How Bad Can Scoliosis Get? [Everything You Need to Know]

Scoliosis is a highly complex and prevalent spinal condition that affects all ages from babies to older adults and every age in between. As a progressive condition, the nature of scoliosis is to get worse over time, but the good news is that with a proactive treatment response, it can be highly treatable.

Scoliosis can range widely in severity from mild to moderate and severe to very severe scoliosis, and as a progressive condition, where a scoliosis is at the time of diagnosis isn't indicative of where it will stay; only proactive treatment can work towards counteracting the condition's progressive nature.

Before exploring the condition's progressive nature, let's first define the condition itself.

What is Scoliosis?

Scoliosis is a structural spinal condition that involves the development of an unnatural sideways-bending and rotating spinal curve, and the rotational component makes the condition 3-dimensional; a scoliotic spine doesn't just bend unnaturally, but also twists.

If the spine curves unnaturally, it introduces a lot of uneven forces to the spine, its surroundings, and the entire body.

There are three main spinal sections, and scoliosis can develop in any one section, or in more than one as a combined scoliosis: cervical spine (neck), the thoracic spine (middle/upper back), and the lumbar spine (lower back).

In most cases, the area of the body that's closest to the scoliotic spinal section is going to feel the majority of its effects; for example, as the sciatic nerve starts in the lumbar spine, a common complication of lumbar scoliosis is sciatic nerve pain.

With current estimates at close to seven million people currently living with scoliosis in the United States alone, awareness through education is important.

Scoliosis is also the leading spinal condition amongst school-aged children, and while scoliosis screening was once performed in schools, that has since changed, shifting the onus of early detection onto the shoulders of parents, caregivers, and patients themselves.

While early detection can't guarantee treatment success, it does increase its likelihood, and this is due to the condition's progressive nature.

Scoliosis is Progressive

One of the hardest parts of giving patients a scoliosis diagnosis is explaining its progressive nature.

Progressive conditions are incurable; they get worse over time, so treatment has to focus on counteracting progression and how best to manage an ongoing condition.

Scoliosis progression means the size of the unnatural spinal curve is increasing, as are the condition's uneven forces, and their effects, and this makes it more complex to treat, hence the benefit of early detection and a proactive treatment response.

When discussing the condition's progressive nature, particularly with young patients, I like to point out the number of celebrities and professional athletes out there who are living with scoliosis; a scoliosis diagnosis doesn't have to mean a life of limitations.

Scoliosis progressing means it's getting more severe, and condition severity is determined by a measurement known as Cobb angle: a key piece of information that's needed to diagnose, classify, and treat scoliosis.

Cobb Angle and Condition Severity

Cobb angle is a measurement that's obtained during X-ray, and a minimum Cobb angle of 10 degrees is needed to be considered a true scoliosis.

Based on X-ray images taken from a variety of angles, lines are drawn from the tops and bottoms of the curve's most-tilted vertebrae, and the resulting angle is expressed in degrees; the higher the Cobb angle, the more severe the condition:

• Mild scoliosis: Cobb angle measurement of between 10 and 25 degrees
• Moderate scoliosis: Cobb angle measurement of between 25 and 40 degrees
• Severe scoliosis: Cobb angle measurement of 40+ degrees
• Very-severe scoliosis: Cobb angle measurement of 80+ degrees

The spine's natural and healthy curves make it stronger, more flexible, and better able to handle mechanical stress incurred during activity, so what happens if an unnatural spinal curve develops?

If a scoliotic curve develops, it doesn't just affect the spinal section the curve develops in; it also effects the spine's surrounding muscles, nerves, and the entire body, and a single unnatural spinal curve can disrupt the biomechanics of the entire spine.

When the spine's healthy curves are in place, its vertebrae (bones of the spine) are stacked on top of one another in a straight and neutral alignment, but as scoliosis develops, certain vertebral bodies are becoming unnaturally tilted, shifting them out of alignment with the rest of the spine.

So how bad scoliosis is at the time of diagnosis is indicated by a patient's Cobb angle, but that doesn't indicate how bad scoliosis can get over time, and there are also different types of scoliosis with different characteristics and progressive rates.

Different Types of Scoliosis

In addition to ranging from mild to very severe, there are also multiple types of scoliosis.

The most-prevalent type overall is called idiopathic scoliosis, and idiopathic means not clearly associated with a single-known cause, and the most prevalent type of scoliosis is adolescent idiopathic scoliosis, diagnosed between the ages of 10 and 18.

Approximately 80 percent of known cases are idiopathic, and the remaining 20 percent are associated with known causes: neuromuscular scoliosis, congenital scoliosis, and degenerative scoliosis.

So this is where, in the context of how bad scoliosis can get, I like to split scoliosis into two categories: typical and atypical cases.

While no two cases are the same, in general, typical cases of idiopathic scoliosis are simpler to treat, while atypical cases tend to be more complex to treat, making them more likely to be severe and/or very severe cases.

In typical cases of idiopathic scoliosis, we don't know what triggers the initial onset, but we do know what triggers it to get worse: growth.

