THORACIC SCOLIOSIS

Questions and Answers

Thoracic Scoliosis Symptoms

Identifying scoliosis early can significantly improve the effectiveness of treatment. Here are some common early signs to watch for:

• Uneven Clothing Fit: One of the subtle indications of scoliosis is when clothing doesn’t seem to fit correctly. Y
• Visible Sideways Curvature: Another common early sign is a noticeable curve in the spine. Family can observe this when the person is in swimwear or changing clothes.
• Asymmetrical Shoulder Height: When a person with scoliosis stands straight, one shoulder might appear higher than the other. This can indicate an abnormal curvature of the spine.
• Uneven Waistline: Similarly, the waist can also show signs of asymmetry. One side of the waist may appear higher, or there may be a noticeable difference in the contour from one side to the other.
• Rib Pain: Rib pain is a common symptom experienced by individuals with thoracic scoliosis. As the spine curves, it can cause the ribs to twist and become misaligned. This misalignment can lead to muscle strain, inflammation, and discomfort along the ribs.
• Chest Discomfort: Thoracic scoliosis can also result in chest discomfort. The curvature of the spine can put pressure on the chest wall, causing a feeling of tightness or pressure in the chest area.

Additional Symptoms

• Uneven Rib Cage: A noticeable symptom of thoracic scoliosis is an uneven rib cage. As the spine curves, the ribs on one side of the body may appear more prominent or elevated compared to the other side.
• Breathing Difficulties: Breathing difficulties can occur in individuals with severe thoracic scoliosis. As the spine curves, it can affect the position and movement of the ribs, restricting the expansion of the chest cavity.
• Tingling Sensations: A noticeable tingling or pins-and-needles sensation might travel down one or both legs.
• Sharp Leg Pain: This type of pain may intensify while walking but typically lessens during rest or inactivity.
• Lower Back Discomfort: Many individuals experience a persistent, dull ache or stiffness in the lumbar region.
• Radiating Pain: A pain that extends from the lower back down into the legs, often following the path of the sciatic nerve.

These symptoms can significantly impact daily activities. It’s essential to recognize them early and consult with a healthcare professional for an accurate diagnosis and suitable management options. If you suspect you might have degenerative scoliosis, paying attention to these signs can help you seek timely medical advice. Managing symptoms effectively often involves a combination of lifestyle adjustments, physical therapy, and sometimes medical interventions.

Anatomy of the Thoracic Spine

The thoracic spine is composed of 12 vertebrae, labeled T1 to T12, which are connected to the ribs. This section of the spine has a natural kyphotic curve, which bends slightly outward, providing structural support and protection for vital organs such as the heart and lungs. In individuals with thoracic scoliosis, this natural curve becomes exaggerated or deviates laterally, resulting in an “S” or “C” shaped curvature when viewed from the back.

Conclusion:

Thoracic scoliosis can manifest with various symptoms, including rib pain, chest discomfort, uneven rib cage, and breathing difficulties. It is important to recognize and understand these symptoms to seek appropriate evaluation and treatment. If you experience any of these symptoms or suspect you may have thoracic scoliosis, it is advisable to consult with a healthcare professional like those at the Southwest Scoliosis and Spine Institute. They can conduct a thorough examination, order imaging tests, and develop a personalized treatment plan to alleviate symptoms, improve spinal alignment, and enhance your overall well-being.

The reason it’s so important to engage in active treatment for scoliosis is because it’s a progressive and incurable condition; this means that it’s in its nature to get worse over time. While we can’t cure scoliosis, we can most certainly treat it and manage it effectively. This proactive approach is crucial for staying ahead of the condition’s progressive line, minimizing its impact on your daily life.

Early intervention and proper management can help mitigate the symptoms and complications associated with thoracic scoliosis. By addressing the condition promptly, we can enhance your quality of life, ensuring that the scoliosis does not interfere significantly with your activities and overall health.

The symptoms of thoracic scoliosis differ from person to person and depend on a number of factors, such as age and stage of development of the patient, as well as the location and severity of the curve, and many more.

How Does Reducing a Spinal Curvature Impact Scoliosis Symptoms?

Reducing a spinal curvature can have profound effects on scoliosis symptoms. Here’s how:

Structural Improvement:

• Straightening the spine helps correct its structural alignment.
• This re-alignment can prevent the curvature from worsening over time.

Symptom Relief:

• Addressing the abnormal curvature often alleviates pain and discomfort.
• As the spine returns to its natural shape, strain on muscles and nerves decreases, leading to fewer symptoms.

