When the Spine Curves: Treatments for Scoliosis

Present Knowledge of Scoliosis

Types of Spinal Curves

Scoliosis occurs most often as one of four types of curves. Each type of curve is classified by its location on the spine. For example, a thoracic curve is found on the upper, or thoracic, portion of the spine. A lumbar major curve is located on the lower, or lumbar, portion.

The thoracic curve is one of the most common scoliotic curves. It affects the upper spine and usually curves to the right side of the body. The vertebrae experience severe rotation with this curve, which results in rib abnormalities and very rarely, cardiopulmonary dysfunction. A right thoracic curve is usually accompanied by smaller curves both above and below the largest curve. 4. X-ray of a spine with a 45 degree right thoracic curve 1979 Courtesy of Stuart Weinstein, MD, UIHC Department of Orthopaedics

The double major curve is difficult to identify as it causes only minor visual distortion. A double major curve is made up of two curves with nearly equal angles. One curve usually occurs on the upper spine, and the other on the lower spine. A thoracic curve typically curves to the right and the lumbar to the left. A shortened trunk (length from shoulders to hips) is commonly seen with this curve. 6. X-ray of a double major curve Thoracic curve of 58 degrees and lumbar of 47 degrees 1999 Courtesy of Stuart Weinstein, MD, UIHC Department of Orthopaedics

Most curves can be classified as either major or compensatory, depending on how far they curve. A major curve is the largest scoliotic curve in the spine and has the greatest degree of vertebral rotation. Compensatory curves are smaller curves with lesser degrees of rotation. These curves are usually more flexible and exist as a result of a larger curve. Compensatory curves are the spine's own attempt at compensating for, or balancing out, large curves.

The degree of curvature is measured using the Cobb method. First, an x-ray of the entire spine is taken from the neck to the pelvis. A line is then drawn on the x-ray at the top of the highest vertebra in the curve. Another line that points down and toward the curve is drawn, connecting the two lines together and creating a right angle. The third line is drawn on the bottom of the lowest vertebra in the curve and a connecting line is drawn upward toward the curve, creating another right angle. At this point, the two lines drawn toward the curve meet near the middle of the curve. The degree of this angle determines the degree of the curvature. For example, if the angle created by the two lines is thirty-two degrees then the degree of the curvature is thirty-two.

This method of determining the severity of the curve is important in diagnosing and treating scoliosis. Curves must be ten degrees or more for a patient to be diagnosed with scoliosis. Curves ranging from ten to thirty degrees are usually very mild and will probably not progress. Patients with these curves are only observed during adolescence. Thirty to forty degree curves are moderate and can be treated with bracing or some other method. Curves over forty degrees, and with the possibility for further progression, require surgery.

Go to iscoliosis.com to see an x-ray with Cobb marks.