Severe Scoliosis: Symptoms, Diagnosis, Treatment, & More

The very nature of scoliosis necessitates a customized treatment approach because it can range so widely in severity from mild to moderate and severe to very severe. Condition severity is an important variable because it tells me how far out of alignment a scoliotic spine is and helps shape the crafting of effective treatment plans.

Scoliosis is the development of an unnatural sideways spinal curve, with rotation, and a minimum Cobb angle measurement of 10 degrees; Cobb angle determines condition severity, ranging from mild to very severe. Severe scoliosis means a person has a Cobb angle measurement of 40+ degrees.

To start, let’s explore some general condition information and how a condition is classified during the diagnostic process.

How is Severe Scoliosis Diagnosed?

In order for a diagnosis of scoliosis to be reached, certain parameters have to be met; there has to be an unnatural sideways spinal curve, with rotation, and a minimum Cobb angle measurement of 10 degrees.

It’s the rotational component that makes scoliosis a 3-dimensional condition because the spine doesn't just bend unnaturally to the side but also twists from front to back, back to front.

A patient’s Cobb angle measurement is taken during X-ray and involves drawing lines from the tops and bottoms of the most-tilted vertebrae at the curve’s apex, and the resulting angle is expressed in degrees.

The higher the Cobb angle, the more misaligned the spine is, and this measurement determines condition severity:

• 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

Part of the diagnostic process involves comprehensively assessing a patient's scoliosis so the condition can be further classified based on specific patient/condition variables.

In addition to condition severity, patient age, condition type (cause), and curvature location are key classification points that help to not only streamline the treatment process but also to guide the design of effective treatment plans moving forward.

So what is severe scoliosis: an unnatural sideways spinal curve, with rotation and a Cobb angle measurement of 40+ degrees. What severe scoliosis looks like will depend on the number and types of symptoms experienced.

What are the Symptoms of Severe Scoliosis?

Scoliosis is a complex condition to treat for several reasons: it ranges widely in severity, there are different types of scoliosis, and scoliotic curves, a person can develop, it can affect all ages, and develop anywhere along the spine.

There are three main spinal sections: cervical (neck), thoracic (middle/upper back), and lumbar (lower back).

With so many different variables shaping a person’s experience of life with the condition, symptoms one patient experiences aren’t indicative of what others will be facing: part of the reason treatment plans need to be fully customized is to address key patient/condition variables that vary from one patient to the next.

So while each case of scoliosis is as unique as the patient themselves, the following are some of the most common symptoms of severe scoliosis:

• Uneven shoulders
• One shoulder blade protrudes more on one side than the other
• The development of a rib arch
• An uneven waistline
• Uneven hips: one can sit higher than the other or appear flatter or more rounded than the other
• Arms and legs that appear to hang at different lengths
• A prominent lean to one side (most noticeable when in a forward-bend position)
• An unnatural spinal curve that’s visible to the naked eye

As scoliosis introduces so many uneven forces to the body, its main visual symptom is postural deviation as the body’s overall symmetry is disrupted.

In addition, ill-fitting clothing, changes to gait, balance, and coordination are also common.

Severe Scoliosis Pain

Pain is another symptom of severe scoliosis, but it’s associated more with adult scoliosis than with children and adolescents.

That being said, while children and adolescents don’t commonly experience a lot of back and/or radicular pain, approximately 20 percent do report issues with muscle pain, and this is due to the strain of trying to support an unnatural spinal curve, not to mention uneven wear and tear due to the condition’s uneven forces.

Until skeletal maturity has been reached, scoliosis isn’t a compressive condition, and it’s compression of the spine and its surrounding muscles and nerves that are responsible for the majority of condition-related pain.

Before reaching skeletal maturity, the spine undergoes a constant lengthening motion, which counteracts the compressive force of the unnatural spinal curve.

