A Bent Backbone

Some may argue that your spine is the most important bone in the whole body. It holds you up throughout life as a back bone for all of your movement. The spine is what holds and protects the spinal cord what allows for any bodily movement. The importance of this organ is sometimes forgotten behind the beauty of a steady heart or a thinking brain, but the spine is truly an anatomical amazement. But it is hard to understand the idea of how the backbones strength affects you when its twisted. Scoliosis is a condition where instead of the spine being straight and holding the body exactly straight, the spine is twisted and curved. The curvature of the spine effects the location of other bones that depend on the spine to hold them in place. People with scoliosis may have protruding ribs, uneven shoulders, or uneven hips, all resulting from a sometimes minimal curvature. 

Anatomical anterior view of a spine with scoliosis and how it effects the body

The curve that people with scoliosis have can be as unique as their finger print. Some people have a singular curve where over time their spine curves into the shape of a “C”. Others have double curves where the spine turns into an “S”. The curve can also be in different locations, cervical (upper), thoracic (middle), or lumbar (lower), further making the spine unique. The severity of the curve is measured in degrees, 1-10 degrees is considered a straight spine while the curvature can get to a degrees of 70 before surgery is the option. People with scoliosis identify with their curve, when they describe their spine it’s like they are speaking a common language. “Double curve, thoracic 35 degrees and lumbar 40 degrees,” someone might say to a friend. 

Comparable Examples of Different Types of Spinal Curvature 

The most common cause of scoliosis is unknown, which is Idiopathic. When 2-3 percent of children in the United States are diagnosed the only explanation they get for their unique spine is it’s random. But according to studies by the U.S National Library of Medicine, the condition is most likely not a single gene disorder and instead based on multiple genes each playing a role in the condition and how the spine curves. The only obvious risk factor is that young girls are 5 times more likely to have the disease.  This would suggest that the condition is an X-linked dominant disease, but parent X-rays dispute that hypothesis. I was diagnosed with scoliosis at age 10, my sister was diagnosed soon after and my mother had a progressive curve when she was an adolescent. When I was younger this was enough to suggest that somehow the condition is genetically linked and passed to my sister and I from our mother. But becoming more aware of this condition I know of its sporadic nature and that familial recurrence only makes up about 10 percent of idiopathic scoliosis patients. 

Many other studies have been done to discover the etiology of scoliosis. For instance, monozygotic twins have a higher prevalence of scoliosis at 73%-92% compared to dizygotic twins at 36%-63%. Hormonal imbalances and theories involving structural tissue abnormalities have also been studied. These are based of the knowledge of diseases such as spinal muscular atrophy and polyostotic fibrous dysplasia that are similar conditions involving the decrease structural integrity of bones. However, even after extensive research and testing the etiology is still unknown. Studies have shown there is a strong genetic linkage to the cause of scoliosis however neurological, environmental and behavioral patterns all play a role. Most of my doctors have even given me special notes so that I do not have to carry heavy books or back packs because even this can lead to a spinal deformity.  

The spinal deformation of scoliosis leads to many problems as the condition progresses in severity and also throughout adult life because of the importance that the spine plays in holding your body together. The possible outcomes of a child’s curve progressing sometimes pushes doctors into suggest a brace as a treatment. The function of this brace is essentially to put so much pressure on the spine that it pushes the curve from increasing. This brace, made of common materials such as plastic or plexiglass, is supposed to act as the spine holding a body straight. The idea that an external force is supposed to correct something that your genes coded for is difficult for a child living with scoliosis to understand, so many do not even wear the brace the amount that they are supposed to.

Boston Brace Used for Keeping Spinal Curvature From Progressing

A very small proportion of people suffering with scoliosis have to have corrective surgery. This is suggested for patients with a curve measured above 40 degrees and progression is expected. The most frequently performed surgery for correcting scoliosis is spinal fusion. This is a posterior approach where the spine is fused using screws to attach two metal rods on the sides of the vertebra, which pull the spine straight. A second surgery is an anterior approach called vertebral body tethering, is less invasive and much more modern. It uses half as many screws to use a tether to pull the spine straight. Both approaches as safe and effective in correcting the curvature of the spine. 

              

Image on the left shows x-ray post spinal fusion surgery, Image on the right shows x-ray post vertebral body tethering surgery.

This disease is something that is very easy to spot. For exact diagnosis you should visit a spinal specialist and get a spinal x-ray. Schools do a simple test to check for scoliosis but it is very easy to do at home. By checking the rotation of your spine by bending over to tough your toes, you can see if you should be check by a professional. Schools do this because it is much easier for scoliosis to be stopped at a younger age, but some countries are not fortunate enough to have these checks or spread awareness of scoliosis. Some children in impoverished countries have curves so bad that surgery is not an option. Part of my reasoning for this article was my personal connection as well as wanting to spread that awareness to others less fortunate so they can recognize scoliosis.