When Is Scoliosis Considered Severe? Understanding Curves

There are different types of spinal curves, some healthy and some not. When it comes to optimal spinal health and function, maintaining the spine's natural curves and straight alignment is key. There are a number of spinal conditions that cause an unhealthy curve to develop.

Scoliosis causes an unnatural sideways-bending and rotating spinal curve to develop, and it's considered severe when the size of the curve has a Cobb angle measurement of 40+ degrees. The goal of proactive scoliosis treatment is to prevent cases from becoming severe.

When scoliosis is diagnosed, part of the process involves comprehensive assessment to further classify conditions based on key factors; these factors shape and customize treatment plans.

Diagnosing and Classifying Scoliosis

Scoliosis isn't always easy to diagnose, particularly in children for whom the condition isn't compressive.

It's compression that causes the majority of condition-related pain, and this involves uneven pressure on the spine, its surrounding muscles and nerves, and can affect the entire body.

Scoliosis is diagnosed through a physical examination, taking the patient's family history, and examining the spine while in a forward bend position (Adam's forward bend test).

If the physical exam and Adams test show indicators of scoliosis, further testing is warranted in the form of a scoliosis X-ray; the only way to officially diagnose scoliosis is with an X-ray to confirm the condition's rotational component and determine a patient's Cobb angle measurement.

For scoliosis to be diagnosed, the spine has to bend unnaturally to the side and twist, and a minimum Cobb angle of 10 degrees is needed.

Cobb Angle and Condition Severity

In addition to needing a patient's Cobb angle to diagnose scoliosis, it's also needed to classify conditions based on severity.

Condition severity can range from mild scoliosis to moderate scoliosis, severe and very severe scoliosis, and as a progressive condition, the nature of scoliosis is to become more severe over time.

Where a scoliosis is at the time of diagnosis doesn't mean that's where it will stay; this is why proactive treatment is needed to work towards counteracting the condition's progressive nature.

Determining a patient's Cobb angle involves drawing lines from the tops and bottoms of the curve's most-tilted vertebrae at the apex of the curve, and the resulting angle is expressed in degrees.

The higher a patient's Cobb angle, the more severe the condition, and the more noticeable its effects are likely to be.

In addition, the more severe scoliosis is, and the longer it's left untreated, the more likely a surgical recommendation is, and scoliosis surgery often involves spinal fusion: an invasive and risky procedure.

The sooner a patient's spine is addressed, the more likely a curvature reduction with a lower Cobb angle measurement becomes:

• 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 of 80+ degrees

So the goal of proactive scoliosis treatment is to prevent progressing into the severe classification because the more severe scoliosis becomes, the less effective non-surgical treatment options become.

Severe Scoliosis Symptoms

The symptoms of scoliosis will change over time.

Mild scoliosis can be difficult to detect as its symptoms can be subtle and difficult for anyone, other than a scoliosis expert trained in what to look for, to notice.

The earliest signs of scoliosis in children involve postural changes such as uneven shoulders and hips.

Changes to movement, gait, balance, and coordination are also common, and the more severe a condition, the more overt its effects are going to be.

Most of my scoliosis patients are diagnosed with moderate scoliosis because the signs of mild scoliosis can be so subtle, and it's not until mild cases progress and become moderate scoliosis that they become noticeable enough to lead to assessment and diagnosis.

While overt postural changes and disruptions to movement are the main signs of severe scoliosis in children, adults have a different scoliosis experience that centers around pain.

Scoliosis Pain

Scoliosis pain is the main symptom of adult scoliosis, but isn't considered a common symptom of childhood scoliosis; the condition doesn't become compressive until skeletal maturity has been reached and growth has stopped.

In young patients whose spines are still growing, the constant lengthening motion of growth counteracts the compressive force of the unnatural spinal curve.

Compression is uneven pressure, and scoliosis introduces a lot of uneven forces to the spine, its surrounding muscles, ligaments, tendons, and nerves, and the effects can be felt throughout the entire body.

