Understanding the Three Types of Scoliosis

Two doctors reviewing images from spinal X-ray

Scoliosis is a common condition, and many mild cases require no treatment or intervention. For some patients, however, scoliosis can be debilitating to the point that back surgery is needed. Scoliosis may be idiopathic, degenerative, or neuromuscular.

Based in northern New Jersey and serving patients throughout the area, Centers for Neurosurgery, Spine & Orthopedics (CNSO) has a team of physiatrists who work in close collaboration with neurosurgeons, pain management, physical therapists, and other medical professionals to treat all forms of scoliosis. Learn about the symptoms and treatment options for the different types of scoliosis.

Assessing the Severity of Scoliosis

Mild curvature of the spine is common and often does not cause any pain or symptoms. More severe cases of scoliosis, however, can be quite debilitating. When diagnosing scoliosis, providers typically use a device that measures the degree of spinal curvature, known as the Cobb angle. A curve of zero to 10 degrees does not indicate scoliosis. A curved spine of more than 10 degrees indicates mild, moderate, or severe scoliosis:

  • 10 – 20 degrees: Mild scoliosis
  • 20 – 40 degrees: Moderate scoliosis
  • More than 40 degrees: Severe scoliosis

Idiopathic Scoliosis

Idiopathic scoliosis usually is detected during childhood but sometimes is not discovered until adulthood either incidentally or because of related symptoms. Pediatricians screen for scoliosis as a part of routine annual checkups by physical examination which will only detect moderate to severe scoliosis. If they detect a noticeable curve, they will order an X-ray to further measure curvature and rotation of the spine. If the degree of curvature is severe or if the patient complains of related symptoms, the patient will be referred to a neurosurgeon or orthopedic spine surgeon for further evaluation, monitoring, and either conservative or surgical treatment.

What Causes Idiopathic Scoliosis?

In medical terminology, idiopathic means that the cause is unknown. Thus, when the cause of the scoliosis is unknown, it is referred to as idiopathic scoliosis.

Idiopathic Scoliosis Symptoms

Fortunately, most cases of idiopathic scoliosis do not cause significant discomfort or loss of function. The condition may be detected during a routine physical examination or if the patient experiences related discomfort. Signs of moderate to severe idiopathic scoliosis can include:

  • Asymmetry in the hips, ribs, or waist
  • One shoulder blade sticking out more than the other
  • One leg appears longer than the other

In rare cases, a child or untreated adult with idiopathic scoliosis will have an “S” shaped spinal curvature so severe that it will affect their ability to move pain-free or breathe and they will be quickly short of breath with minimal exertion.

Treating Idiopathic Scoliosis

Treatment for idiopathic scoliosis will depend on the severity of the condition. For mild cases, a physician may simply recommend ongoing monitoring. Moderate scoliosis often is treated with bracing. A scoliosis brace helps hold the spine in the correct position. If a patient has severe scoliosis, they will need corrective spine surgery otherwise the condition will continue to become more debilitating. A surgical correction for idiopathic scoliosis is medically indicated if the Cobb angle is 30 or greater.

Degenerative Scoliosis

This type of scoliosis occurs in adults, resulting from normal wear and tear on the spine as a person ages.

What Causes Degenerative Scoliosis?

Degenerative scoliosis typically begins to develop around the age of 50, as the spine begins to deteriorate. Portions of the vertebral bone can continuously degenerate and decay leading to the formation of bone spurs, facet joint arthropathy, and osteoporosis. These structural changes can contribute to the formation of a curvature of the spine. Repetitive, jarring work-related movements, motor vehicle accidents, and sports injuries can also contribute to the onset of degenerative scoliosis.

Degenerative Scoliosis Symptoms

In some cases, patients with degenerative adult scoliosis do not notice any symptoms on a regular basis. Other patients frequently or continuously may experience:

  • Neck pain
  • Back pain
  • Hip pain caused by malalignment of the hips or pelvis
  • Difficulty breathing
  • Shortness of breath with minimal exertion
  • Difficulty standing up straight
  • One leg appears longer than the other

If degenerative scoliosis causes pressure on the spinal nerve roots, patients may also have feelings of numbness or weakness in the legs.

Treating Degenerative Scoliosis

For some patients, degenerative scoliosis will have only minor or occasional symptoms which may be treated with physical therapy. If symptoms become worse, however, transitioning from conservative treatment to an interventional treatment path would have the following progression:

A nerve block may offer relief if medication and physical therapy are not effective. The patient will be monitored to see if their scoliosis is worsening. Scoliosis surgery typically is not recommended until the Cobb angle measures 50 degrees or more.

Neuromuscular Scoliosis

Neuromuscular scoliosis can progress more rapidly than idiopathic or degenerative scoliosis and usually does not improve with bracing.

What Causes Neuromuscular Scoliosis?

An imbalance in the spinal nerve pathways causes this form of scoliosis, which affects the development of certain muscle groups. Underlying conditions can cause neuromuscular scoliosis, including cerebral palsy, muscular dystrophy, and spina bifida.

Neuromuscular Scoliosis Symptoms

Signs of neuromuscular scoliosis can include:

  • Difficulty maintaining balance or standing upright
  • Difficulty breathing at rest or with minimal activity
  • Asymmetry in the hips, shoulders, or rib cage
  • Changes in posture or gait

Severe cases of neuromuscular scoliosis interfere with proper breathing, lung function, and cardiac performance.

Treating Neuromuscular Scoliosis

Nonsurgical treatments such as physical therapy and bracing cannot cure neuromuscular scoliosis, but they can help improve function. Corrective spine deformity surgery would be a part of the treatment plan for the underlying condition that is causing neuromuscular scoliosis.

The surgical treatment for this form of scoliosis is a multilevel spinal fusion. During this operation, a neurosurgeon reconstructs the spine to minimize the curvature and maximize the patient’s ability to move pain-free and restore lung and cardiac function. After correctively aligning the vertebral bones, and taking great care of the spinal cord, the spine surgeon will utilize hardware and place small pieces of a bone graft between the spinal vertebrae to fuse and maintain the new construct of the patient’s spine while allowing new bone growth to solidify its stabilization. Depending on the extent of the correction, fusion surgery may be performed with interoperative image guidance or robotics.

Choose CNSO for Scoliosis Diagnosis and Treatment

As a comprehensive spine care center, CNSO offers a wide range of innovative non-surgical and surgical treatment options for all forms of scoliosis. With a patient-centered approach to care, CNSO has a team of award-winning onsite specialists that includes:

  • Neurosurgeons
  • Orthopedic spine surgeons
  • Interventional pain management physicians
  • Physiatrists
  • Rehabilitation specialists
  • Certified doctorate physical therapists

Treating adolescents and adults throughout northern New Jersey and the surrounding areas, the experienced staff works together to coordinate each patient’s diagnosis and treatment. With multiple locations in Bergen, Passaic, Essex, Morris, and Hudson counties, patients can receive advanced care without having to travel long distances. To learn more about CNSO or request an appointment, contact CNSO today.


Centers for Neurosurgery Spine & Orthopedics