According to health experts, scoliosis affects between 2% and 3% of the American population. That is about 6-9 million people! Scoliosis is an abnormal lateral curvature of the spine and there are many different forms. Scoliosis’s cause and the patient’s age are the most common way of categorizing the condition.
All kinds of scoliosis involve some degree of spinal bending, some are worse than others. Newer research in scoliosis genetic testing has revealed new insights into the possible cause of the curvature of the spine.
Genetic testing may help us better determine which type of scoliosis is which, more accurately in the future.
Clayton J. Stitzel DC,
What Sets the Different Types of Scoliosis Apart?
There are many ways to determine the differences between the various forms of scoliosis. The most common method uses etiology or the underlying cause for the condition. Most experts feel there are three categories of scoliosis. idiopathic, congenital, and neuromuscular.
Idiopathic is the most common type of scoliosis. This means that the cause is unknown or that there is no single factor that contributes to the development of the disease.
Congenital forms of scoliosis result from a spinal defect present at birth. This is usually detected at a much earlier age than idiopathic forms of scoliosis.
Neuromuscular scoliosis is spinal curvature that develops because of some kind of another disease. Examples include muscular dystrophy or cerebral palsy. This form of scoliosis tends to progress much more quickly than others.
Knowing how spinal curvatures are classified is important. It may provide a foundation of knowledge on how to treat a specific type of scoliosis.
Below are eight types of scoliosis in greater detail:
Congenital scoliosis is rare, affecting only 1 in 10,000 newborns. It results from spinal abnormalities that develop in the womb. Before birth, malformation of the spine is the most common cause of this type of scoliosis. It may also result from the partial formation of certain bones or the absence of one or more bones in the spine. Congenital scoliosis leads to a sideways curvature of the spine. It can cause the child to develop extra curves in the opposite direction. This may be the body’s attempt to compensate for the abnormality.
Congenital scoliosis relates to spinal defects present at birth. it is diagnosed much earlier than other forms of the disease. Symptoms of congenital scoliosis include
- tilted shoulders,
- an uneven waistline,
- the prominence of the ribs on one side,
- head tilt,
- the appearance of the body leaning to one side.
- When symptoms develop, diagnostic tests such as EOS imaging, x-rays, MRIs, and CT scans confirm the diagnosis.
Early Onset Scoliosis
One of the most common age ranges at which scoliosis develops in young children. Hence, the name juvenile scoliosis. When scoliosis is present before the age of 9, but, doctors refer to it as early-onset scoliosis. It is important to differentiate between adolescent and early onset scoliosis. Genetic origins between the 2 categories may be different.
Often, children with early-onset scoliosis do not show any signs of spinal problems. Especially if they have mild scoliosis. Detection of early-onset scoliosis is important. Pay attention to the symmetry of the affected child’s body. Uneven shoulders, the asymmetric contour of the waist, uneven hips, tilted head, and leaning can all be signs of scoliosis. Early treatment for this form of scoliosis is important because the child is still developing. Delayed treatment can contribute to lung and heart problems called Cor Pulmonale.
Adolescent Idiopathic Scoliosis (AIS)
This is the most common form of scoliosis. Adolescent idiopathic scoliosis affects as many as 4 out of 100 children between the ages of 10 and 18. The name for this condition comes from the age of onset (adolescence). Genetic research is beginning to pinpoint the possible causes of idiopathic scoliosis.
By the age of 10, spinal growth has begun to speed up. This increases the likelihood of rapid curve worsening during growth spurts.
Adolescent Idiopathic is the most common form of the scoliosis condition
There are many theories about the possible causes of adolescent idiopathic scoliosis. These include hormonal imbalances causing asymmetric growth. About 30% of all adolescent idiopathic scoliosis patients have a family history of scoliosis. This suggests a genetic link. In most cases, adolescent idiopathic scoliosis patients do not experience any pain or other problems. They may even look normal when viewed from the side. When symptoms do develop, they take the form of uneven shoulders, a rib hump, or a leaning torso. This form of scoliosis is also sometimes correlated with lower back pain.
ScoliSMART doctors recommend “reflexive retraining” through Early Stage Scoliosis Intervention (ESSI)as soon as a curve is detected. Early treatment almost always improves treatment results.
Degenerative Scoliosis (De Novo Scoliosis)
Also known as adult onset scoliosis, late onset scoliosis, or de novo scoliosis. Degenerative scoliosis is characterized by a sideways curvature of the spine that develops over time as an adult. One of the natural consequences of aging is degeneration of the joints and discs in the spine. Uneven “wear and tear” of these discs and joints can cause spinal curvature to become more pronounced on one side. A hallmark of scoliosis.
Degenerative scoliosis is often linked to loss of bone health.