Scoliosis pain can involve the muscles, back pain, and most often, radiating pain into the extremities (hands and feet) due to nerve compression.

Once severe and compressive, scoliosis pain can be chronic and debilitating.

While adults also experience postural changes caused by the condition's uneven forces disrupting the body's overall symmetry, it's pain that brings most adults in to see me for diagnosis and treatment.

Severe Scoliosis Treatment Options

When scoliosis is severe, treatment options can become more limited as the condition will be more complex to treat.

As scoliosis progresses, the size of the unnatural spinal curve is increasing, making the spine increasingly rigid and less responsive to treatment.

While severe scoliosis can still respond to non-surgical treatment, the more severe and atypical cases of scoliosis are, and the longer they are left untreated, the more likely a future surgical procedure will be.

Spinal fusion surgery is invasive, risky, and can impact the spine in a number of ways.

The procedure involves fusing the curve's most-tilted vertebrae into one solid bone so they can't become more unnaturally tilted over time, but this is contrary to the spine's movement-based design and can cause a reduced range of motion and less flexibility in the spine.

In addition, a fused spine is weaker, more vulnerable to injury, and can be painful at the fusion site.

Risks of the procedure itself include excessive blood loss, infection, adverse reaction to hardware used, and nerve damage.

Non-Surgical Treatment Options

Conservative non-surgical treatment is proactive, and when applied early, can prevent conditions from becoming severe; multiple types of treatment are combined to customize treatment plans and impact conditions on every level.

Here at the Scoliosis Reduction Center®, patients benefit from a multifaceted treatment approach that combines the power of chiropractic care, physical therapy, corrective bracing, and rehabilitation.

Through customizing treatment plans, the specifics of a patient's condition are addressed, including condition severity, type, curvature location, and patient age.

Chiropractic care is applied to work towards adjusting the curve's most-tilted vertebrae back into alignment with the rest of the spine and reducing the curve size and Cobb angle.

Physical therapy can include a series of scoliosis-specific exercises, stretches, and therapies to improve posture, increase spinal flexibility, and improve the surrounding spine's muscle balance and strength.

Conservative treatment is less invasive, risky, and works towards preserving as much of the spine's natural strength and function as possible.

While spinal fusion surgery can help straighten a scoliotic spine, the reality is that many cases of scoliosis don't need surgery, particularly those that are diagnosed early and treated early, with the goal of preventing progression into the severe classification.

Conclusion

A scoliotic curve with a Cobb angle measurement of 40+ degrees is considered severe scoliosis.

Even mild scoliosis can progress and become moderate, severe, and very severe scoliosis if left untreated, or not treated proactively.

The goal of conservative treatment is to restore the spine's healthy curves, balance, and stability through impacting the condition on a structural level with chiropractic care, physical therapy to balance and strengthen the back muscles, corrective bracing to push the spine into a corrective position, and scoliosis-specific exercise to further heal and stabilize the spine.

An unnatural spinal curvature should always be addressed because it can disrupt the biomechanics of the entire spine, and an unhealthy spine can further disrupt quality of life.

Regardless of type or severity, scoliosis should always be taken seriously and addressed with treatment.

Abnormal spinal curvatures can affect the body in a number of ways, from postural changes to mobility issues and neurological symptoms due to compressed spinal nerves.

The spine doesn't just give the body structure, facilitate movement, and protect important organs, it also works with the brain to form the body's central nervous system, so spinal conditions can disrupt nerve health and function.

Early diagnosis gives patients the opportunity to benefit from early intervention, when a proactive treatment approach is applied, and here at the Center, the goal is to minimize scoliosis affects, prevent progression of mild and moderate scoliosis into severe curves.

Scoliosis management means treating an ongoing condition, but a scoliosis diagnosis doesn't have to limit a person's goals, particularly when proactive conservative treatment is applied immediately following a diagnosis.