While scoliosis isn’t generally painful for children and adolescents, pain is the number-one symptom in adults, so it’s pain that brings adults in for a diagnosis and treatment: localized back pain or radicular pain felt throughout the body due to compressed nerves.

In addition to back pain, adults commonly experience radicular pain felt in the arms, hands, and feet.

Severe Scoliosis Hip Pain

Severe scoliosis hip pain can also be an issue, and this is due to the uneven forces introduced by the condition.

Hip pain can develop because of stretched ligaments caused by the scoliotic curve, and when the curve’s pull on the pelvis causes it to become tilted, one hip takes on more weight than the other, and this can lead to the uneven use of tendons and supporting muscles.

Severe scoliosis hip pain is closely related to uneven straining of the iliolumbar and sacroiliac ligaments: tough bands of connective tissues that help stabilize/support the spine where it joins the pelvis; this kind of pain is called sacroiliac joint pain (SIJ pain).

In addition, severe scoliosis hip pain is also related to pelvic dysfunction caused by changes in the way a person walks: their gait.

Disruptions to the natural rhythm and movement patterns of walking can cause uneven wear and tear on the parts and systems that are engaged during movement: the spine, pelvis, and hips.

Severe Scoliosis Headaches

Severe scoliosis can also cause other kinds of pain and is associated with headaches, with the potential to reach migraine status, and this is due to a disruption in the flow of cerebrospinal fluid (CSF).

Cerebrospinal fluid cushions and protects the brain and spinal cord, but when the spine is unnaturally curved, it can disrupt the flow within, causing low levels in and around the brain and building pressure, and this can cause debilitating headaches or migraines.

Severe scoliosis is also associated with lung impairment and digestive issues.

Severe Scoliosis Lung Impairment

Lung impairment related to scoliosis tends only to be noticed by those placing higher-than-average demands on their respiratory systems, like professional athletes, long-distance runners, etc.

When an unnatural spinal curve, and particularly those that develop in the thoracic spine (middle/upper back), develops, it can pull on the rib cage, causing the development of a rib arch, which affects the space available for the lungs to function within.

When there is decreased space due to the unnatural spinal curve and disrupted positioning of the rib cage, it can make it difficult for the lungs to inhale/exhale fully.

Severe Scoliosis Digestive Issues

When it comes to digestive issues, we’re talking about the digestive system slowing down or just having its general function altered.

Scoliosis can affect the digestive system in three ways: structurally, neurologically, and in the motion and mobility of the spine.

As a progressive condition, symptoms can escalate as a condition gets worse, which is why proactive treatment is so important.

Can/Will Severe Scoliosis Get Worse?

Another reason that scoliosis is a complex condition to treat is that it’s progressive, meaning it has it in its nature to worsen over time, particularly if left untreated or not treated proactively.

When I say get worse, what I mean is that the unnatural spinal curve increases in size, which increases the uneven forces being exposed to the body and tends to cause symptoms to escalate alongside condition severity.

In addition, as a scoliotic curve progresses, it becomes increasingly rigid, and spinal rigidity makes the spine less responsive to treatment.

In fact, with many of my adult patients, particularly those who have had scoliosis for years unaware, because they’ve already progressed significantly and spinal rigidity has set in, work has to be done beforehand to restore a baseline level of spinal flexibility prior to starting the regular course of treatment.

So the takeaway here is that being proactive means working towards preventing progression and all that comes with it; while there are no treatment guarantees, early detection, if responded to with proactive treatment, increases the chances of treatment success, so the right time to start treatment, regardless of age or severity, is always now.

As a progressive condition, where scoliosis is at the time of diagnosis is not indicative of where it will stay, even a diagnosis of mild scoliosis, if left untreated, can easily progress to moderate, severe, or very severe, and a diagnosis of severe scoliosis can easily progress to very severe.

While scoliosis is incurable, it is highly treatable, and when successful, proactive treatment can help prevent increasing condition severity, escalating symptoms, and the need for invasive treatment in the future.

