How Does Scoliosis Develop? Can Scoliosis Occur Later in Life?

In order to address why scoliosis develops, the type of scoliosis has to first be determined, and this is part of the diagnostic process. When scoliosis is diagnosed, it's further classified based on a number of important patient and condition variables, one of which is condition type, and scoliosis can develop at any age.

There are different types of scoliosis, and condition type is determined by causation. The cause of scoliosis developing isn't always known, as in idiopathic scoliosis, but neuromuscular, degenerative, and congenital scoliosis develop in different ways.

The classification points used to diagnose scoliosis shape how scoliosis develops and affects different ages, so let's explore how scoliosis is first diagnosed and classified.

Diagnosing Scoliosis

Scoliosis is a highly-prevalent spinal condition that warrants awareness; current estimates have close to seven million people with scoliosis living in the United States alone, and it's the leading spinal deformity amongst school-aged children.

The way a diagnosis of scoliosis is responded to with treatment is key because how scoliosis is treated will shape long-term spinal health and function, and while scoliosis is progressive and incurable, it can be highly treatable.

When scoliosis is diagnosed, there are certain parameters that have to be met; there are a number of spinal conditions that cause a loss of its healthy curves, but scoliosis has some characteristics that set it apart from the rest.

Scoliosis involves the development of an unnatural side to side curve of the spine that also rotates, making scoliosis a complex 3-dimensional condition.

In addition, the size of a scoliotic curve has to be specific: a minimum Cobb angle measurement of at least 10 degrees.

So scoliotic curves don't just bend unnaturally, they also twist, and they have to meet a size requirement.

As a progressive condition, the nature of scoliosis is to get worse over time, which is why a proactive treatment plan is so important; scoliosis only gets more complex to treat as it gets worse.

As mentioned, part of the diagnostic process involves comprehensive assessment so conditions can be further classified, and this is done to streamline the treatment process across different treatment providers and care facilities, and also to inform the crafting of customized treatment plans.

The classification points are key patient and condition factors that shape a person's experience of life with scoliosis, including its initial onset and how it's likely to develop over time.

Scoliosis classification points include patient age, curvature location, condition severity, and type, so let's start with what a patient's age can tell us about why scoliosis developed initially, and how it's likely to develop in the future.

Patient Age

Patient age is an important patient factor not only because it indicates overall health and fitness, but also in terms of progression and pain.

All types of scoliosis are progressive regardless of severity or patient age, and that means they are virtually guaranteed to get worse over time; the size of the unnatural spinal deformity is going to increase, as are its effects.

We know that growth is the main trigger for progression, so a patient's age indicates whether or not fast progression is likely to be a factor; this shapes a patient's progressive rate and how the condition will develop (progress) in the future.

The more growth a patient has yet to go through, the more at risk they are for continued progression, and adolescents going through puberty are the most at risk for rapid-phase progression because of the rapid and unpredictable growth spurts associated with the stage of puberty.

So we know that in adolescent idiopathic scoliosis (AIS), scoliosis can develop quickly, becoming more noticeable and in need of treatment, because these patients are facing the constant progressive trigger of growth, so a focus of treatment is on reducing the curve significantly, and holding that reduction throughout growth.

In adults, the focus of treatment is also to achieve a curvature reduction, but it's more about reducing the size of the curve back to where it was before becoming painful, rather than a significant curvature reduction to counteract growth.

In addition, a patient's pain level is largely shaped by age because scoliosis becomes a compressive condition once skeletal maturity has been reached; prior to that, the constant lengthening motion of a growing spine counteracts the compressive force of the unnatural spinal curvature.

While children can experience a certain degree of muscle pain caused by muscle weakness and/or an imbalance, the majority of scoliosis-related pain involves back pain and pain that radiates into the extremities due to nerve compression.

Scoliosis can also affect all ages from babies born with congenital scoliosis to infantile scoliosis diagnosed between the ages of 6 months and 3 years old, juvenile scoliosis, adolescent idiopathic scoliosis, and adult scoliosis diagnosed once skeletal maturity has been reached.

While discussing patient age, let's take a little sidebar and address a frequently-asked question regarding how scoliosis affects older adults.

Can Scoliosis Develop Later in Life?

Because scoliosis is so highly prevalent in children, it's commonly regarded as a childhood condition, but the truth is it affects all age groups, and the actual rate of scoliosis increases with age.

The two most common condition types to affect adults is called idiopathic scoliosis (cause unknown) and degenerative scoliosis; out of the two, it's degenerative scoliosis that affects older adults, so let's explore how it develops.

Degenerative scoliosis patients are commonly over the age of 50, and the condition is more prevalent in females than males, and this is understood as a result of the changes in bone density and hormone levels caused by menopause.

Degenerative scoliosis is caused by natural age-related spinal degeneration that commonly starts in the intervertebral discs and the cumulative effect of certain lifestyle factors: carrying excess weight, leading a sedentary lifestyle, chronic bad posture, excessive consumption of alcohol and/or smoking, and repeatedly lifting heavy objects incorrectly and straining the spine.

The spine's intervertebral discs play many roles that are key to preserving spinal health and function from providing cushioning between adjacent vertebrae to acting as the spine's shock absorbers, combining forces to facilitate spinal flexibility and range of motion, and giving the spine structure (adjacent vertebrae attach to the disc in between).

