Here’s a fun fact about your spine: Most humans are born with 33 vertebrae, which are the small individual bones that make up the spine. By adulthood, some of those vertebrae fuse together during normal development, reducing the number to 24. Flexible joints called facets connect the bones and allow the spine to bend and move, and most people have a slight natural curve in their backs.
However, a condition called scoliosis can cause the spine to curve more than it should, sometimes forming a C or S shape. Without treatment, this can lead to back pain and other problems. In this video, San Diego Health host Susan Taylor talks with Greg Mundis, MD, an orthopedic surgeon who specializes in scoliosis at Scripps Clinic Torrey Pines.
Scoliosis can affect both children and adults. It most often develops in children during the pre-teen years, and genetics is thought to play a role in how their spine develops.
Children often have no symptoms of scoliosis, but some may have uneven shoulders, one hip that appears to be higher than the other, or ribs that protrude. Sometimes, a coach or teacher may notice an imbalance in the child’s posture or movement, or the child may simply feel that something is not right.
Among adults, scoliosis tends to appear after age 40. Arthritis may be a culprit; as the joints in the spine degenerate, the discs collapse and cause a curvature of the spine. Spinal tumors or infections also may cause the spine to twist or collapse, as can trauma and broken bones.
Back pain is usually one of the first scoliosis symptoms in adults, as the curving spine presses on nearby nerves. The spine also may feel weak, or the legs may feel numb or tingly. Adults also may notice uneven shoulders or hips, or a bump in their back.
Doctors diagnose scoliosis in two ways. During an in-person examination, the doctor may evaluate the patient’s spine by having them lean forward, and then measuring the amount of curvature with a tool called a scoliometer. This degree of curvature determines whether the second diagnostic method, an X-ray, is needed.
“Traditional X-ray is typically used to diagnose scoliosis, but at Scripps we now have access to new, state-of-the-art technology that allows us to take these X-rays at a fraction of the radiation dose, as well as evaluate the spine as it relates to the entire body,” says Dr. Mundis. “We can measure the degree of curvature and where it’s located, and then more appropriately recommend management.”
Because children’s spines are still developing, a back brace may help correct the curve and straighten the spine, especially if the curvature is not severe. Most children wear the brace for 12 hours a day until their growth is complete and can remove it to participate in their usual activities. Physical therapy to strengthen weak areas and bring the body into balance also may help.
“Adults are done growing, so brace wear actually doesn’t help very much,” says Dr. Mundis. “For scoliosis-related pain, we first try nonsurgical management, such as chiropractic care or acupuncture or physical therapy. If symptoms are going into the legs, like nerve pain or sciatica, often times we’ll use nerve blocks or epidural injections.”
If nonsurgical treatments aren’t effective, surgery may be the next step. Depending on the severity of the scoliosis, some patients may need only minor surgery that can be done using minimally invasive techniques, with a few weeks of recovery time. Severe cases may require more extensive procedures.
Not all spinal curvature requires treatment, notes Dr. Mundis, but pain should be evaluated sooner rather than later.
“Having a curve is actually quite normal as we age. You want to keep the pain at a minimum, and that’s the type of progression that we would like to prevent,” he says. “If you are plagued by pain more than four days a week, or you have symptoms of shooting pains down your legs or sciatica or nerve pain, then I would definitely recommend seeing someone for help.”