Scoliosis

Scoliosis is a condition in which the spine curves sideways in an “S” or “C” shape, rather than staying straight.
While mild scoliosis may cause little to no symptoms, more significant curves can lead to pain, posture changes, and reduced mobility.
In severe cases, scoliosis can affect lung or heart function due to the twisting of the chest cavity.

Scoliosis can develop at any age, but it most often appears during growth spurts in adolescence or as a result of age-related degeneration in adults.

Scoliosis has several potential causes depending on the type and age of onset.
In many cases, the exact cause is unknown.

• Idiopathic scoliosis (most common): no clear cause, often develops during adolescence.
• Degenerative scoliosis: caused by age-related spinal changes, such as arthritis, disc degeneration, or osteoporosis.
• Congenital scoliosis: present at birth due to spine formation issues during development.
• Neuromuscular scoliosis: associated with conditions like cerebral palsy or muscular dystrophy.
• Trauma or injury: fractures or spinal surgery may lead to curve progression.
   

Scoliosis symptoms depend on the severity of the curve and whether there is nerve involvement.
Mild scoliosis may not cause any noticeable symptoms.

• Uneven shoulders, hips, or waist, sometimes with one shoulder blade that appears more prominent.
• Postural changes, such as leaning to one side or rib prominence when bending forward.
• Back pain or stiffness, especially in adults with degenerative scoliosis.
• Leg pain, numbness, or weakness if nerves are compressed by the curve.
• Reduced endurance for standing or walking due to muscle fatigue.
• Breathing difficulties in very severe cases, when the curve affects the chest cavity.

Progression alert: Curves that are worsening over time, particularly during adolescence or later adulthood, should be evaluated promptly.

Dr. Fried uses a comprehensive evaluation to determine the severity and progression risk of scoliosis.

• Medical history: including family history, growth patterns, and symptom onset.
• Physical examination: observation of posture, shoulder and hip alignment, and forward-bend test to detect rib prominence.
• Imaging studies:
  • X-rays: the gold standard for measuring the degree of curvature (Cobb angle).
  • MRI or CT scans: used when nerve compression or congenital abnormalities are suspected.
  • Serial imaging: to monitor curve progression over time, especially in growing adolescents or adults with degenerative scoliosis.
     

Treatment depends on the severity of the curve, patient age, and whether symptoms are affecting daily life.
Dr. Fried focuses on non-surgical care first, reserving surgery for severe or progressive curves.