If one or more of the spine's discs start to degenerate, this commonly causes them to change their shape, and this affects the position of adjacent vertebrae and can be a factor in the development of an unnatural scoliotic curve.

So yes, scoliosis can develop later in life; as the approximate rate of scoliosis in adolescents sits at 2 to 4 percent, and the rate of adult scoliosis is between 12 and 20 percent, with some studies on scoliosis prevalence in adults over 60 suggesting rates as high as 68 percent, it's clear that age-related spinal degeneration affects how scoliosis develops in older adults.

Now let's return to the condition's classification points with curvature location.

Curvature Location

The spine has three main sections, and each section has its own characteristic curvature type: the cervical spine (neck), the thoracic spine (middle/upper back), and the lumbar spine (lower back).

When a healthy spine is viewed from the sides, it has a soft 'S' shape, and when viewed from the front and/or back, it will appear straight, and this is due to the spine's curves that make it stronger, more flexible, and better able to handle mechanical stress incurred during movement.

Certain curvature locations for scoliosis are associated with specific symptoms; the area of the body located closest to the scoliotic spinal section is most likely to feel the majority of the condition's direct effects.

So curvature location tells me where I need to concentrate my treatment efforts and helps predict specific symptoms a patient might experience; for example, a common complication of scoliosis that develops in the lumbar spine is sciatic nerve pain because the sciatic nerve starts in the lumbar spine and the unnatural spinal curve can expose it to uneven pressure.

Thoracic scoliosis is the most common location because the thoracic spine is the largest spinal section, but the condition can develop in any of the main spinal sections, or in more than one as a combined scoliosis (thoracolumbar scoliosis).

The larger an unnatural curvature of the spine is, the more likely it is to continue to progress, and the more proactive treatment is needed.

Condition Severity

Condition severity is a key condition factor that treatment plans are shaped around, and severity is determined by a measurement known as Cobb angle.

As mentioned, a minimum Cobb angle of 10 degrees is needed to diagnose scoliosis, and as a progress condition, scoliosis severity can change as the condition develops and progresses over time.

So scoliosis that's diagnosed as mild scoliosis can easily progress and become moderate scoliosis, severe or very severe scoliosis; only proactive treatment can work towards counteracting the condition's progressive nature.

A patient's Cobb angle is determined during X-ray, and the higher a patient's Cobb angle, the further out of alignment the spine is, and the more severe the condition is:

• 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

So as a progressive condition, where a scoliosis is at the time of diagnosis isn't indicative of where it will stay; the key is to work towards counteracting the condition's progressive nature through treatment.

Symptoms of scoliosis tend to become more noticeable as scoliosis progresses, and it gets harder to reverse their effects once they're established; hence the benefit of proactive treatment that works towards preventing progression and increasing condition effects.

In severe cases of scoliosis and/or if left untreated, patients can be at risk for a number of complications from digestive issues to increasing levels of back and radiating pain, leg pain, nerve damage, body image issues, breathing problems, and migraines.

Most cases of scoliosis don't require treatment that involves spinal fusion and metal rods attached to the spine to hold it in place, but the more severe a condition, the more likely it is that invasive surgical treatment will be recommended in the future; this is something I want to help patients avoid.

Spinal fusion surgery can indeed help straighten a bent spine, but the way it does so is invasive and risky and can cost the spine in terms of its flexibility and range of motion: a side effect that can disrupt a patient's quality of life, not to mention that a fused spine is weaker and more vulnerable to injury.

Condition Type

Condition type is another key condition variable because in order to be treated effectively, a condition's underlying cause has to be addressed; this is the difference between addressing symptoms of scoliosis, or their underlying cause: the scoliosis itself.

Type is determined by a condition's cause, and the most common type of scoliosis to affect all ages is idiopathic scoliosis, and idiopathic means not clearly associated with a single-known cause.

Idiopathic doesn't mean there is a complete absence of a cause; idiopathic scoliosis is, instead, considered to be multifactorial, meaning caused by a combination of variables that can vary from patient to patient.

So idiopathic scoliosis is the most prevalent type of scoliosis, and while we don't know what triggers its initial development, we do know what triggers its development/progression over time: growth.

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

Neuromuscular scoliosis develops as a complication of larger neuromuscular conditions such as spina bifida, cerebral palsy, and muscular dystrophy.

People with scoliosis that's considered atypical often have developed their scoliosis due to an underlying pathology, and in cases of neuromuscular scoliosis, the underlying neuromuscular condition has to be the focus of treatment, so this complicates the treatment process, and as a result, my neuromuscular scoliosis patients are among the most challenging to treat.

Congenital scoliosis develops in utero as the spine is forming, so babies are born with the condition; the spine is malformed and this disrupts its ability to develop natural and healthy curves.

Congenital scoliosis patients often present with additional birth defects so have to be comprehensively assessed, and this is a rare type that develops in approximately 1 out of 10,000 babies.

The most prevalent type of scoliosis overall is adolescent idiopathic scoliosis, so let's focus in on some condition characteristics of AIS and how it develops over time.

How Does Adolescent Idiopathic Scoliosis Develop?

So as an idiopathic condition, clearly we don't fully understand what triggers the condition's initial development in adolescents, and adolescent idiopathic scoliosis is diagnosed in adolescents between the ages of 10 and 18.

We do fully understand how to treat it effectively, and we also fully understand how the condition progresses over time and how its affects on the body can also change over time.