What Is Severe Scoliosis? Diagnosis, Symptoms, and Treatment

What Is Severe Scoliosis? Diagnosis, Symptoms, and Treatment Image

Every case of scoliosis is unique and will affect patients differently. Variables like patient age and condition severity help shape a person's experience of life with the condition. Treatment plans for patients, of all severity levels, have to be designed around the needs of each patient and their specific condition; there is no generic blanket-approach to treating scoliosis. As severe scoliosis has a high risk of progression, the condition needs to be taken seriously and treated proactively; the sooner, the better.

Scoliosis develops across a wide severity spectrum of mild to moderate and severe. Scoliosis is classified as ‘severe’ if the abnormal spinal curvature has a Cobb angle measurement of 40+ degrees. Cases of severe scoliosis are virtually guaranteed to progress, which is why proactive treatment is key.

Before we explore the specifics of severe scoliosis in terms of symptoms and treatment, let’s start with how conditions are diagnosed and assessed.

Diagnosing and Assessing Scoliosis

In order for a diagnosis of scoliosis to be given, certain condition parameters have to be met.

Scoliosis involves having an abnormal sideways spinal curvature, but that curvature has to include rotation, making it a 3-dimensional condition, and be of a certain size.

The size of a scoliotic curve is determined by a measurement known as ‘Cobb angle’. A patient’s Cobb angle is measured during X-ray by drawing intersecting lines from the tops and bottoms of the curvature’s most-tilted vertebrae (bones of the spine). This involves multiple vertebrae and places a condition on its severity scale of mild, moderate, or severe.

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

"An important aspect of scoliosis to understand is that it’s not a static condition; where it is in terms of severity when it’s first diagnosed is not indicative of where it will stay." An important aspect of scoliosis to understand is that it’s not a static condition; where it is in terms of severity when it’s first diagnosed is not indicative of where it will stay. As a progressive condition, scoliosis has it in its nature to get worse over time, especially if left untreated, or not treated proactively.

People with severe scoliosis have experienced progression and are likely to continue progressing if an effective and proactive treatment plan isn’t applied.

As we have addressed what it means to be diagnosed with severe scoliosis, let’s move on to some common symptoms of the condition.

Symptoms of Severe Scoliosis

As previously mentioned, every case of scoliosis is as unique as the patient affected, and while every case is different with its own treatment needs, there are some common symptoms characteristic of life with severe scoliosis.

As scoliosis develops, it introduces a lot of uneven forces to the body, the spine, and its surrounding muscles and nerves.

In cases of severe scoliosis, these patients are in the later stages of progression, and symptoms that might have started out as mild are likely to increase alongside progression, such as postural changes and pain (more common in adults).

Postural Changes

One of the earliest telltale signs of scoliosis involves postural changes that affect the body’s overall symmetry. Again, while every case is different, as a curvature increases in size, it tends to cause more noticeable postural deviation:

  • Uneven shoulders with one sitting higher than the other
  • One shoulder blade protruding more than the other
  • The presence of a rib arch
  • Uneven hips
  • Arms and legs that seem to be different lengths

As a result of these types of postural changes that give the body an asymmetrical appearance, clothing tends to hang unevenly, and changes to balance, coordination, and gait are also common.

In addition, with severe scoliosis patients, it’s not uncommon to be able to see the spine’s abnormal curvature and rotation with the naked eye; whereas in mild, and even some moderate cases, these qualities aren’t commonly noticeable to people who aren’t trained in how to recognize condition indicators.

In general, the progressive line from mild to severe involves symptoms evolving from subtle and difficult to notice, to overt and difficult to miss.

As the most effective indicator that something is wrong with the body, pain can also be a common symptom of severe scoliosis, but more so in adults than in children and adolescents.

Pain

Another important condition variable to understand is pain. While an abnormal spinal curvature can seem like it would always cause noticeable pain, this is not necessarily the case, particularly when it comes to the difference in how adults and adolescents commonly experience the condition.

While the likelihood that scoliosis will be painful can increase based on the angle of trunk rotation (ATR) and condition severity, whether a condition is painful or not is also largely determined by patient age, and this is due to skeletal maturity.

In children and adolescents who have not reached skeletal maturity, the spine is experiencing a constant lengthening motion due to growth, and this counteracts the compressive force of the unnatural curvature; however, in adults whose spines have settled due to gravity and maturity, they are vulnerable to compression felt in the spine and its surrounding muscles and nerves.

In fact, when it comes to adult scoliosis, pain is often the most noticeable symptom and is what brings them in to see me for a diagnosis and treatment.

So while approximately 20 percent of adolescents experience muscle pain related to their condition, even in severe cases, the condition isn’t always painful.

In adults, in addition to postural changes that include a prominent lean to one side, plus the aforementioned symptoms, pain can be the most noticeable symptom of severe scoliosis.

While postural changes and pain are the most common symptoms of severe scoliosis, additional symptoms reveal how the condition can affect the body in many ways.

