Scoliosis is an abnormal side-to-side curvature of the spine, typically forming a “C” or “S” shape. While many are familiar with this common presentation, “reverse scoliosis” describes a less typical spinal curvature. This specific type of curvature involves the spine bending in an unexpected or opposite direction, setting it apart from more frequently observed forms.
Defining Reverse Scoliosis
Reverse scoliosis, also known as “wrong way scoliosis” or a “reverse S-shaped curve,” involves spinal curvature contrary to typical patterns. For example, if a common scoliosis curve in a spinal region bends right, a reverse curve in that area would bend left. This can occur in any part of the spine.
It can also manifest as a straightening or reversal of the spine’s natural inward curves, known as lordosis. For instance, the lower back (lumbar spine) naturally has an inward “C” shape; a loss of this curve, termed hypolordosis, means this section becomes unusually straight or curves outward. Such alterations disrupt the spine’s normal biomechanics, affecting its strength, flexibility, and ability to distribute stress.
Identifying Causes and Symptoms
The causes of reverse scoliosis vary. Many cases are idiopathic, meaning the specific reason for the curvature is unknown. It can also stem from congenital factors, where spinal bones do not form correctly before birth, or from neuromuscular conditions affecting nerves and muscles that support the spine. Degenerative changes, often due to age-related wear and tear, can also contribute, particularly in adults. Sometimes, reverse curves arise as compensatory mechanisms, where the body adjusts to an existing spinal imbalance.
Individuals with reverse scoliosis may experience symptoms common to other forms of scoliosis, such as uneven shoulders, a prominent shoulder blade, or an uneven waist and hips. Specific to reverse scoliosis, or more pronounced, can be back pain, balance issues, or walking difficulties. In severe cases, spinal curvature can impact lung function, leading to breathing problems.
Diagnostic Procedures
Diagnosing reverse scoliosis begins with a medical history review, including any family history. A physical examination involves observing posture and checking for unevenness in the shoulders, shoulder blades, waist, and hips. The Adams forward bend test, where an individual bends forward at the waist, helps identify any rotational aspect of the spinal curve, such as a rib prominence. A scoliometer may provide a preliminary estimate of the spinal curvature.
Imaging techniques are essential for confirming the diagnosis and measuring curve severity. Standing X-rays of the entire spine are standard to assess side-to-side curvature and determine the Cobb angle, which quantifies the curve’s degree; a curve over 10 degrees is generally considered scoliosis. Magnetic Resonance Imaging (MRI) may be performed if an underlying neurological issue, such as a spinal cord problem, is suspected.
Management and Treatment Options
Management and treatment for reverse scoliosis are individualized, depending on the curve’s severity, location, patient age, and overall health. For mild curves, especially in growing individuals, observation and regular monitoring with physical exams and X-rays are recommended to track progression. Physical therapy plays an important role in conservative treatment, with approaches like the Schroth method aiming to de-rotate, elongate, and stabilize the spine through customized exercises. These exercises focus on improving muscular symmetry, posture, flexibility, and strengthening core muscles.
For moderate curves in growing individuals, bracing may prevent worsening. Braces push the spine into alignment and are customized to the specific curve. When conservative methods are insufficient, or for severe curves exceeding 40-50 degrees, surgical intervention may be considered. Spinal fusion joins two or more vertebrae with bone grafts and metal implants to straighten and stabilize the spine. Another surgical option for growing children is vertebral body tethering, a fusionless approach using a cord to correct the spine while allowing continued growth.