PrizmScoliosis / Lordosis / Flatback

Overview | What causes spinal curves? | Types of scoliosis | How scoliosis progresses | Early Detection | Screening | Symptoms | Diagnosis | Treatment Options | Scoliosis Surgery | Flatback Syndrome

Click here to download
Scoliosis Overview


Scoliosis is a disease characterized by an abnormal curvature to the spine, in which the vertebrae twist like a bent corkscrew. In less severe cases, scoliosis may cause the bones to twist slightly, making the hips or ribs appear uneven. When this occurs, the problem is more cosmetic and less of a health risk.

Scoliosis does present a health risk if bones are so severely twisted that they compress vital organs, or if the spinal deformity is so severe that spine health and posture is threatened. If this happens, surgery may be necessary. If left untreated, severe cases of scoliosis can shorten a person's life span.

The normal spine has a slight curve when viewed from the side. There can be a variety of abnormal curves. Lordosis is an excessive curve in the low back. Kyphosis is an excessive curve in the upper back. Flatback can be the result of spinal surgery that fuses vertebrae into a too flat position.

Scoliosis is when the spine has an abnormal curve when viewed from behind. When a scoliosis curve worsens, it can put pressure on internal organs and cause back pain symptoms.

The key to managing scoliosis is early detection, bracing to prevent it from worsening, and if necessary, scoliosis surgery.

What causes spinal curves?

Scoliosis is in most cases a painless condition that can progress unnoticed for years. Ultimately, as the curve worsens, it causes an abnormal curvature in the spine. This will often result in a rotation of the spine and rib cage, which affects the symmetry of the shoulders, trunk and waist.

Although most cases of scoliosis are mild, severe scoliosis can be disabling, inflicting excruciating back pain as a symptom. Certain conditions like cerebral palsy, may actually cause scoliosis, but in most cases the cause of scoliosis is unknown. Sometimes there can be a hereditary tendency to pass along the problem from generation to generation.

The exact cause of scoliosis is unknown. Only 1-4 percent of the population has this condition. It is more common in women than men and most often affects adolescents between the ages of 10 and 18. A child's likelihood to develop scoliosis is much higher if their parent or a sibling has it. Scoliosis can also develop over time in mid- to late childhood, usually before puberty. In other cases, the disease is congenital, meaning a person is born with a vertebral abnormality that causes it.

Types of scoliosis

The three main types of scoliosis are Functional, Neuromuscular, and Degenerative. Functional scoliosis is where the spine is normal, but over time an abnormal curve develops due to another aliment in the patient’s body, such as having one leg longer than the other.

Neuromuscular scoliosis can usually be much more severe since the condition is present at birth. This type of scoliosis is due to the failure of the spine bones to properly form, or fail to correctly separate from each other. People born with birth defects or cerebral palsy can often have neuromuscular scoliosis.

Degenerative scoliosis is found in adults where the weakening of normal ligaments and other soft tissues of the spine can lead to an abnormal curve in the spine. Many times this can be linked to the patient having complained about arthritis.

Idiopathic scoliosis is not linked to a known cause, but it is the most common type of scoliosis in adolescents. Doctors are unsure what causes this type of scoliosis, but it is suggested that it is hereditary because the disorder tends to run in families.

Congenital scoliosis is a condition where there is deformity in the spine present at birth, but typically it is revealed only as the baby continues to grow. The cause of congenital scoliosis is abnormally shaped or fused bones in the spine that do not grow or fuse correctly. Children diagnosed with more advanced scoliosis can often feel like they sometimes have trouble breathing. They are also prone to more back and leg pain symptoms.

Because kids are fairly flexible, spinal curves can progress unnoticed for years without any symptoms. This explains why school screenings are important to detect scoliosis early on. During the screening, a school nurse or pediatrician may notice a hump, uneven shoulder blades or hips, or an “S” shaped curve in their spine.  The potential for the curvature in the spine to worsen is linked to the amount of growth remaining in the bones and spine. This growth may relate to the treatment decision and recommendation from the scoliosis surgeon.

One way to determine how much growth has yet to take place is to perform an X-ray of the pelvic hip region. Another way is to note the changes of puberty in girls and boys which can give insight if the person has more growth left. In girls, evidence suggests that after their first period, there may be one to two more years of spine growth remaining.

