Scoliosis and kyphosis (curvature of the spine)

‘Scoliosis’ comes from ancient Greek and means curvature.

Scoliosis refers to a curvature of the spine, in which the spinal column rotates around the longitudinal axis and the vertebral bodies are deformed. ‘Kyphosis’ refers to a forward curvature which creates a hump in the spine.

There are three different types of scoliosis. In idiopathic scoliosis, the cause is unknown. Secondary scoliosis is caused by diseases or deformities. When the condition occurs in adulthood, usually due to wear and tear, it is referred to as acquired (novo) scoliosis. If scoliosis occurs in old age, it is usually accompanied by osteoarthritis or osteoporosis. Kyphosis can develop due to complications such as osteoporotic vertebral fractures in old age, but can also occur in young people (Scheuermann’s disease), in which case there is often a genetic component.

Depending on the cause, scoliosis or kyphosis can present itself at any age.

Regardless of the type of curvature, it must be actively treated because it does not go away on its own and can lead to severe pain and disability as the condition progresses.

Symptoms

The most common type of scoliosis is de novo scoliosis, which occurs in adults and affects the lumbar spine. Typical symptoms of the disease include chronic back pain, which occurs even when walking short distances. The severity of the symptoms depends on the degree of lateral deviation of the spine. As the scoliosis progresses, for example, a narrowing of the spinal canal (spinal canal stenosis) or other diseases of the spine can occur, which give rise to other symptoms. These include leg pain, sensory disturbances and even paralysis.

Possible symptoms:

  • visible curvature of the spine
  • severe back pain that affects mobility
  • severe pain in the buttocks
  • pain in the back and knees
  • signs of paralysis
  • incontinence

Causes

Scoliosis is usually due to several degenerative changes in the spine.

Asymmetrical wear leads to unequal load distribution in the vertebral segments. This leads to instability between the vertebrae and, as a result, one or more of the vertebral bodies can tip over.

As the vertebral bodies are connected to each other like a joint, there is rotation as well as tilting. If this instability cannot be compensated for and adjacent vertebrae are involved in the process, a vertebral curvature of the spine occurs: the condition referred to as ‘de novo scoliosis’. ‘De novo scoliosis’ is also exacerbated by osteoporosis and degeneration of the intervertebral discs.

Diagnosis

Diagnosis begins with an examination of the patient’s medical history and current symptoms. This is followed by further examinations, including a physical examination using a method known as the ‘Adams test’. In this test, the patient leans forward with their arms hanging loosely in front of them, while also stretching their legs. The doctor stands behind the patient and looks over their back to see if there are any asymmetries can be seen, such as in the ribs or shoulder blades. This also allows the doctor to see whether the lumbar muscles are more pronounced on one side, or if the spine is crooked.

After these manual tests, various X-rays are taken. The entire lumbar and thoracic spine is X-rayed and measured. A distinction is made here between overview and functional scans. With the overview, the scan is produced in two levels so that the angle of curvature can be calculated. The functional scan is used to determine if there are any instabilities in individual motion segments. X-rays can be used to assess the severity of the scoliosis and to locate where exactly the deformities in the spine are.

Depending on its position in the spine, scoliosis is divided into three areas:

  • thoracic – curvature at chest level
  • thoracolumbar – curvature between the thoracic and lumbar spine
  • lumbar – curvature at the lumbar spine

 Depending on the angle of curvature, there are three degrees of severity:

  • angle greater than 10 but less than 40 degrees – mild scoliosis
  • angle between 40 and 50 degrees – moderate scoliosis
  • angles over 50 degrees – severe scoliosis

Treatments

There are many factors that determine if and how scoliosis needs to be treated. Which treatment is suitable is determined according to the age of the patient, as well as the degree of severity, probable progression of the disease and the risk involved.

Conservative therapies

Where the angle of curvature is less than 20 degrees, physiotherapy is the most appropriate treatment for scoliosis. Specific exercises are used to strengthen the muscles and improve the posture of the body.

If the curve is diagnosed as between 20 and 25 degrees and the curvature is expected to progress, a brace made from lightweight plastic is used. The brace counteracts the twisting of the spine.

Here, the patient’s cooperation is a crucial factor to the success of the treatment. The brace must be worn for 22 hours a day. Physiotherapy is also used to help build up the muscles.

Surgical treatments

The aim of the surgical treatment is to correct and stabilise the shape of the spine as far as possible. The procedure is performed either from the back or from the side via the abdomen or chest.

In special but rare cases where there is no relevant instability, a procedure known as microsurgical decompression can also be used to help improve the current condition. In most patients, decompression is performed carried out alongside the fusion of multiple spinal segments. The combination of both of these techniques creates a stable axis for the spine.

During the procedure, there are various place holders that can be used to maintain the position of the spine, such as titanium and rod-screw systems. With the help of these techniques, the original height and inclination of the intervertebral discs are restored. This leads to a ‘fusion’ of the neighbouring vertebrae. Fixation brings the spine back to its original position.

Aftercare

After scoliosis surgery, the most important factors in recovery are rest and appropriate physiotherapy. Since it is not only bones that have to heal but also muscles, it is important to rest the back over a longer period of time and rebuild your strength and mobility.

After about four to six weeks and after stopping the painkillers, you can return to everyday life. Physical exertion (during sports or work) must be avoided for a certain period, the duration of which will be determined by the doctor as part of the recovery process.

FAQs

How can you tell if you have scoliosis?

In older adults, scoliosis symptoms include back pain and tension. If there is a strong and also visible curvature, the patient may also experience nerve problems or the internal organs may be impaired.

Is there anything in particular to be aware of with scoliosis?

If you are affected by scoliosis, your sleep also suffers. It is therefore advisable to choose a mattress and/or sleeping position that exerts as little pressure as possible on the spine. You should also avoid carrying heavy loads on one side, as well as intensive sports that exert pressure on the back (e.g. stop-and-go sports or those with a risk of dislocations or falls).

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