Dissecting Low Back Pain: Congenital Causes- Scoliosis

Congenital reasons to have lower back pain have to do with spinal abnormalities that one is born with. Among these abnormalities one of the more common ones is congenital scoliosis. In this post I will explain what scoliosis is, how it can contribute to development of lower back pain, differentiate it from scoliosis acquired later in late, and briefly touch on treatment options.

So what is scoliosis?

Simply put scoliosis is an abnormal curvature of the spine. When viewed from the back the spine should run down the middle in a straight line without any deviation from midline. Looking from the side the spine will have an normal curvature in lower part (lumbar) called lordosis. Any deviation from these normal parameters is deemed a curvature abnormality. There are three main types called kyphosis, lordosis (more than normal), and scoliosis. The specific abnormality in scoliosis is that the curvature is more sideways compared to normal.

What are the different kinds of scoliosis?

The types of scoliosis can be divided into four main kinds; congenital, neuromuscular, degenerative and idiopathic. In congenital scoliosis the abnormal curvature starts to develop before the child is born and can be due to abnormal formation of the vertebral bones of the spine or fusion of vertebral bones. While the problem develops before birth it may not be identified and diagnosed until later in life. Neuromuscular scoliosis results because of certain nerve or muscular system disorders when nerves and muscles are unable to maintain the normal alignment of the spine. This can be seen in cerebral palsy, spina bifida, and muscular dystrophy. The curvature may progress into adulthood and can become very severe and may even result in inability to walk. In degenerative scoliosis the abnormal curvature develops late in life and is due to excessive wear and tear of the spine that comes with aging. With aging comes degeneration of spinal joints and discs. When the degenerative process is more significant on one side versus another the spine can start to develop abnormal curvatures including one like scoliosis. Finally, the last kind of scoliosis is also the most common type and has no known or definitive cause and is therefore called idiopathic scoliosis. Its more common in women then men and tends to run in families.

Does scoliosis cause back pain?

Due to the abnormal curvature of the spine and asymmetry in scoliosis there will be excessive pressure and wear and tear that will develop over time. The pressure on the intervertebral discs for example will lead to disc bulges, disc tears and even disc herniation. The asymmetric load on one side of the spine will lead to wear and tear and arthritis of the spinal facet joints which is also painful. All of this can also reduce the diameter of the small openings in the spine through which spinal nerves exit the spine leading to nerve root pressure or even compression causing nerve pain.

Are there treatment options?

The standard of care to manage scoliosis has been observation, bracing and surgery. The level of treatment necessary will depend on the degree of the curvature as well as how rapidly its progressing. If the curve is mild (less than 20 deg) and not changing on follow up imaging then the best course of action recommended typically is to observe and follow with imaging, usually about about every 6 months. If progression is worsening then bracing may become indicated to help keep it from getting worse. Research studies have shown that proper bracing can help prevent the curve from progressing to the point of needing surgery. For children most experts recommend surgery when the curve is greater than 40 degrees and there are sings of progression. For adults its when the curvature becomes greater than 50 degrees and there is signs of nerve compression or damage, neurological problems, and/or significant pain due to the scoliosis.