Enhanced Functionality:

• Correcting the spine’s shape can improve overall mobility and flexibility.
• Activities that were once painful or difficult become manageable.

Underlying Cause:

• By targeting the curvature, the root cause of many symptoms is addressed.
• This holistic approach helps in reducing or even eliminating associated symptoms such as back pain, fatigue, and restricted motion.

In summary, reducing spinal curvature in scoliosis not only halts the progression of the condition but also brings significant relief from its accompanying symptoms, enhancing the patient’s quality of life.

The Causes of Thoracic Scoliosis

There is no known exact cause of thoracic scoliosis, and doctors categorize it as idiopathic scoliosis. Idiopathic scoliosis is the most common form of scoliosis, accounting for about 80% of cases. It typically develops during adolescence, particularly during the growth spurt phase. While doctors do not know the exact cause, research suggests that a combination of genetic, hormonal, and environmental factors may contribute to its development. Some potential factors that may play a role in the development of thoracic scoliosis include:

• Genetic Factors: Evidence suggests that certain genetic factors contribute to the development of idiopathic scoliosis. It tends to run in families, indicating a genetic predisposition. However, scientists continue to study specific genes and their inheritance patterns.
• Abnormal Spinal Growth: During adolescence, rapid growth occurs, and the spine may grow unevenly. This uneven growth can lead to an asymmetrical curvature of the spine, resulting in thoracic scoliosis. Doctors do not know the exact reasons for this abnormal growth, but some believe that the cause emanates from genetic and environmental factors.
• Hormonal Factors: Hormonal imbalances during adolescence, particularly about growth hormones and the pubertal growth spurt, have been proposed as potential contributors to the development of scoliosis. However, scientists continue to investigate the exact role of hormones in the development of thoracic scoliosis.

It’s important to note that while the causes of idiopathic scoliosis are not completely understood, research continues to explore these factors to gain a better understanding of its origins. Other types of scoliosis, such as congenital scoliosis (caused by spinal malformations at birth) or neuromuscular scoliosis (related to underlying neuromuscular conditions), have different underlying causes.

Diagnosing Thoracic Scoliosis

When children or adolescents with scoliosis experience back pain, it’s often due to conditions other than the spinal curvature itself. One common cause is muscle strain, often resulting from imbalanced muscle use as the body compensates for the scoliosis. Another possibility is disc degeneration, which can occur if the abnormal spine alignment places extra stress on spinal discs. Additionally, inflammatory conditions such as juvenile arthritis can contribute to back pain. Infections, though less common, might require immediate medical attention. Finally, structural abnormalities like spondylolisthesis (a condition where one of the vertebrae slips out of place) can cause discomfort.  By thoroughly investigating these potential issues, healthcare providers aim to ensure that any underlying problems are promptly addressed.

Our Doctors diagnose Thoracic Scoliosis through visual inspection and X-ray imaging. During an initial exam, the doctors at the Southwest Scoliosis and Spine Institute use our advanced low-dose X-ray imaging system to measure the curve. Further imaging tests are sometimes required for cases that may require surgery. In these cases, the doctor will order more tests, such as CT or MRI scans.

Types of Thoracic Scoliosis

Thoracic scoliosis refers to a lateral curvature of the spine that primarily affects the thoracic region, which includes the upper and middle back. There are several different types of thoracic scoliosis based on their causes and characteristics. Here are some common types:

Idiopathic Thoracic Scoliosis:

This is the most common type of scoliosis with no known cause. Idiopathic thoracic scoliosis typically develops during adolescence and may progress during growth spurts.

Congenital Thoracic Scoliosis:

Congenital scoliosis is present at birth and results from abnormal spinal development during fetal development. In the case of congenital thoracic scoliosis, there are vertebral anomalies or malformations in the thoracic spine.

Neuromuscular Thoracic Scoliosis:

This type of scoliosis is associated with neuromuscular disorders such as cerebral palsy, muscular dystrophy, or spinal muscular atrophy. The underlying muscle weakness or imbalance affects spinal alignment and leads to scoliosis.

Degenerative Thoracic Scoliosis:

Degenerative scoliosis occurs as a result of age-related changes in the spine, such as degeneration of intervertebral discs, facet joints, and spinal ligaments. It commonly affects older adults and is often accompanied by other spinal conditions like spinal stenosis.

Secondary Thoracic Scoliosis:

Secondary scoliosis refers to scoliosis that develops as a result of another underlying condition or factor. For example, scoliosis can occur due to trauma, spinal tumors, spinal infections, or previous surgeries that affect the thoracic region.

