Scoliosis & Women
Scoliosis is defined by sideways curvature in the spine producing a C shape versus the typical I shape. The cause behind the condition are placed into one of the three categories, including idiopathic, congenital, and neuromuscular. An idiopathic cause is determined when the other two categories have been ruled out. Congenital scoliosis occurs during embryonic stage from abnormal development of the spinal vertebrae. Neuromuscular causative factors develop from an initial neurological or muscular disease, which then leads to conditions of scoliosis.
Even though scoliosis has been a diagnosable condition for generations there, are still many unknown factors regarding this condition, including the why? Research has indicated that the condition is typically diagnosed in adolescents and is more common in females. In addition to scoliosis being more common, females have also been identified to have worsening curvature.
How is diagnosed?
Does anyone remember back in elementary school, having a screening where a wooden block was ran down your back? An Adam’s Forward Bend Test was being conducted, which is an earlier identifier for scoliosis. The screening has become controversial regarding its effectiveness, but 21 states still have mandates or recommendations for the screening to be completed.
If screening reflects a positive result, the child’s parent/legal guardian is notified to have further evaluation. Further evaluation can include a physical exam, x-ray, CT scan, or MRI.
Since screening is not always completed, there are additional signs and symptoms you can monitor. If any of the signs and symptoms were observed, scheduling an appointment with a primary care physician for additional evaluation would be the next step.
- Uneven shoulders
- Head alignment with pelvis
- Leaning body frame
- Abnormal skin over the spine
- Rib cage symmetry
- Uneven Hips
With a scoliosis diagnosis, part of the evaluation will include the measurement of curvature degree to determine the level of severity. The severity level will guide the healthcare team in preparing a personalized and optimal treatment plan.
- 10-25 degrees
- Observation is usually recommended with continued and ongoing evaluation, which includes radiograph studies throughout lifespan.
- 25-45 degrees
- If diagnosis is confirmed in childhood, bracing is recommended while the bones are still maturing and growing.
- Continued evaluation is recommended to monitor for changes in condition, including increase or decrease of curvature degree.
- 45 and greater
- Diagnosis in childhood can have surgical options to correct the curvature during the bone growth.
- Adults that have underwent childhood surgery for correction, sill have the potential need for revision surgery later in life, if the curvature returns.
- Adults who didn’t receive childhood corrective surgery may still be candidates if additional complications are present, including nerve damage or bowel/bladder dysfunction.
Scoliosis during pregnancy and childbirth
Since, pregnancy on its own can come with a series of physical and mental changes during its course, there are several important factors to be aware of when diagnosed with scoliosis. Always remember that each individual will differ, depending of the severity of the curvature in the spine.
- Fortunately, a diagnosis of scoliosis independently has not been linked to infertility issues.
- Back pain is commonly reported by many women during pregnancy. Curvature of the spine can already induce back pain, so adding in pregnancy, it creates a high potential to worsen during this period.
- Multiple factors can induce back pain during labor for all women, so an additional severity of back pain can happen with scoliosis.
- Pain management with epidural is commonly used during labor, which are placed into the epidural cavity of the spine. Clear communication between your prenatal provider and facility anesthesia is very important. Anesthesia will request x-ray images to determine spinal anatomy for safe epidural placement, if requested for pain relief.
- Spinal curvature can effect normal anatomy leading to asynclitic positioning of the fetus in-utero. Vaginal deliveries can still be a promising outlook if both fetal position and maternal pelvis structure are appropriate.