So when cases are idiopathic, we know what the focus of treatment is: counteracting progression (particularly in young patients) and correcting the scoliosis.

In typical cases of scoliosis, curves bend to the right, away from the heart (dextroscoliosis), but in atypical cases, curves can bend to the left, towards the heart (levoscoliosis).

When I see a left-bending curvature of the spine on an X-ray, this is a red flag that there is an underlying pathology, meaning something has caused the scoliosis to develop, and the underlying cause has to be the focus of treatment, which complicates the process.

Neuromuscular Scoliosis

My neuromuscular scoliosis patients are among the most difficult to treat because their scoliosis tends to be severe, very severe, and can progress quickly.

Neuromuscular scoliosis is caused by the presence of a larger neuromuscular condition causing a disruption in communication between the brain, the muscles, and connective tissues that support the spine.

Neuromuscular conditions capable of causing the development of neuromuscular scoliosis include spina bifida, muscular dystrophy, and cerebral palsy, to name a few.

While having a neuromuscular condition doesn't guarantee the development of scoliosis, it is a common complication, and it's the neuromuscular condition that has to shape treatment, so I can't offer these patients the same prognoses I can with typical idiopathic scoliosis patients.

Patients with neuromuscular scoliosis can become non ambulatory (unable to walk on their own) and wheelchair bound, so neuromuscular scoliosis is a condition type that is known to get particularly severe.

Congenital Scoliosis

Congenital scoliosis is a rare type affecting approximately 1 in 10,000; this is another type that can be severe because it's caused by a malformed spine that develops in utero.

Babies are born with the condition and often present with additional congenital abnormalities, so these infants have to be comprehensively assessed and monitored for a number of birth defects.

Congenital scoliosis is difficult to treat because of the unique challenges associated with such young patients.

Some congenital scoliosis patients will need surgery, and for those that don't, modified nonsurgical treatment can include physical therapy and bracing.

Degenerative Scoliosis

When it comes to degenerative scoliosis, it affects older adults.

Degenerative scoliosis is also more common in females than males due to changes in hormones and bone density related to menopause.

Degenerative scoliosis is caused by natural age-related spinal degeneration and the cumulative effect of certain lifestyle factors: carrying excess weight, low activity levels, chronic poor posture, excessive consumption of alcohol and/or smoking, and repeatedly lifting heavy objects incorrectly.

Degenerative scoliosis can get bad simply because a spine that's degenerating is not as strong or stable, so once deterioration starts (often with the spinal discs), scoliosis can develop and progress quickly, so a main focus of treatment is on increasing spinal support/stabilization.

In addition, as scoliosis becomes a compressive condition once skeletal maturity is reached, adult scoliosis tends to be far more painful than childhood scoliosis.

In addition to pain, postural changes are the most noticeable condition effect, so let's now address how the body can change alongside scoliosis progression.

What Happens to the Body if Scoliosis Gets Worse?

For children, the main condition effect is postural deviation, and this is due to the condition's uneven forces disrupting the body's overall symmetry.

For adults, the main condition effect is pain, and this is because once the condition becomes compressive, the spine and its surrounding muscles and nerves are exposed to uneven pressure.

For young patients who are still growing, the constant lengthening motion of a growing spine counteracts the compressive force of the unnatural spinal curve.

It's back pain and pain that radiates into the extremities (arm and leg pain) that brings the majority of adults in to see me for a diagnosis and treatment.

In mild cases of typical scoliosis, functional deficits are rare, postural changes are subtle, and in children, the condition is usually painless, and these factors can be a challenge to early detection; however, knowing the condition's early subtle signs can help, so let's take a look at the condition's earliest signs in adolescents.

Early signs of scoliosis in adolescents include uneven shoulders and hips, and additional changes to watch for that can get worse over time include:

• An uneven eye line
• The head uncentered over the torso
• One shoulder blade protruding more on one side than the other
• The development of a rib cage arch
• An uneven waistline
• Arms and legs that hang at different lengths

These postural changes will become more overt and noticeable as scoliosis progresses, and additional changes to balance, coordination, and gait are also common.

While adults also experience postural changes, including a prominent lean to one side, it's pain that becomes more noticeable alongside progression, so sustainable pain relief is a focus of treatment.

Now that we've defined the condition itself, explored its progressive nature, and how progression effects the body, let's now discuss the best means of preventing scoliosis symptoms from getting worse: proactive treatment.

Scoliosis Treatment Options

When it comes to a scoliosis diagnosis, the most important decision a patient has to make is how to treat their scoliosis because as a life-long condition, it has to be managed effectively.

There are two main treatment approaches for patients to choose between, and I can't overstate enough how important it is that patients fully understand how each shapes long-term spinal health and function.

Traditional scoliosis treatment tends to funnel patients towards surgical treatment that's lengthy, costly, invasive and risky, while modern conservative treatment offers a non operative treatment alternative with proven results.

Traditional Scoliosis Treatment and Spinal Fusion Surgery

Traditional scoliosis treatment was the dominant choice for many years, but that doesn't mean it was the best, or only option available.

Traditional treatment offers a surgical response, and spinal fusion is an invasive procedure that should be taken seriously.