How scoliosis progresses

Most of the time the patient is unaware of the curvature in their spine until it is noticed by someone else. Some of the warning signs to look for are shoulders at different heights, appearance of a uneven waist, rib cages at different heights, leaning of entire body, fatigue, backache, low-back pain and head not aligned with the pelvis. These signs and symptoms typically begin in adolescence when boys and girls hit their growth spurt.

Boys and girls develop mild scoliosis around the same rate, but interestingly, girls have an increased risk of the scoliosis worsening.  Severe scoliosis — a curve greater than 100 degrees — can create dangerous problems. The spinal curve can encroach upon the lungs and heart, as well as other organs, making it more difficult to breathe and for the heart to pump blood flow properly.

If there is uncertainty that you or your child might have scoliosis, you should see a scoliosis specialist to get evaluated. School examinations include Adam’s Forward Bend Test for scoliosis. This test has the child bend over and touch their toes, which exposes the spine to the examiner so he or she can easily detect any abnormal spinal curvatures. Additional testing can be done by taking an X-ray from the front and the side to get a clearer view of the spine’s alignment.  A scoliosis specialist will monitor the patient over several follow up visits to compare the results of the previous visits to get a better idea of the pace of the progression of the spinal curve.

Detect a Spinal Curve Early

Scoliosis is seen more in young girls than boys, but it can affect both. It can appear at birth, or later on as the child grows into their teens.

Many school programs have a scoliosis screening program with a school nurse who can easily detect scoliosis by having the child bend over and look for a high or uneven shoulder blades.

If scoliosis is suspected, the next step is to have an orthopedic surgeon perform X-rays and measure the degree of curve.  This will be important to document if the curve is worsening or staying the same.

Having the child wear a brace can sometimes prevent the curve from worsening. In other cases, scoliosis surgery may be performed to untwist and correct the spinal curve.

The key is to detect an abnormal spinal curve early before it worsens and requires more aggressive surgery to correct it.

How to Screen for Scoliosis

Viewed from the side the healthy spine has natural curves. But viewed from behind, the alignment should be straight. Scoliosis is an abnormal curve of the spine, which over time if left untreated, can damage internal organs and shorten one’s lifespan. There is no known cause for scoliosis, although in some cases it can be inherited.

It is crucial to detect scoliosis early as spinal curves typically appear from age 8 to 18.  The easiest way to screen a child, teen or adult for scoliosis, is to have the person bend over at the waist, facing away from you, and observe the shoulder blades to see if they are uneven. If the spine is curved, one shoulder will appear higher than the other.

In scoliosis, the spine is not just abnormally curved, but also twisted, like a corkscrew. Severe curves can cause back pain and severely limit activities.  Scoliosis can be treated if detected early before the curve worsens.


Sometimes, the symptoms of scoliosis are visible. For instance, the child may have uneven shoulders, chest, hips, shoulder blades, waist, or a child may have a tendency to lean to one side. In other cases, there are no visible symptoms. To diagnose a child with scoliosis, have them touch their toes. If either one or both shoulder blades are prominent, the waist is shifted or ribs are uneven, scoliosis may be present. For a child or teenager, your pediatrician often screens for scoliosis. There are school screening programs as well.


Outlined below are some of the diagnostic tools that your physician may use to gain insight into your condition and determine the best treatment plan for your condition.

Medical history: Conducting a detailed medical history helps the doctor better understand the possible causes of your back and neck pain which can help outline the most appropriate treatment.

Physical exam: During the physical exam, your physician will try to pinpoint the source of pain. Simple tests for flexibility and muscle strength may also be conducted.

X-rays are usually the first step in diagnostic testing methods. X-rays show bones and the space between bones. They are of limited value, however, since they do not show muscles and ligaments.

MRI (magnetic resonance imaging) uses a magnetic field and radio waves to generate highly detailed pictures of the inside of your body. Since X-rays only show bones, MRIs are needed to visualize soft tissues like discs in the spine. This type of imaging is very safe and usually pain-free.

CT scan/myelogram: A CT scan is similar to an MRI in that it provides diagnostic information about the internal structures of the spine. A myelogram is used to diagnose a bulging disc, tumor, or changes in the bones surrounding the spinal cord or nerves. A local anesthetic is injected into the low back to numb the area. A lumbar puncture (spinal tap) is then performed. A dye is injected into the spinal canal to reveal where problems lie.

Electrodiagnostics: Electrical testing of the nerves and spinal cord may be performed as part of a diagnostic workup. These tests, called electromyography (EMG) or somato sensory evoked potentials (SSEP), assist your doctor in understanding how your nerves or spinal cord are affected by your condition.