Degenerative scoliosis most develops in the lumbar spine or the lower back, and it forms a slight C-shape. When the degree of sideways curvature exceeds 10 degrees (as measured by the Cobb angle), it is diagnosed as scoliosis.
Although many forms of scoliosis are not painful, degenerative scoliosis certainly can be painful. Common symptoms include:
- a dull ache or stiffness in the lower back,
- a radiating pain that spreads to the legs,
- a tingling sensation that runs down the leg,
- or sharp pain in the leg that occurs while walking but subsides during periods of rest.
A recent study on Adult Scoliosis suggests that more than 60% of the population over the age of 60 has some degenerative scoliosis.
- De novo scoliosis is caused by age-related degeneration of the spine. It occurs in adult patients who have no prior history of scoliosis. It is diagnosed in people over the age of 50 through physical examination and x-rays. Patients with de novo scoliosis often experience:
- muscle fatigue and lower back pain,
- stiffness and leg symptoms such as numbness or weakness.
- Over time, patients often develop poor posture and loss of balance. Treatment is tricky because of the risks associated with back surgery in older individuals.
Neuromuscular scoliosis develops secondary, because of another condition. Spinal curvature occurs when the brain and muscles are unable to communicate well. This curvature is likely to progress into adulthood and may become more severe in patients who are unable to walk. Patients who are confined to wheelchairs may have trouble sitting upright and may have a tendency to slump to one side.
Some of the underlying conditions known to contribute to neuromuscular scoliosis include:
- cerebral palsy,
- Duchenne muscular dystrophy
- Freidrich ataxia
- and spinal muscular atrophy
Neuromuscular scoliosis is often not painful unless the spinal curvature becomes very pronounced. Often the first sign of scoliosis is a change in posture. Either leaning forward or leaning to one side while standing or sitting. Clinical exam and full spinal x-rays, usually show a long, C-shaped curvature that affects the entirety of the spine.
Knowing how spinal curvature disorders are classified provides a foundation of knowledge on which to build an understanding of the specific types of scoliosis.
Whereas scoliosis is defined as an abnormal curvature of the spine when viewed from the front, kyphosis is a forward rounding of the spine. Scoliosis most affects the lower spine or lumbar spine. Kyphosis usually affects the cervical spine and thoracic spine. Scheuermann’s kyphosis is one of three types of kyphosis and it is diagnosed during adolescence. It develops secondary to some structural deformity in the vertebrae. Early symptoms include:
- poor posture,
- back pain,
- muscle fatigue,
- and stiffness in the back.
- In most cases, these symptoms remain fairly consistent and they generally do not worsen over time except in severe cases.
Understanding scoliosis begins with identifying its location and the type of spinal curvature.
Knowing this information can help predict what types of scoliosis symptoms may be experienced and how the condition can best be treated.
There are several detailed systems for classifying specific scoliosis curves. Still, some of the most common terms identify curves based on their location within the spine and their bend direction.
Thoracic, lumbar, and thoracolumbar scoliosis all refer to location, while terms such as dextroscoliosis and levoscoliosis indicate whether the spine curves to the right or left.
Though all forms of scoliosis involve some degree of spinal curvature, recent research in scoliosis genetic testing has revealed new insights into the root cause of the condition. See how genetic testing is making scoliosis intervention possible. (Emailed directly to your inbox)
Thoracic scoliosis describes curvature positioned in the middle, or thoracic, part of the spine. It is the most common location for scoliosis curves and often includes the rib cage and spine deformity. As the rib cage develops asymmetrically, one shoulder may become lifted, or one leg may appear longer than the other.
Lumbar scoliosis occurs in the lower, or lumbar, part of the spine. It may cause one hip to appear higher than the other or one leg to appear longer.
In some cases, lumbar scoliosis is degenerative, developing after age 50 due to a spine breakdown — as opposed to the more common adolescent idiopathic form, which presents no known cause. Those with degenerative lumbar scoliosis may exhibit no symptoms at all, or they may become severely disabled.
With thoracolumbar scoliosis, the curve includes vertebrae from both the spine’s lower thoracic and upper lumbar parts. It is often congenital, occurring in utero during the third to sixth week, and detectable at birth. It may even be the secondary effect of a neuromuscular condition (such as spina bifida or cerebral palsy).
Thoracolumbar scoliosis usually involves a curve toward the right and occurs more often in females than males.
New research points to the importance of genetic and neurotransmitter testing to further define your child’s scoliosis diagnosis.
Types of Scoliosis Spinal Curvature
The side view of the human spine has natural curves to help absorb the stresses of everyday movement. When viewed from the side, a healthy spine has gentle curves; it runs straight down the middle of the body when viewed from behind. With scoliosis, the spine develops an abnormal sideways curvature that can range from mild to severe. Other conditions may cause the spine to curve inward or backward.