The main issues I have with this treatment approach is that it doesn't have a strategy for addressing scoliosis while mild, when it's likely to be at its most responsive, and instead, commonly recommends watching and waiting.

Watching and waiting means monitoring for further progression, and returning at specific intervals for re-assessment to see how the spine is responding to growth, but as we know that virtually all cases of scoliosis are going to progress at some point, this is wasting valuable treatment time.

As we also know that growth is what triggers progression and the majority of idiopathic scoliosis patients are adolescents in the stage of puberty, it's particularly dangerous for this age group to not respond to a scoliosis diagnosis proactively.

Spinal fusion is performed when/if a patient on the traditional treatment path progresses into the severe classification at 40+ degrees, and the procedure involves fusing the curve's most-tilted vertebrae into one solid bone and metallic implants (metal rods) with pedicle screws are attached to the spine to hold it in place.

In most cases, intervertebral discs that sit between adjacent vertebral bodies are removed and replaced with bone grafts.

While fusing the spine in this manner can straighten a scoliotic spine, it is contrary to the spine's movement-based design, and many patients are disappointed with the loss in spinal flexibility and range of motion they are left with.

So while the goal of spinal fusion is to stop scoliosis from getting worse, particularly in young patients who are still growing, there are no guarantees, and if the fusion is unsuccessful, the only recourse is more surgery, and the risks increase with each subsequent procedure and increasing age.

Conservative Scoliosis Treatment

Conservative scoliosis treatment has the goal of managing progression through corrective results; this means that as a structural spinal condition, scoliosis needs to be, first and foremost, impacted on a structural level.

I don't want to watch and wait while young people's curves are left to progress unimpeded, making the condition more complex to treat; this is why I start treatment as close to the time of diagnosis as possible, when it's at its mildest.

Here at the Scoliosis Reduction Center, I address each case of scoliosis with a customized treatment plan shaped around key patient/condition variables: patient age, condition type, severity, and curvature location.

I know how bad scoliosis can get, but I also know how to prevent it from getting worse: by being proactive.

Conservative treatment offers an integrative approach so patients can benefit from what multiple condition-specific forms of treatment have to offer; this also allows for treatment plans to be easily adjusted based on how the spine is responding to growth and/or treatment.

Combining chiropractic care, physical therapy and a variety of therapeutic exercises, corrective bracing, and rehabilitation allows me to impact conditions on every level.

Chiropractic care involves a series of techniques and manual adjustments that can work towards adjusting the position of the most-tilted vertebrae back into alignment with the rest of the spine.

Physical therapy and condition-specific exercises with corrective potential can help work towards increasing core strength so the spine is optimally supported and stabilized by its surrounding muscles, bad posture is improved, and specific areas of the brain are stimulated for better brain-body communication.

Corrective bracing is particularly effective on growing spines so is a common facet of adolescent idiopathic scoliosis treatment, and it can help augment corrective treatment results by pushing the spine into a corrective position.

Rehabilitation is how I help patients sustain treatment results for the long term and often involves a series of custom-prescribed home exercises that help further heal and stabilize the spine.

Again, there are never treatment guarantees, and there is no way of knowing how bad a patient's scoliosis will get, but there are many indicators that help predict a patient's rate of progression, such as condition type and severity.

If severe cases are left untreated, scoliosis is likely to continue getting worse, and this makes the condition more complex to treat and increases the chances that invasive spinal surgery will be necessary in the future.

Conclusion

I diagnose scoliosis through a combined physical exam that includes taking the patient's family history, medical history, and performing the Adam's forward bend test.

When patients bend forward at the hips and I examine their backs from behind, the spine is highly visible in this position, as are any related trunk asymmetries.

If my screening examination shows indicators of scoliosis, further testing is warranted and includes a scoliosis X-ray to see what's really happening in and around the spine, to confirm the spine rotates, and a minimum Cobb angle measurement of at least 10 degrees.

If a young patient is diagnosed with an unnatural side to side curve of the spine, they need to understand that as a progressive condition, its nature is to get worse over time, hence the importance of a proactive treatment response.

While, again, there are never treatment guarantees, with early detection and intervention, there are fewer limits to what can be achieved.

Serious problems can occur when scoliosis is severe and/or is left untreated including increasing levels of pain and spinal imbalance, muscle spasms, a visibly curved spine, nerve compression, chronic back pain, digestive issues, headaches, and breathing problems.

Common symptoms of scoliosis in children involve disruptions to the body's overall symmetry, and if left unaddressed, this can lead to activity restrictions, self-esteem and body image issues, and a lesser quality of life; in adults, the main symptom of scoliosis is pain, and this will only increase once natural age-related spinal degeneration becomes a factor later in life.

The best way to prevent scoliosis from getting worse is to treat it proactively, and this means a conservative treatment approach that's started as close to the time of diagnosis as possible, is fully customized, and addresses its underlying structural nature.

People with scoliosis should take it seriously, and if scoliosis is in the family and/or certain symptoms of scoliosis have been noticed, a medical evaluation by a professional is recommended as it can help lead to early detection and treating scoliosis proactively.