises
• Supporting Braces

Medication

Some OTC(Over-The-Counter) medications like Tylenol and Advil can help with the pain. If the pain doesn’t get relieved, patients should notify their doctor who can prescribe stronger pain medication.

Physical Therapy

Physical Therapy treatment helps to increase flexibility and loosen the affected muscles while helping to reduce pain. It does not provide a cure but it definitely helps. However, finding physical therapists who specialize in scoliosis is important as therapists without adequate experience, can do more harm than good.

Spinal Injections

These injections inject steroids around the nerves in the spine and joints of the spine to reduce pain. They combat acute and severe pain.

Surgery

As mentioned above, for Severe cases of Scoliosis, Surgery is often recommended.

Scoliosis X-Rays

An X-ray provides a diagnostic and management tool that utilizes a relatively safe amount of radiation to create images of the spine. During the process, the X-ray machine sends a beam through the patient’s back which is then reflected and an image of the skeletal structure of the trunk becomes saved and visible to doctors on a monitor.

The X-ray taken shows the thoracic spine and the lumbar spine of the back. Specialists take the images in two dimensions, one from the back and the one taken from the patient’s side.

Depending on the discretion of the doctor who requests the x-rays, other views can get taken. The X-rays get taken by certified technicians in a radiology center or hospital. The procedures may take only about 15 minutes with the actual exposure to x-rays being only a few seconds. It is a painless procedure and our technicians will ensure that each and every patient is comfortable during the taking of x-rays.  

Complications of Untreated Severe Scoliosis

As soon as there is a diagnosis, treatment or monitoring should begin depending on the stage of diagnosis. If a spinal curve worsens without any interventions, a lot of physical and emotional complications can arise. Some of these include;

Breathing and Heart Problems

With untreated scoliosis, the curvature of the spine keeps increasing. And therefore, this causes a restriction in the rib cage which ultimately restricts lung capacity and expansion. This presents severe shortness of breath and can lead to heart problems as well.

Musculoskeletal Problems

Spondylosis, an arthritic condition, can develop in individuals with long-standing untreated scoliosis. In addition, the spinal cartilage gets thinned out and the joints get inflamed. Bone spurs may also develop and if the inflammation causes the bone to press on spinal nerves, the result is severe pain.

Also, in long-standing cases, there’s a misalignment of the pelvis and hips causing a limb to appear shorter. Also, this affects posture and gait, with the muscles wanting to maintain balance by overcompensating. This leads to pain in the lower limbs, especially where lumbar stenosis exists.

Emotional Problems 

This condition affects the emotional and mental health of individuals, especially the younger population.  Pain and social isolation can occur and provide a source of concern.  Furthermore, it may cause behavioral problems without adequate emotional and mental support throughout the journey.

Bad Posture or Appearance

Doctors can manage Mild scoliosis that does not cause significant body changes. But curves greater than 40 degrees are obvious and serious, and cause tilting that affects a person’s appearance.

Back Pain

In adult scoliosis, the lower back usually becomes affected. This can lead to pain when they sit or go about normal daily activities.

Why Choose Southwest Scoliosis and Spine Specialists

Orthopedics is a specialty of our doctors and surgeons at Southwest Scoliosis and Spine Institute. They understand your concerns, can answer your questions regarding your condition, and know how to use their specialized knowledge to assist you.  Richard Hostin, MD, Devesh Ramnath, MD, Ishaq Syed, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD, have many years of training and experience in Spine and Back Pain for kids, adolescents, young adults, and seniors and can help people of all ages get back to living the life they love.

The following are just a few of the many reasons why patients might choose Southwest Scoliosis and Spine Institute.

• Expertise in the spine: The team of specialists at Southwest Scoliosis and Spine Institute is spine experts.  They specialize in the diagnosis and treatment of spinal conditions, ensuring the best possible care for their patients.
• Cutting-edge technology: Our practice uses the latest technology and techniques to diagnose and treat a wide range of conditions.  In addition, we use minimally invasive procedures that reduce pain and promote faster recovery.
• Comprehensive care: Our practice offers a full range of services, from diagnostic imaging and physical therapy to surgery.  We ensure that patients receive complete, seamless care for their spinal conditions.
• Dedicated facilities: Southwest Scoliosis and Spine Institute is dedicated to providing patients with a safe and comfortable environment.

Finally, our board-certified physicians and fellowship-trained orthopedic surgeons use the full range of treatments to treat their spine patients. Southwest Scoliosis and Spine Institute’s experts with offices in Dallas, Plano, and Frisco, Texas offer cutting-edge technology, comprehensive care, and dedicated facilities to ensure the best possible care for their patients. Get in touch with us today at (214) 556-0555 to schedule an appointment.

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American Association of Neurological Surgeons
Kids Health