Intro to the Anatomy of the Spine
The spine is composed of 33 individual bones (including the pelvis), called vertebrae, stacked one on top of the other. The spinal column is part of the skeletal system, which provides structure and support for the body while also enabling movement. Only the top 24 vertebrae are movable, divided into three regions: cervical, thoracic, and lumbar. The sacrum is the set of five bones that make up the pelvis together with the iliac bones, while the coccyx region consists of four fused bones that make up the tailbone. Both the sacrum and coccyx are fused in place.
A healthy spine should have a natural “S” shape consisting of three natural curves when viewed from the side. The cervical spine (the neck) and the lumbar spine (the lower back) both exhibit a slightly concave curve, while the thoracic spine (the middle back) has a gentle convex curvature. The spine’s curves work almost like a coiled spring, compressing to absorb shock while allowing a full range of motion throughout the spinal column.
Unfortunately, there are several ways the spine can develop an abnormal curve:
Dextroscoliosis is characterized by an abnormal sideways curvature of the spine that goes to the right, known as dextrocurvature. (When the spine curves to the left, it is called levoscoliosis.)
Dextroscoliosis is one of the more common scoliosis curvatures and, depending on the degree of severity; it gives the spine an “S” or “C” shape. This form of scoliosis typically affects the thoracic spine region and usually develops in children between 10 and 15 when they go through their first growth spurt. Later in life, it can also be triggered by various muscle or connective tissue disorders.
The symptoms of dextroscoliosis include uneven shoulder height, asymmetrical shoulder blade or rib prominence, uneven hips or waistline, and noticeable spine curvature. In more severe cases, the abnormal curvature may cause the patient to tilt their head or lean the entire body to one side. Depending on the degree of curvature, dextroscoliosis can compress the organs, leading to problems with breathing and circulation. It may also cause pain in the chest, legs, or back.
Unfortunately, as many as 85% of scoliosis cases are idiopathic, meaning no known cause. The condition is either congenital, neuromuscular, or age-related in the other 15-25% of dextroscoliosis cases. It can affect anyone, but it is most prominent in preteen and teenage girls.
Dextroconvex scoliosis is characterized by an S-like curvature of the spine, specifically in the lumbar region. This type of scoliosis is also known as lumbar dextroscoliosis or dextroscoliosis of the lumbar spine. When the curve is very slight, about 10 to 20 degrees, it is sometimes called mild dextroscoliosis. This term doesn’t refer to the severity of symptoms associated with the spinal curvature; it relates to the degree of curvature in the spine.
Thoracic dextroscoliosis is characterized by an abnormal curvature in the thoracic region of the spine, in which it curves laterally to the right. As is true for lumbar dextroscoliosis, mild thoracic dextroscoliosis typically refers to a curvature 20 degrees or less on the Cobb angle measurement scale. Although this form of scoliosis can be mild, it may still cause pain and other symptoms. It is also possible for the curve to progress over time.
The opposite of dextroscoliosis, levoscoliosis is characterized by an abnormal sideways curvature of the spine that goes to the left, known as levocurvature. While this form of scoliosis typically affects the lumbar spine, it may affect the thoracic spine in some cases. When the thoracic spine becomes involved, it can compress the organs and lead to problems with the heart and lungs. In mild cases, levoscoliosis may not produce any symptoms and can potentially resolve on its own; in more severe cases, it may cause asymmetry with the shoulders and hips, as well as breathing problems. It isn’t usually a painful condition.
There is no specific cause for levoscoliosis, but it is a condition present at birth (known as congenital scoliosis) in many cases. It can also be secondary to muscle and tissue disorders like muscular dystrophy.
Levoscoliosis in the thoracic spine is often a strong indicator that a tumor is growing on the spinal cord. Diagnosis can be made using x-rays, while MRI and CT scans can determine the severity of the condition and its impact on the internal organs.
Levoconvex scoliosis, also known as thoracic levoscoliosis, affects the spine’s thoracic region and is characterized by an abnormal lateral curvature that goes to the left. As is true for other types of scoliosis, levoconvex scoliosis can range in severity from mild to severe, but the curvature is typically limited to the T1 through T12 vertebrae. Even so, this type of scoliosis can affect the rib cage and might cause compression of the organs, which can be dangerous. It is important to monitor levoconvex scoliosis for signs of progression.
The opposite of lumbar dextroscoliosis, lumbar levoscoliosis is characterized by an S-like curvature of the spine in the lumbar region. The curve affects the vertebrae in the lower back – L1 through L5 – and the curve itself goes to the left. Like dextroscoliosis, lumbar levoscoliosis is often mild, but it has the potential to progress over time – mainly when it develops during childhood or early adolescence.
Treatment Solutions for All Ages
Scoliosis takes many different forms, and understanding the differences is important for determining the proper course of treatment.
Don’t know where to start? Take our FREE “ScoliQuiz.” (No x-ray required)