What Causes Spinal Curvature? Key Factors Explained

The spine is curved for a number of reasons including strength, flexibility, and the ability to absorb and distribute mechanical stress evenly. If the spine develops an unhealthy spinal curvature, the effects can be felt throughout the body.

Scoliosis is the most common type of unnatural spinal curvature among school-aged children; in cases of idiopathic scoliosis, the cause is unknown, and condition types with known causes include neuromuscular scoliosis, degenerative scoliosis, and congenital scoliosis.

Let's explore the different types of scoliosis with their different causes and treatment needs.

Developing Scoliosis

In a healthy spine, its natural curves will be in place at each of the spine's main sections, and its vertebrae will be aligned in a straight and neutral position.

If a healthy spine is viewed from the side it will take on a soft 'S' shape, and if viewed from the front and/or back, it will appear straight.

Developing scoliosis means an unnatural spinal curve has developed that bends to the side and rotates, making scoliosis a 3-dimensional condition.

Developing scoliosis means the unnatural spinal curvature is likely to get worse over time; as a progressive condition, the nature of scoliosis is to become more severe with growth.

Because scoliosis progression is triggered by growth, childhood scoliosis should always be taken seriously and treated proactively.

While we don't always know what triggers scoliosis to develop initially, we know how to respond with treatment; that being said, when the cause is known, it's important that treatment plans are shaped around it.

What Causes Scoliosis?

Scoliosis affects all ages, and the most common type of scoliosis is idiopathic scoliosis, meaning not clearly associated with a single-known cause.

Idiopathic scoliosis is thought to be multifactorial, meaning caused by a number of variables, or combination of variables, that can differ from one patient to the next.

Idiopathic scoliosis is generally regarded as familial, and not genetic.

Given how prevalent scoliosis is, and the amount of research that's attempted to identify a single gene, or genetic mutation, that accounts for the development of idiopathic scoliosis, if a scoliosis gene existed, I feel it would have been identified by now.

A factor that favors the genetic nature of scoliosis is that family history is considered a risk factor; if a person in the family has been diagnosed, it increases the likelihood that another family member will be diagnosed.

A lot of effort has been made in an attempt to answer the question is scoliosis genetic, but remember, families share a lot more than just their genes.

Families share socioeconomic factors, geography, lifestyle, body type, diet, posture, responses to stress, and considering the multifactorial nature of idiopathic scoliosis and the many common traits among families, the familial nature of scoliosis is evident.

Idiopathic scoliosis accounts for approximately 80 percent of known cases, and the remaining 20 percent have known causes; these types are considered atypical and can be particularly severe.

Scoliosis with Known Causes

Typical cases of idiopathic scoliosis feature right-bending curves that bend away from the heart (dextroscoliosis), but in atypical types of scoliosis, curves can bend to the left (levoscoliosis), towards the heart.

When I see levoscoliosis on an X-ray, this is a red flag that there is an underlying pathology causing the scoliosis.

Scoliosis treatment has to be fully customized because no two cases are the same; not only are there different types of scoliosis, the condition ranges widely in severity from mild scoliosis to moderate scoliosis, severe and very severe scoliosis, and scoliosis with known causes tend to be more severe.

Atypical condition types with known causes include neuromuscular scoliosis, congenital scoliosis, and degenerative scoliosis.

Neuromuscular Scoliosis

Some of the most difficult cases to treat involve my neuromuscular scoliosis patients because the scoliosis develops as a secondary complication of a larger neuromuscular condition such as spina bifida, muscular dystrophy, and cerebral palsy.

So in these types of cases, the larger neuromuscular condition has caused a disconnect between the brain, the muscles, and/or the connective tissues that support the spine, and the larger neuromuscular condition has to be the focus of treatment.

Congenital Scoliosis

Congenital scoliosis affects babies born with scoliosis due to a malformed spine that develops in utero; these cases can involve vertebrae failing to form into distinct and separate bones, or vertebral bodies being more triangular in shape than rectangular, disrupting their ability to form in a straight and neutral alignment.