Additional Symptoms of Severe Scoliosis

"In addition to postural changes and pain, severe scoliosis is also associated with impairments in lung function, headaches, sleep problems, digestive problems, balance issues, and irregular menstrual cycles." In addition to postural changes and pain, severe scoliosis is also associated with impairments in lung function, headaches, sleep problems, digestive problems, balance issues, and irregular menstrual cycles.

As the spine works in tandem to form the body’s central nervous system (CNS), spinal conditions can have a wide range of effects felt throughout the body, and scoliosis is no exception.

So if a person is diagnosed with severe scoliosis, what’s next?

Treatment Options for Severe Scoliosis

Throughout the article, I’ve highlighted some condition-related variables that are particularly important to understand; another area of crucial importance is treatment.

Patients, and their families, need to understand that different treatment approaches offer different potential outcomes, so the decision of which treatment approach to commit to can have life-long consequences.

There are two main scoliosis treatment approaches: chiropractic-centered and traditional.

Here at the CLEAR Scoliosis Institute, our team of CLEAR-certified scoliosis chiropractors offer a chiropractic-centered approach that values proactive treatment and addresses the underlying structural nature of the condition.

We also value treating the whole patient and the condition itself, not just its symptoms; this is an important distinction because solely addressing a condition’s symptoms is not akin to treating the underlying cause of those symptoms, which is the condition itself.

The CLEAR approach is also referred to as conservative and involves integrating multiple treatment disciplines for the most effective and customized treatment plans possible.

We combine scoliosis-specific chiropractic adjustments, a variety of therapies, scoliosis-specific exercises, and balance-training exercises. While CLEAR scoliosis treatment does not typically involve the use of a brace, a well-designed corrective brace can complement CLEAR treatment.

The results of the CLEAR approach speak for themselves and offer patients the benefits of synergistic treatment that, unlike the traditional approach to scoliosis treatment, doesn’t funnel them towards invasive spinal-fusion surgery.

Under the umbrella of traditional treatment, patients are mainly observed while the condition is mild, but once a condition progresses into the severe classification and passes the surgical-level threshold, spinal fusion is commonly recommended as the best treatment option.

While spinal fusion can help straighten a scoliotic spine, the way it’s achieved can come at a heavy price. In addition, it’s an invasive procedure, and results can never be guaranteed. Many patients are also disappointed with their pain and mobility levels post-surgery; life with a fused spine can come with some unexpected dynamics and limitations.

While it’s true that treating severe scoliosis is more challenging than milder forms, which is why many people mistakenly assume surgery is their only option, this is not the case; through proactive treatment and hard work, improvements can be made on a structural level, in the form of a curvature reduction, and the spine can be stabilized while simultaneously addressing the underlying cause of related symptoms.

Conclusion

Living with severe scoliosis means living with certain symptoms. While not everyone will experience the same symptoms, or to the same extremity level, there are some that are common enough to signify the presence of the condition and/or further progression.

While scoliosis can range from mild to moderate and severe, many times, conditions remain undiagnosed and untreated for years, until they start to produce more noticeable symptoms, such as postural changes and pain.

Patients with severe scoliosis have Cobb angles of 40+ degrees, and even within one level of severity, there can be a wide range of curvature degrees. A severe curvature, especially if left untreated, can continue to progress well beyond 40 degrees, and for those following the traditional approach to scoliosis treatment, once it crosses that surgical-level threshold, spinal fusion is a common recommendation and choice.

For severe scoliosis patients of the CLEAR Scoliosis Institute, our proactive treatment approach can help them live their best lives by working towards improvements that prevent further progression and the need for more invasive forms of treatment.

CLEAR photo

Author: Dr. Dio Kim, DC, DICCP, DACBSP

Dr. Dio Kim graduated from Palmer College of Chiropractic West in 2000 and practices in Tustin, California. He has been CLEAR Certified since 2011, and became one of the first members of the CLEAR Fellowship Program in 2019. Among the many certifications allowing him to be recognized as a CLEAR Fellow are the Cox Technic, Kinesio Taping, ScoliBrace, Scientific Exercise Approach to Scoliosis (SEAS) Level 1, and many more. Dr. Dio specializes in scoliosis, sports, and pediatric chiropractic. He holds a Diplomate in Clinical Chiropractic Pediatrics (DICCP) and Diplomate American Chiropractic Board of Sports Physicians (DACBSP®). The DICCP is a board-certified credential in pediatrics for doctors of chiropractic who specialize in children, from infants to teenagers. Moreover, he is one of only a few chiropractors invited by the United States Olympic & Paralympic Committees (USOPC) to the Olympic Training Center in Colorado Springs to treat elite athletes. He is a graduate of the World Masters of Scoliosis Conservative Treatment from ISICO, and is also a licensed acupuncturist.
Reach out to Dr. Dio Kim, DC, DICCP, DACBSP

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This website is for informational and general purposes only. Information provided is not a substitute for professional medical advice, diagnosis, or treatment. Never ignore professional medical advice because of something you have read on this site. 

CLEAR Scoliosis Centers are privately owned and operated chiropractic clinics. Doctors at CLEAR Scoliosis Centers are personally responsible for all clinical decision making. CLEAR Scoliosis Institute, a nonprofit organization, does not have any authority over the clinic, make any clinical recommendations, or dictate patient care.
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