So what are the treatment options for severe scoliosis?

How to Treat Severe Scoliosis

Considering the severity of severe scoliosis symptoms and how much simpler it is to treat scoliosis while still mild, why not work towards prevention, so conditions never progress to the point of becoming severe?

Once a person receives a diagnosis of severe scoliosis, the most important decision to be made is how to treat it moving forward.

Different treatment approaches offer patients different potential outcomes, so it’s important that patients, and their families, are aware of all treatment options available to them, and their pros and cons.

There are two main scoliosis treatment approaches for patients to choose between: traditional and conservative.

Traditional Surgical Severe Scoliosis Treatment

Many people ask, does severe scoliosis require surgery? The reality is that most cases of scoliosis can be treated non-surgically.

As mentioned earlier, there are different types of scoliosis, and as the most prevalent condition-form is adolescent idiopathic scoliosis (AIS), diagnosed between the ages of 10 and 18, this is the type we’ll currently focus on.

The idiopathic designation means we don’t know why it developed initially and is thought to be multifactorial, meaning caused by multiple variables that can vary from person to person.

The vast majority of known diagnosed scoliosis cases (approximately 80 percent), and the remaining 20 percent are associated with known causes: neuromuscular, congenital, degenerative, and traumatic.

For those on the path of traditional treatment, the chances are high that they will be funneled in the direction of spinal fusion surgery.

I should take a minute here to talk about the difference between stopping progression as an end goal of treatment, versus correcting scoliosis.

There is a big difference between treatment that aims to stop the condition from getting worse and treatment that works towards correcting scoliosis on a structural level.

Traditional treatment has to stop progression as its end goal, and it actually doesn’t have a strategy for treating scoliosis while mild, which is why patients with mild scoliosis are commonly told to watch and wait for signs of continued progression.

The danger of this is that while an adolescent patient with mild scoliosis is doing nothing but returning for periodic assessments every 3, 6, or even 12 months (intervals will depend on the treatment provider), they could have a significant growth spurt, and what’s the trigger for progression: growth and development.

This is why the traditional approach is considered more reactive than proactive because it does little to prevent progression and only has a treatment strategy once the condition progresses past the surgical-level threshold.

The only form of treatment applied prior to entering into the severe classification is bracing, and there are a number of shortfalls associated with traditional bracing options.

The most commonly used traditional scoliosis brace is the Boston brace, and its efficacy is limited for a number of reasons:

• It only addresses the condition as 2-dimensional (ignoring its rotational component)
• It doesn’t have a correction as an end goal
• Squeezes the spine unnaturally from the sides via a 3-point pressure system
• Known to weaken the spine over time
• Mass-produced design
• Not customized to address body/condition type = uncomfortable to wear
• Compliance issues

If the Boston is recommended, it’s generally during the moderate classification level, and if it’s unsuccessful at stopping progression, the next stop is spinal fusion surgery.

Spinal Fusion Surgery

Like all surgical procedures, spinal fusion comes with its share of risks and potential side effects, and while it can be successful in terms of straightening a crooked spine, how it’s achieved can come at the cost of the spine’s overall health and function.

There are different types of spinal fusion, but the procedure commonly involves fusing the most-tilted vertebrae of the curve together into one solid bone; this is done to eliminate movement (progression) in the area.

Rods are attached to the spine with screws to hold the spine in a corrective position, but it hasn’t actually corrected the scoliosis itself on a structural level, and instead is holding the spine there unnaturally.

While each patient will respond to the surgery in their own way and there’s no guarantee they will experience any of the following complications or side effects, the risk is there, so it should at least be considered:

• Infection
• Excessive blood loss
• Nerve damage
• Adverse reaction to hardware
• Hardware malfunction
• Pain at the fusion site
• Disappointing cosmetic results
• Loss of spinal flexibility and range of motion
• Increased risk of spinal injury

In addition, there is the very real psychological effect of living with a fused spine that’s at an increased risk of injury; some patients are fearful of trying new things or taking part in once-loved activities.