Babies born with congenital scoliosis have to be comprehensively assessed because they often present with additional congenital abnormalities.

Degenerative Scoliosis

Degenerative scoliosis affects older adults and is caused by natural age-related spinal degeneration, most often starting with the intervertebral discs.

The condition is more common in females due to changes in bone density and hormones related to menopause.

As the spinal discs start to degenerate, they can become desiccated and change shape as a result; as adjacent vertebrae attach to the disc in between, this can disrupt the position of nearby vertebrae, causing them to shift out of alignment with the rest of the spine.

So changes in the spine's stability and balance caused by degenerative changes can also cause an unhealthy spine curvature to develop, and as scoliosis can cause an aging spine to become increasingly unbalanced and unstable, it can be particularly painful.

In addition, degenerative scoliosis patients can be more vulnerable to injury from a fall, so the goal of treatment is to restore as much balance and stability to the spine as possible.

Common Symptoms of Scoliosis

The most valuable approach to scoliosis is awareness: knowing how prevalent the condition is, understanding its risk factors, and being able to recognize the condition's early signs.

Current estimates have close to seven million people living with scoliosis in the United States alone, and as the leading spinal deformity in children, awareness is important.

Risk factors for scoliosis include age, gender, and a family history. Childhood scoliosis should be treated proactively because it's growth that triggers progression, and young females tend to develop more severe curves than males of the same age.

As explained earlier, a family history means more than one person within a family has been diagnosed with the condition.

Common symptoms of scoliosis in children involve postural changes:

• Uneven shoulders
• Uneven shoulder blades (one shoulder blade protruding more than the other)
• Development of a rib cage arch
• Uneven hips (hip appears higher on one side)
• Arms and legs hanging unevenly

Disruptions to movement, balance, coordination, and gait are also common.

The uneven forces of the condition disrupt the body's overall symmetry, and a misaligned spine can unbalance the body from the head to the feet, and as a progressive condition, these effects are likely to get worse over time.

Treatment options for scoliosis will depend on a number of characteristics including patient age, condition type, severity, and curvature location.

Experienced symptoms are also important when crafting a customized treatment plan, so when it's time to discuss treatment options, pain management is important.

Scoliosis Pain

While it can seem hard to believe that an unnatural curve in your spine wouldn't cause back pain, not all patients will experience back pain, but for those who do, a focus of treatment is on pain management.

The ultimate goal of scoliosis treatment is to help patients have a better quality of life, and this can include non surgical treatments; the truth is many patients with scoliosis don't need scoliosis surgery.

Curve progression can be managed, and when it comes to patients experiencing scoliosis pain, these most often involve my adult patients because scoliosis doesn't become a compressive condition until skeletal maturity has been reached.

A sideways curve in the spine that's always growing, as in childhood scoliosis, is one that can counteract the compressive force of the unnatural spinal curve, and it's compression of the spine and the spine's surroundings that causes the majority of condition-related pain.

For adults, scoliosis pain can involve the muscles, the back, and most often, pain that radiates into the extremities due to pinched nerves caused by nerve compression.

The best way to address scoliosis pain with treatment is the best way to address all symptoms of scoliosis: to treat it proactively and impact it on a structural level primarily.

Conclusion

There are many different types of unnatural spinal curves, and the most common type to affect children is scoliosis.

Scoliosis treatment options include spinal fusion surgery or non surgical treatment options that include condition-specific chiropractic care, physical therapy, a corrective back brace, and rehabilitation.

There are never treatment guarantees, but particularly with cases that are diagnosed early and treated early, there are fewer limits to what conservative treatment can provide.

Here at the Scoliosis Reduction Center®, a physical examination and imaging tests can diagnose scoliosis, and a proactive non surgical treatment response can address the condition on every level from working towards a curvature reduction on a structural level to increasing the balance and strength of the spine's surrounding muscles for more support and stability for the spine.

So an unnatural scoliotic spinal curve can have unknown causes or be caused by a larger neuromuscular condition, a malformed spine, or degenerative changes within the spine, but what's most important is not what causes an unhealthy curve to develop, but how it's responded to with treatment.