Written by Christina Young and Edited by Ariel Min
From behind, the spine is straight. From the side, it appears as an S, curving out by your shoulders and in towards your lower back. The bones in your back are connected enough to give a form that is both rigid, but still flexible — allowing movement while still having a form. Since the spine acts as a rod to keep you upright, it’s easy to tell when you or your surroundings are off-kilter. Usually. For about three percent of youth, however, this distinction can be a little harder due to different and improper curvatures in the spine [1].
Scoliosis is a disorder characterized by an abnormal sideways curvature of the spine, giving it a C or S-like shape when seen from the back. Typically diagnosed during the early teens, scoliosis can form from the uneven growth of the body during puberty. This disease is so common that it is screened for in schools throughout the U.S. [2]. Physicians generally characterize scoliosis upon Cobb angles, which are measurements of the difference between the 180º straight spine and the abnormal curvature. Mild cases are below 25º, moderate cases are between 25º-40º, and severe cases are upwards of 40º [2]. Many people diagnosed with scoliosis have very mild cases and initially write off their symptoms, such as fatigue and rapid shortness of breath, as normal inconveniences [3]. Though these effects are taken lightly, scoliosis is a serious disease that greatly impacts individuals, especially those with moderate or severe cases [4]. Since the backs of those with scoliosis are structured improperly, these individuals have an uneven balance due to one side of their torso being shorter than the other. In severe cases, this imbalance affects the amount of space that the individual’s organs have and leads to breathing issues as well as complications during pregnancy for females. Moreover, individuals with scoliosis suffer from a build-up of pressure that can be both painful and disorienting.
As of yet, scoliosis has no long-term cures since the vertebrae still retain some ability to move and disrupt each other even after corrective measures have been taken. However, scoliosis patients may be prescribed temporary measures that alleviate pain and prevent rapid progression of the disease. Depending on the severity of the spinal curvature, scoliosis patients may be recommended or prescribed a wide range of treatments from simple lifestyle changes, to a rigid back brace, and to invasive treatments such as corrective surgery. Currently, bracing is only recommended to those who have moderate scoliosis with a future of further growth [5]. Bracing only aims to stop the progression of improper spinal curvature by providing a rigid structure that pushes the spine slightly to its proper orientation. In essence, the brace provides a guideline for the body to grow upwards instead of bending. The effectiveness of bracing for moderate cases has been seen time and time again in preventing progression of the disease and, in some cases, having slightly straightening effects. However, in severe cases of scoliosis, these effects have not been observed. For severe cases, corrective surgery has the highest prospect of reducing the worsening of the curvature and is thus recommended for patients with severe scoliosis or patients who experience rapid progression of their adverse symptoms [3]. The most common form of corrective surgery is the fusing of vertebrae in the back, which reduces the ability of the bones to move [1]. Despite such high prospects, physicians are hesitant to prescribe surgery to patients of a young age.
To reduce the number of severe cases that are recommended corrective surgery, a recently published study by Xu et. al. attempted to apply bracing beyond mild cases of scoliosis by looking at the effect that bracing may have on severe curvatures between 40-45º [4]. In the five year study, adolescents with > 40º curves were prescribed a brace and evaluated on its effectiveness to either reduce or maintain the curve. Bracing was determined to be effective in preventing the progression of the curvature of the spine, with 28% of the individuals requiring further corrective surgery compared to 52% of the individuals who did not undergo bracing treatment at all – suggesting that bracing may be a viable treatment for even severe cases [5]. But as brace treatment for these individuals becomes an option, the risks of failure increase as well. In some cases within the study, the curvature continued to progress despite brace treatment, and since surgical intervention was withheld, individuals were at risk of a higher-stakes surgery and more health complications.
Ultimately, existing variations in the kinds and the degree of severity in the sideways curvature of the spine requires risks to be weighed on an individual basis. Nevertheless, the widening of treatments available for individuals with severe cases of scoliosis is a welcome prospect, giving options to those afflicted. It might just be better to brace yourself!
References:
- Weinstein, S.L., Dolan, L.A., Cheng, J.C.Y., Danielsson, A., Morcuende, J.A. (2008). Adolescent Idiopathic Scoliosis. The Lancet. 9623: 1527-1537.
- Konieczny, M.R., Senyurt, H., Krauspe, R. (2013). Epidemiology of adolescent idiopathic scoliosis. Journal of Children’s Orthopaedics. 7: 3-9.
- “Adolescent Idiopathic Scoliosis.” SRS, Scoliosis Research Society. n.d. https://www.srs.org/patients-and-families/conditions-and-treatments/parents/scoliosis/adolescent-idiopathic-scoliosis
- “Scoliosis” AANS, American Association of Neurological Surgeons. n.d. https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Scoliosis
- Xu, L., Yang, X., Wang, Y., Wu, Z., Xia, C., Qiu, Y., Zhu, Z. (2019). Brace Treatment in Adolescent Idiopathic Scoliosis Patients with Curve Between 40º and 45º: Effectiveness and Related Factors. World Neurosurgery. 10: E1-E6.