Scoliosis

What is scoliosis?

To better understand scoliosis, we should first know how the normal spine looks like.
There are three planes of the human body: (1) frontal (coronal), that divides the body into front and back sides, (2) sagittal, that divides the body into left and right and (3) axial (horizontal, transverse), that cuts the body into upper and lower parts. Observed from the front or back (frontal plane), the normal human spine is straight with 33-34 spinal bones, called vertebrae superimposed one above another. The spine observed from the side (sagittal plane) is not straight and has normal curves in the neck, mid back and low back. Looking from the top, (horizontal plane), the spine is centered.
Scoliosis means “crooked spine”. It is often defined as a 3D deformity of the spine. This means that scoliosis twists the spine and curves it forward and sideways, like on the picture. Scoliosis is a distorted presentation of the spine in all three planes of the body. The frontal plane is affected by vertebrae translation in the left-right direction, the sagittal plane by front-back translation of the vertebrae and the horizontal plane by rotation of the vertebrae.

For the most part, we don’t know what causes scoliosis, and researchers estimate that about 80% of all scoliosis is of unknown cause. That’s why, most of scoliosis are called “idiopathic”, which means “unknown cause”.

When looking into the body from the front (frontal plane), scoliosis can appear as “S” shaped or “C” shaped. This unique morphology is linked with scoliosis specific signs, which include:

  • Uneven shoulders
  • Uneven waist
  • Uneven hips (pelvis) where one hip seems higher
  • One side of the back sticks out
  • One shoulder blade sticks out more than the other
  • One side of ribs on the front stick out more than the other
As scoliosis progresses, the symptoms, such as pain, difficulty breathing, osteoarthritis, depression, anxiety, decreased self-esteem, and a decreased health-related quality of life become more apparent.

What is scoliosis?

Standard of care for scoliosis includes:
  • Observation
  • Physiotherapeutic scoliosis specific exercises (PSSE)
  • Bracing
  • Surgery

The goal of observation during adolescence is to monitor the progression of the curve, while PSSE aims to prevent progression and improve the appearance and the quality of life; the goal of bracing is to prevent curve progression; and the goal of surgery is to correct the curve as much as possible.

Observation is recommended for children with curves less than 25° who are still growing and for patients with curves less than 50° who are done growing. Observation consists of monitoring patients for progression, but with no specific treatment applied. This treatment for scoliosis is also known as “watchful waiting”. The International Society on Scoliosis Orthopedic Rehabilitation Treatment (SOSORT) 2016 Guidelines recommends physiotherapy scoliosis-specific exercises, such as the Schroth exercises for patients with curves <35° to prevent further progression of the deformity, its consequences and, the need for bracing or surgery. Bracing is standard for growing children with curves between 25° and 45° to prevent the curve from progressing. Surgery is recommended for patients whose curves are greater than 45° while still growing or greater than 50° when growth has stopped to prevent curve progression and/or obtain curve correction.

PSSE, such as the Schroth method, has been shown to improve scoliosis outcomes both when applied as a standalone therapy as well as in combination with bracing. It is also known that the scoliosis specific exercises help reduce the correction loss in brace during weaning. 

When it comes to surgical candidates, Schroth exercises can improve flexibility, breathing function and back muscle endurance, and thus better prepare a patient for spinal surgery. In addition, Schroth exercises can help after surgery by stopping the progression of the curve above and below the fused part of the spine, and also to improve the appearance of the back and trunk.
The best treatment for scoliosis is prevention, and prevention when it comes to scoliosis is screening for scoliosis. During the ’70 scoliosis screening in schools was a norm in Canada. However, it has been discontinued in 1979. Research suggests that, nowadays 32% of children who are seen at scoliosis clinics in Canada are late referrals, which means that they have already missed a window for brace treatment. We offer free screening for scoliosis and kyphosis to assure that everyone receives the treatment as soon as the condition is detected for the best possible results.