Dextroscoliosis:

Dextroscoliosis is when the spine curves to the right, known as dextrocurvature; the left curve is referred to as levoscoliosis. This condition is common in children aged 10-15 during growth spurts and affects the thoracic region. Muscle disorders can trigger it later in life. Symptoms include uneven shoulders, hips, noticeable spine curve, and potential organ compression causing breathing issues or pain. Depending on the degree of curvature, dextroscoliosis can lead to leaning or tilting the body to one side and may compress the organs, causing problems with breathing and circulation. Severe cases may require medical intervention and it is important to monitor dextroscoliosis for signs of progression.

Thoracogenic Scoliosis:

Thoracogenic scoliosis occurs due to changes in the shape or structure of the thoracic region, which can lead to a curvature of the spine. This type of scoliosis typically develops as a secondary consequence of conditions or factors affecting the chest cavity, such as lung diseases, chest wall deformities, or surgical procedures impacting the thoracic region like lung resection or thoracotomy. An abnormality or trauma to the chest can affect the spine, potentially leading to a lateral curvature.

Unfortunately, as many as 85% of scoliosis cases are idiopathic, meaning there is no known cause. The condition is either congenital, neuromuscular, or age-related in the other 15-25% of cases. Scoliosis can affect anyone, but it is most prominent in preteen and teenage girls.

By understanding the different types of thoracic scoliosis and their underlying causes, we can better identify, monitor, and treat this spinal condition.

What Sets the Different Types of Scoliosis Apart?

Understanding the various forms of scoliosis can help clarify how each type uniquely affects the spine. The primary ways to differentiate them involve looking at their underlying causes or etiologies. Experts generally classify scoliosis into three main categories: idiopathic, congenital, and neuromuscular.

Idiopathic Scoliosis

Idiopathic scoliosis is the most prevalent form and accounts for the majority of cases. This type is characterized by an unknown cause, meaning there is no identifiable factor that leads to the development of the curvature. Despite extensive research, the reasons remain elusive, but this form typically manifests in adolescence.

Congenital Scoliosis

Congenital scoliosis arises from a spinal abnormality that is present at birth. These spinal defects develop in the womb and are usually detected at a much younger age compared to idiopathic cases. The early onset and clear congenital roots make this type distinct, requiring specialized early intervention.

Neuromuscular Scoliosis

Neuromuscular scoliosis occurs due to an existing disease or condition that impacts muscle control and spinal alignment. Conditions such as muscular dystrophy or cerebral palsy are common culprits. Unlike other types of scoliosis, this form tends to progress rapidly, making early and aggressive treatment essential to manage its effects.

Key Takeaways:

• Idiopathic: Most common with unknown causes, typically appearing in adolescence.
• Congenital: Present at birth due to spinal abnormalities, detected early in life.
• Neuromuscular: Resulting from another disease affecting muscle and spine, progresses quickly.

By fully understanding these categories, individuals and healthcare providers can better tailor their approach to diagnosis and treatment, ensuring each case is managed effectively.

Exploring the Link Between Scoliosis and Back Pain

While the structural impact of scoliosis is well-documented, its direct correlation to back pain remains a topic of extensive discussion and research. It is often believed that scoliosis by itself does not typically cause pain. However, if a child or adolescent with scoliosis presents with back pain, clinicians are inclined to investigate other potential underlying causes that may explain the discomfort.

Despite the prevailing medical consensus, there is a notable segment of patients with idiopathic scoliosis who report experiencing pain they attribute directly to their spinal curvature. This discrepancy has led to conflicting views within the research community. Current trends in medical literature suggest that individuals with scoliosis might report back pain at a higher rate compared to the general population, although the exact nature of this relationship continues to be studied. This highlights the complexity of scoliosis as a condition and underscores the necessity for a tailored approach to each patient’s symptoms and treatment options.

Treatment

In many cases, doctors begin by treating thoracic scoliosis through observation and a scoliosis brace. By reducing a curvature, treatment not only impacts the condition structurally but also helps prevent further progression. This dual approach is crucial because it addresses the underlying cause of any experienced symptoms. As the spine’s healthy curves are restored, symptoms are lessened or even eliminated.However, in cases where the patient’s curve grows to the point that they are in pain or having breathing problems, surgery becomes the best option.

