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Scoliosis curves come in different shapes and sizes. They may be in the thoracic spine (chest region), the lumbar spine (low back) or the thoracolumbar spine (both areas). More rarely they may involve the upper thoracic and cervical or neck regions, as well as the lumbosacral regions. They may appear as a C shape or have an S shaped appearance. There may be a single curvature or two or more curvatures of the spine. Typically there is a single structural curve with one or two flexible compensatory curves as the body attempts to realign itself is spite of the scoliosis.
One other component of scoliosis is the rotational aspect which produces the typical hump of scoliosis as seen from the back. As the spine deviates laterally it may also rotate like a screw twisting, this causes the ribs or lateral musculature of the lumbar area to become more prominent in a hump often seen with or without clothing. As the spine and chest wall move laterally and rotate the scapula or shoulder blade may also become more prominent. The shoulder height may be asymmetric, one higher than the other as well as the pelvis or hips also having a similar appearance. Women may complain of one breast being more prominent. In more severe cases the head may be aligned laterally to the pelvis and the patient may appear to lean to one side and even walk leaning as if one leg is longer than the other, a common complaint but generally not the cause of scoliosis.
In some cases the scoliosis may involve an abnormal curvature of the spine as seen in the lateral or side view. Generally, looking from the side, in normal individuals the neck curves toward the front, the chest towards the back and the lumbar area curves toward the front again to produce a balance of the head over the pelvis, and the upright posture, which is optimal. In kyphosis there is an abnormal forward bending of the spine which produces a sagittal imbalance or the tendency of the head to be in front of the body and the body to lean forward. This is called kyphoscoliosis. This is a three plane deformity and may be more challenging to treat.
Generally, scoliosis does not produce significant back pain but there may be associated muscular pain with increased severity of the curve especially in the thoracic area around the scapulae or shoulder blades. Also there may be low back pain with lumbar kyphotic deformities or humps. Significant pain or night pain is worrisome for possible tumors which in rare instances can cause scoliosis. These need to be evaluated by MRI or CT imaging since plain X-ray often will not pick up occult spinal tumors.
Rarely does scoliosis involve leg or radicular or sciatic-like pain. Even less frequently, there exist motor deficits or weakness, as well as sensory paresthesias or tingling. These generally are caused by either extreme cases of scoliosis which produce traction on the nerve roots or a degenerative condition associated with the scoliosis called spinal stenosis. In spinal stenosis, the spinal canal and nerve foramen or openings become narrowed by arthritis of the facet or spinal joints. These may require decompression by a laminectomy to alleviate pain at the time of scoliosis surgery. One cautionary note is that lumbar laminectomy alone without fusion in a scoliotic spine may worsen the scoliosis as many structures which hold the spine in place may be disrupted during the decompression or laminectomy. Very infrequently scoliosis will have bowel and bladder incontinence associated with it. These, are more frequently the result of a herniated disc and require immediate evaluation if new onset. Scoliosis is usually a limited disease but in extreme cases can compromise of the cardiovascular and pulmonary system and may cause early death.
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