Bone scan: Bone imaging is used to detect infection, malignancy, fractures and arthritis in any part of the skeleton. Bone scans are also used for finding lesions for biopsy or excision.

Discography is used to determine the internal structure of a disc. It is performed by using a local anesthetic and injecting a dye into the disc under X-ray guidance. An X-ray and CT scan are performed to view the disc composition to determine if its structure is normal or abnormal. In addition to the disc appearance, your doctor will note any pain associated with this injection. The benefit of a discogram is that it enables the physician to confirm the disc level that is causing your pain. This ensures that surgery will be more successful and reduces the risk of operating on the wrong disc.

Injections: Pain-relieving injections can relieve back pain and give the physician important information about your problem, as well as provide a bridge therapy.

Treatment Options for Scoliosis

The treatment of scoliosis is based on the severity of the curve and the potential of the spine to curve even worse. Scoliosis treatment involves observation, bracing, and in severe cases where the curve is worsening, surgery. The first step is to observe if the curve is worsening or staying the same over time.

A custom back brace may be used to prevent worsening of the spinal curve, rather than to reverse the curve. Scoliosis experts caution the patient and the parent that at best, a brace may slow a curve, which may make corrective surgery less complex.

It’s important to note that the majority of children diagnosed with scoliosis will not need any type of treatment. Only about one in seven adolescents diagnosed with scoliosis will ever need to begin some type of treatment whether that be bracing or surgery. Early detection is key to prevent a surgery, or make correction surgery less complex.

For adults, scoliosis over time can cause discs to herniate from the pressure placed on them from the curve. Another complication can be osteoporosis, where the vertebrae in the spine become porous and brittle, causing vertebral fractures. This can limit the surgical treatment options.


How can I tell if I have scoliosis?
Your doctor will take X-rays of your spine which will reveal whether or not scoliosis is present as well as how severe it may be.

When is scoliosis considered dangerous to my health?
Scoliosis can be life-threatening when bones are so severely twisted that they compress vital organs. Surgery is most likely the best option in such cases. If left untreated, severe cases of scoliosis can shorten a person's life span.

What are some of the nonsurgical ways to treat scoliosis?
There are some nonsurgical ways to treat scoliosis such as physical therapy, exercise, bracing, shoe inserts and medication. However, only a spine surgeon can determine if any of these options might apply to you.


Flatback Syndrome

When the proper curves in the spine that support an economical stance requiring minimum energy to stand or walk fail, the result is a condition called Flatback syndrome.


Some of the symptoms include having trouble maintaining a proper posture, low back pain and thigh pain. Since the person has trouble maintaining proper alignment, the symptoms might increase throughout the day due to fatigue. Patients might also have upper back and neck pain due to constantly trying to realign themselves. These symptoms can often develop to be very painful and leads some patients to having to take medications.


Flatback syndrome was originally used to describe Harrington rods recipients (1960s- early 1990s) due to the fact the rods sometimes flattened the normal sway of the spine.  This was due to the rods extending down into the lower part of the spine.

The rods were unable to follow the natural curve of the lower back, which caused the spine to unnaturally straighten out. This unnatural movement helped advance the degeneration of discs in the spine. New advancements in modern scoliosis technology have been credited it making flatback syndrome a much less common problem.

Degenerative Disc Disease can contribute to the person having trouble maintaining upright posture. This disease is from normal wear on the intervertebral discs.

Other conditions that may cause flatback syndrome include having collapsed vertebrae. Arthritis can also contribute to flatback syndrome and cause inflammations in the spine, which may cause pain and stiffness.


Most patients with flatback syndrome will complain of having trouble maintaining a standing upright posture. If the doctor determines you might have flatback syndrome, he or she will order a full-length X-ray of the spine. An MRI or CT scan might also be taken to help the doctor better understand the health of the spine and discs.

Patients diagnosed with Flatback syndrome will initially be treated with an individualized physical therapy program and anti-inflammatory medication. If all non-surgical options have become exhausted, it may be necessary to surgery.


Disclaimer: Internet Explorer is now obsolete and has been replaced by Microsoft. If you are viewing in Internet Explorer 8 or older, you will need to update your browser by Clicking here.

Need an Appointment?

Gus Varnavas, MD at Community Hospital of Anaconda specializes in the treatment of back and neck pain and strives to help people return to activity. Request an appointment with Dr. Varnavas in his office in Anaconda, MT.