Idiopathic Scoliosis: Why Are Scoliosis Causes So Elusive?

Scoliosis is deemed idiopathic when it doesn’t have a distinct congenital or neuromuscular cause. But, it can still be treated in adults and kids.

Throughout the world, many people—and pets, as well—have been diagnosed with an idiopathic disease or condition. This type of diagnosis can be frustrating because idiopathic issues are those that have no obvious cause.

This can leave you with more questions than answers, and idiopathic scoliosis is no exception.

“Idiopathic scoliosis means that there is no cause identified to create the spinal deformity,” states Jason Lowenstein, MD, medical director of the Scoliosis and Spinal Deformity Center at Morristown Medical Center in New Jersey. “It differs from other types of scoliosis in which there is a specific diagnosis identified that relates directly to scoliosis. It also contributes to the development of spinal deformity in patients with this condition.

“Idiopathic scoliosis is by far the most common type of scoliosis, affecting 2% to 3% of people within the United States.¹”

Idiopathic vs. Congenital Scoliosis

“Congenital scoliosis is an abnormal curvature of the spine which is directly related to a structural difference of the spine or chest wall that the patient was born with,” states Dr. Lowenstein. “Typically, there is either a failure of formation or a failure of segmentation in normal development that leads to the creation of the scoliosis.”

Idiopathic vs. Neuromuscular Scoliosis

“Patients with neuromuscular scoliosis are typically born with neurological disorders that contribute to muscular unevenness, which frequently results in the development of scoliosis,” Dr. Lowenstein says. “For example: Patients with cerebral palsy are born with muscular unevenness that can contribute to scoliosis development.”

In short, anyone can develop scoliosis, but children and adults are divided into separate categories.

Children with Scoliosis

Children with this condition are broken down into three subcategories:idiopathic infantile scoliosis, juvenile idiopathic scoliosis, and adolescent idiopathic scoliosis.

These classifications are based on age and skeletal maturity—infantile affects zero- to 3-year-olds, juvenile is 3- to 10-year-olds, and adolescent is from 11 onward or when the child begins puberty, to the point where the skeleton fully matures.

Idiopathic scoliosis can occur in any of these categories but makes up the majority of adolescent scoliosis cases.

Adults with Scoliosis

Idiopathic scoliosis in adults is the result of scoliosis that went undiagnosed or treated in childhood that gradually progresses over time.

“There is data to support that there is a genetic predisposition to developing scoliosis, as scoliosis commonly will run in families; genetic testing has been developed to help determine the risk of developing progressive scoliosis,” says Dr. Lowenstein. “There are theories that abnormalities of the nervous system—such as brain stem or equilibrium dysfunction—are more frequently identified in patients with idiopathic scoliosis and may contribute to its development.

“Other theories suggest that skeletal growth abnormalities or hormonal/metabolic dysfunction may contribute to scoliosis. However, despite significant research focused on determining the cause of idiopathic scoliosis, its exact cause continues to remain unknown.”

Here are some things to look out for if you suspect you or a loved one may have scoliosis:

• Head is not positioned directly above the pelvis
• The body leans to one side
• Uneven ribcage or hips
• Uneven shoulders (shoulder blades may also stick out)

“Idiopathic scoliosis curves tend to follow predictable patterns (right thoracic, or middle back) scoliosis, left thoracolumbar (mid and low-back) scoliosis, relative thoracic hypokyphosis², etc.) with magnetic resonance images (MRIs) of the spine showing no evidence of any significant abnormality other than scoliosis,” says Dr. Lowenstein.

“If no other related condition is present to suggest other scoliosis causes—such as neuromuscular or congenital—the diagnosis of idiopathic scoliosis can be made.”

Treatment of idiopathic scoliosis is largely dependent on your age and the degree of curvature in your spine. In many cases, patients with adolescent or juvenile idiopathic scoliosis that have a mild curve can be treated by wearing a brace.

Conversely, adults with idiopathic scoliosis may have more of a need for surgical intervention, such as a fusion surgery where rods and screws are added to realign the spine and relieve pressure on the nerves.

Regardless of the cause—or lack thereof—scoliosis is a treatable condition that nobody must live with. If you suspect you or a loved one may be living with scoliosis, seek out a specialist for the best chance of relief.