Considering the heavy risks, not to mention the monetary cost of the procedure, patients need to be aware that there is a far less costly, invasive, and risky option: conservative non-surgical treatment.

Conservative Non-Surgical Severe Scoliosis Treatment

Fortunately, for patients choosing to forgo a surgical recommendation or for those who simply want to try a safer, less-invasive, and less costly option first, there is a conservative non-surgical treatment option with proven results.

Here at the Scoliosis Reduction Center, I treat patients with a conservative chiropractic-centered treatment approach that values proactive treatment started as close to the time of diagnosis as possible.

I see watching and waiting as wasting valuable treatment time, while complicating the treatment process by only starting treatment later in the condition’s progressive line.

Scoliosis is far simpler to treat when at its mildest, before progression has increased spinal rigidity, and the body has had time to adjust to the unnatural curve’s presence: making the spine less responsive to treatment and complicating the treatment process.

In addition, my approach is integrative, combining multiple condition-specific treatment modalities, so the benefits of each are available and accessible to my patients under one roof.

By combining chiropractic care, in-office therapy, corrective bracing, and custom-prescribed home exercises, I can work towards impacting scoliosis on every level.

As a structural spinal condition, it has to, first and foremost, be impacted on a structural level, and I can achieve this through chiropractic care; through a variety of techniques and manual adjustments, I can work towards repositioning the most-tilted vertebrae of the curve back into alignment with the rest of the spine.

Once I start to see structural results, I can shift the focus to in-office therapy to increase core strength so the muscles surrounding the spine can provide it with optimal support.

In addition, certain scoliosis-specific exercises (SSEs) are known to activate specific areas of the brain for improved brain-body communication, postural remodeling, and better body positioning.

To meet my patients’ severe scoliosis brace needs, I favor the use of the ultra-corrective ScoliBrace: a modern corrective brace that represents the culmination of what we’ve learned about bracing efficacy over the years.

The ScoliBrace has correction as its end goal and addresses many of the shortcomings associated with traditional bracing:

• Addresses the condition as 3-dimensional
• Has correction as its end goal
• Pushes the spine, instead of squeezing it
• Each brace is customized to suit the patient’s body/curvature type
• More comfortable to wear and easy to put on/take off = higher compliance rates
• Improves postural deviation

The ScoliBrace can help augment corrective results achieved by other treatment disciplines and can be particularly effective on growing spines.

No one form of treatment has it in its scope to correct scoliosis and impact it on multiple levels, which is why integrating different treatment modalities that complement one another is key to treatment success.

Custom-prescribed home exercises can help establish a home-rehabilitation program to further stabilize the spine for sustainable long-term results.

Conclusion

If a person is diagnosed with severe scoliosis, it means they have developed an unnatural sideways spinal curve, with rotation and a Cobb angle measurement of 40+ degrees.

Scoliosis ranges in severity from mild to moderate and severe to very severe, and as a progressive condition, proactive treatment is key to preventing progression, increasing condition severity, escalating symptoms, and the need for more invasive treatment in the future.

The symptoms of severe scoliosis include postural deviation, such as uneven shoulders, the development of a rig arch, uneven hips, an uneven waistline, and arms and legs that appear to hang at different lengths.

In adults, postural deviation also occurs, but pain is the main symptom because scoliosis becomes compressive in adulthood.

When it comes to treatment for severe scoliosis, the best time to start is always now, and while traditional treatment funnels patients towards spinal fusion, conservative treatment works towards preserving as much natural spinal function as possible through proactive and integrative treatment plans.

If you, or someone you care about, has been recently diagnosed with severe scoliosis, don’t hesitate to reach out for guidance and support; it can be the first step on the path of proactive treatment and condition improvement.