Scoliosis: Symptoms, Diagnosis, and Treatment Options

The spine is curved?

I have been experiencing lower back pain and neck pain since around the third year of junior high school, and now I am in my first year of graduate school.
During high school, I had an X-ray taken, and the doctor mentioned that my bones looked a bit unusual.
Recently, another X-ray revealed that I have scoliosis, possibly with rotation.
The doctor did not specify the degree of the curvature, but I do not notice any visible abnormalities.
However, during photo sessions, the photographer often comments that my head tilts to one side.
I do not feel any difference in shoulder height, but when I palpate my spine, it does feel somewhat curved.
I would like to know the degree of the curvature.
Sometimes, I suddenly feel a sharp pain in my shoulder and neck; what could be the cause? I often hear a "cracking" sound when I turn my neck, which sometimes comes from my shoulder or upper back, and it feels relieving.
Could this have any negative effects? My left shoulder is more painful than my right; could this be due to the scoliosis? My parents say I have had a "pigeon chest" since childhood, meaning my chest bones are particularly protruding, and my ribs are also prominent.
Could this be a reason for the spinal curvature? There is a bony protrusion in my lower back that is painful when pressed; is this normal? If I want a comprehensive skeletal examination, which specialty should I consult, and how should I communicate this to the doctor? Is it true that at my age, lower back pain cannot be completely cured and can only be managed with pain relief and anti-inflammatory medications? Given my situation, is massage advisable?

Freeze Wang, 20~29 year old female. Ask Date: 2002/08/09

Dr. Huang Longde reply Orthopedics

The spine, commonly referred to as the backbone, is the main structure of the human body, consisting of seven cervical vertebrae, twelve thoracic vertebrae, five lumbar vertebrae, and four sacral vertebrae arranged in a straight line from top to bottom.
If there is any lateral tilt or asymmetry, it is referred to as "scoliosis." Among patients with scoliosis, over 80% have no known cause, and it is more prevalent in girls during their developmental years.
If there is noticeable asymmetry in the spine, such as one shoulder being higher than the other or the waistband of pants being uneven, it is important to seek medical evaluation promptly for early detection and treatment.
Scoliosis not only affects physical development and aesthetics but also leads to long-term muscle imbalances on both sides of the spine, which can result in chronic back pain.
Additionally, it may impact the psychological and personality development of adolescents.
In severe cases, it can cause deformities of the thoracic cavity and even respiratory difficulties, often leading to parental concern.
Risk factors for scoliosis include:
1.
Family history of scoliosis
2.
Female gender
3.
Adolescence (ages 12-17)
4.
Tall and slender body type
Diagnosis of scoliosis typically involves the patient standing straight with feet together and arms hanging down, bending forward while the physician observes from behind.
This method is simple, cost-effective, and allows for the early detection of mild scoliosis.
For measuring the curvature angle, a full spine X-ray is performed.
Treatment for scoliosis must consider the underlying cause, age, location, and severity of the condition.
Due to advancements in surgical fixation methods and instruments for scoliosis, surgical outcomes and stability have greatly improved, with low risks associated with the procedure, leading to a high willingness among patients to undergo surgery.
Additionally, because scoliosis can worsen over time, regular and long-term follow-up is crucial.
Treatment methods based on curvature angles are as follows:
- Less than 20 degrees: Observation and regular follow-up
- 20 to 40 degrees: Consideration of electrical stimulation or special braces
- Over 40 degrees: Surgical correction and stabilization
As for the "pigeon chest" mentioned in the inquiry, it is characterized by the abnormal growth of the fourth to eighth ribs, causing the sternum to protrude forward.
As long as it does not affect cardiac or pulmonary function, regular health check-ups are sufficient.
However, for moderate to severe cases that impact heart and lung function, further examination and treatment are necessary.
In conclusion, each disease may present with varying symptoms beyond the typical ones, and diagnosis relies on physical assessment and instrumental support to determine the best treatment.
This information aims to provide basic knowledge about scoliosis and pigeon chest, but it is still recommended that individuals consult an orthopedic specialist for professional evaluation and treatment.

Reply Date: 2002/08/09

More Info

Scoliosis is a condition characterized by an abnormal lateral curvature of the spine, which can lead to various symptoms and complications. It is essential to understand the symptoms, diagnosis, and treatment options available for managing scoliosis, especially in your case, where you have experienced back pain and discomfort for several years.

Symptoms of Scoliosis
The symptoms of scoliosis can vary significantly depending on the severity of the curvature. In mild cases, individuals may not notice any significant changes, while more severe cases can lead to noticeable physical deformities. Common symptoms include:
1. Back Pain: Chronic back pain is a common complaint among individuals with scoliosis. The pain may be localized to the area of curvature or may radiate to other parts of the back.

2. Postural Changes: You mentioned that people have commented on your head tilting and that your shoulders appear uneven. These are classic signs of scoliosis, where one shoulder may be higher than the other.

3. Neck and Shoulder Discomfort: The discomfort you feel in your neck and shoulders could be related to muscle imbalances caused by the spinal curvature.

4. Audible Sounds: The "cracking" or "popping" sounds you hear when moving your neck or shoulders may be due to the movement of joints and tendons around the spine. While this is often harmless, it can sometimes indicate underlying issues, especially if accompanied by pain.

5. Chest Deformities: The "chicken chest" you described, where the rib cage appears prominent, can be associated with scoliosis, particularly if the curvature affects the thoracic spine.

Diagnosis
To determine the degree of your scoliosis, a healthcare provider typically uses X-rays. The Cobb angle is the standard measurement used to quantify the curvature of the spine. A curvature of less than 20 degrees is generally considered mild, while curvatures greater than 40 degrees may require more intensive intervention. Since your doctor did not specify the degree of curvature, it would be beneficial to ask for this information during your next appointment.

Treatment Options
1. Observation: For mild scoliosis (less than 20 degrees), regular monitoring may be all that is necessary, especially if you are not experiencing significant pain or functional limitations.

2. Physical Therapy: Engaging in physical therapy can help strengthen the muscles around the spine, improve posture, and alleviate pain. A physical therapist can design a personalized exercise program tailored to your needs.

3. Pain Management: Over-the-counter pain relievers, such as NSAIDs (e.g., ibuprofen), can help manage discomfort. However, it is essential to use these medications as directed and not rely on them long-term without consulting a healthcare provider.

4. Bracing: In adolescents, if scoliosis is detected early and the curvature is between 20 and 40 degrees, a brace may be recommended to prevent further progression of the curve as the spine grows.

5. Surgery: For severe cases (typically over 40 degrees) or if scoliosis is causing significant pain or functional impairment, surgical options such as spinal fusion may be considered to correct the curvature.

Next Steps
If you are considering a comprehensive evaluation of your spine, you should consult an orthopedic specialist or a spine specialist. When you make an appointment, you can express your concerns about scoliosis and request a full assessment of your spinal structure. You might say, "I have been experiencing chronic back and neck pain, and I was recently diagnosed with scoliosis. I would like a thorough evaluation of my spine and to discuss potential treatment options."

Conclusion
While scoliosis can lead to discomfort and pain, many individuals manage their symptoms effectively through a combination of observation, physical therapy, and pain management strategies. It is crucial to maintain open communication with your healthcare providers and seek further evaluation if your symptoms worsen or if you have concerns about your spinal health. Regular follow-ups can help monitor any changes in your condition and adjust treatment plans accordingly.

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