Comprehensive Treatment Strategy

• Observation: Initially, doctors may recommend non-invasive methods like observation and a scoliosis brace to monitor and manage the condition. The doctors at Southwest Scoliosis and Spine Institute recommend observation for younger patients whose curves are less than 25 degrees. Using our in-house 2D/3D EOS imaging system, doctors can order images of the spine every 4 to 6 months to determine if the curve gets worse.  The X-ray delivers an extremely low dose of radiation. This low-dose imaging system helps prevent too much radiation because children get are more susceptible to the cumulative effects of radiation than adults.
• Bracing: In patients whose curve has progressed past 20-25 degrees, doctors often prescribe a scoliosis brace until the patient reaches full skeletal maturity. Though bracing cannot correct the curvature, in many cases it can stop it from growing. For this reason, bracing becomes effective when it starts early and when a brace is worn as prescribed.
• Physical Therapy and Rehabilitation: Exercises designed to strengthen the muscles supporting the spine, enhance mobility, and reduce pain.

These early treatments aim to address both the structural deformity and the symptoms, such as pain or discomfort, which might arise from the curvature.  The effective management of the curvature from the outset can prevent the condition from worsening, reducing the likelihood of needing surgical intervention.

When Surgery Becomes Necessary

Despite the best efforts with non-surgical treatments, some patients may experience worsening conditions. When the spinal curve progresses to the point of causing significant pain or breathing issues, spinal-fusion surgery becomes the recommended course of action.

By addressing scoliosis comprehensively—managing both the structural and symptomatic aspects—early treatments can often prevent the need for more invasive procedures later on. This holistic approach not only improves the patient’s quality of life but also minimizes the risk of severe complications that would necessitate surgery.

If the curve grows beyond 40-50 degrees, the doctor may recommend surgery. Also, the most common type of surgery to address this condition uses spinal fusion, which involves placing rods and screws into the vertebrae to prevent the spinal curvature from growing any bigger.

Surgeries to fix thoracic scoliosis are complex, multi-step procedures, but Richard Hostin, MD, Devesh Ramnath, MD, Ishaq Syed, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD are specially trained and have years of experience performing these types of complex spine surgeries. With offices in Dallas, Plano, and Frisco, Texas, these spine experts have appointments within 24 hours during the work week.  If you are having back pain from a spinal condition and want the very best spine specialists, please give us a call.

Is Scoliosis Likely to Progress to a Fatal Condition?

The answer is that while it’s possible, it’s extremely rare. Scoliosis is typically monitored closely by healthcare professionals, and if it starts to advance, medical interventions such as surgery can be accessed long before it reaches a life-threatening stage. Therefore, under normal circumstances with proper medical care, scoliosis is unlikely to ever become fatal.

How Does Scoliosis Affect Self-Esteem?

Scoliosis can have a profound impact on self-esteem, particularly among adolescents who are highly sensitive to social perceptions. The visible curvature of the spine can make individuals self-conscious about their appearance. This physical difference often leads to feelings of embarrassment or self-doubt, especially when trying to fit in with peers.

Wearing a back brace, a common treatment for scoliosis adds another layer of complexity. The brace can be both physically uncomfortable and emotionally distressing. Its noticeable presence can make wearing certain clothes difficult and sometimes invite unwanted attention or questions.

These factors collectively contribute to a decrease in self-confidence and an increase in stress or depression. Adolescents may find themselves avoiding social interactions or activities they once enjoyed, further isolating themselves and exacerbating feelings of low self-worth.

Cardiovascular Problems and Thoracic Scoliosis

Cardiovascular problems have been associated with scoliosis. When the rib cage twists or changes shape significantly, it can reduce the space available for the heart, potentially hindering its ability to pump blood efficiently. This can lead to a range of complications, such as decreased cardiac output and increased strain on the heart. In severe cases, this restriction can result in more serious cardiovascular issues, underscoring the importance of monitoring and managing scoliosis effectively.

Why Choose the Southwest Scoliosis and Spine Institute

The Southwest Scoliosis and Spine Institute with offices in Dallas, Plano, and Frisco, Texas specializes in the treatment of scoliosis and other spinal conditions, including neck and back pain. They offer a range of non-surgical and surgical treatments including physical therapy, medication, injections, and surgical interventions. In the past, we have sometimes been referred to as the Dallas Minimally Invasive Spine Institute.

The Institute’s team of spine specialists, orthopedic spine surgeons, and pain management doctors, work together to develop individualized treatment plans for each patient. They use the latest technology and techniques to provide effective, minimally invasive treatments that minimize pain and recovery time. Surgeons Richard Hostin, MD, Devesh Ramnath, MD, Ishaq Syed, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD treat patients with minimally invasive surgery whenever possible. The surgeons at the Southwest Scoliosis and Spine Institute use Minimally invasive spine surgery to treat conditions that affect the spinal column and the nerves that run through it.

Footnote:

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Physiopedia: Thoracic Vertebrae