The spinal cord consists of 31 pairs of spinal nerves, and if the spine’s unnatural curve and twist exposes the spinal cord to excessive/uneven pressure, nerve compression can disrupt an affected nerve’s function. While neurological symptoms aren’t considered a primary effect of scoliosis, they can occur and are most closely associated with severe cases of adult scoliosis and/or neuromuscular scoliosis (NMS).

The spine and brain work together to form the central nervous system, so spinal health can impact nerve health and vice versa. While nerve damage isn’t a common effect of scoliosis, nerve compression can occur in severe cases, cases of adult scoliosis, and/or neuromuscular scoliosis.

One of the main benefits of early diagnosis and intervention is the potential to prevent progression and increasing symptom severity.

Scoliosis Severity

No two cases of scoliosis are the same, which is why treatment plans need to be fully customized.

Scoliosis can range widely in severity from mild scoliosis to moderate scoliosis and severe cases.

What’s most important to understand about scoliosis severity is that it can change over time; the nature of scoliosis is progressive, and while we don’t know why many cases of scoliosis develop initially, we know it’s growth that makes it progress (1).

How scoliosis is managed during periods of rapid growth is key as proactive treatment is necessary to work towards counteracting the progressive nature of scoliosis (1, 2).

While there are a number of factors that shape a patient’s scoliosis severity and symptoms, it’s largely determined by a patient’s Cobb angle measurement that’s based on the size of the spine’s unnatural lateral curve.(3).

Cobb angle is determined during X-ray; the higher a patient’s Cobb angle, the more severe the scoliosis (3).

Additional severity factors include a patient’s angle of trunk rotation; scoliosis is 3-dimensional so it doesn’t just cause the spine to curve unnaturally, but also twist. The more rotation there is, the more the position of the rib cage is affected and the more potential there is for impacting lung function (4).

When it comes to the effects of scoliosis, including potential neurological symptoms, the higher its severity, the more noticeable and disruptive its symptoms are likely to be, including neurological symptoms.

Scoliosis and the Nervous System

The spine and brain make up the body’s central nervous system: a vast communication network that facilitates brain-body communication.

The spinal cord consists of 31 pairs of spinal nerves, and they exit the spine through openings (intervertebral foramina) between the vertebrae (bones) and branch off to supply sensory information and motor commands throughout the body (5).

The spinal nerves send signals for voluntary (walking, speaking) and involuntary functions (reflexes, heart rate, breathing, digestion, blinking) and provide sensory info: touch, temperature, and pain (5).

So as you can see, the health of the spinal nerves is important for optimal functioning of a number of body systems.

Spinal nerves are mixed nerves, containing both sensory and motor fibers, so symptoms of nerve irritation can include sensory and motor issues (5).

The more severe scoliosis is, or becomes over time, the more likely nerves involvement becomes, and while nerve damage isn’t a common effect of scoliosis, it can occur, and if left untreated, can lead to more issues.

So if the spine is unnaturally curved and rotates, it can be exposing the spinal cord to uneven and excessive pressure, and this can disrupt the function of an affected nerve in the spinal cord, or at its root, where it exits the spine.

As severity is largely determined by the size of the unnatural spinal curve, the larger the curve, the more likely it is to impact spinal nerves.

In addition to severity, there are other factors that shape the degree of nerve involvement, including patient age and type of scoliosis.

Patient Age and Nerve Compression

When it comes to potential nerve involvement with scoliosis, this is not only shaped by severity, but also patient age.

While childhood scoliosis involves the highest risk for rapid advancement because progression is triggered by growth, it’s not closely associated with nerve pain and compression (2).

Scoliosis-related pain can involve the back muscles, spinal structures, and nerves, leading to radiating pain.

Scoliosis becomes compressive once skeletal maturity has been reached; while growth is occurring, the spine is being lengthened, and this can counteract the compressive force of the spine’s unnatural curve and rotation (6, 7).

Compression is excessive/uneven pressure, so scoliosis that involves compression is most likely to affect the spinal nerves, and is most likely in cases of adult scoliosis (7).

In addition to severity and patient age, the type of scoliosis is also an important factor when it comes to potential neurological problems, and the type most closely associated with neurological problems is neuromuscular scoliosis (7, 8).

Neuromuscular Scoliosis

Part of diagnosing scoliosis involves further classifying cases based on key variables, including the type of scoliosis, and type is determined by causation.

The majority of scoliosis cases are idiopathic, meaning not clearly associated with a single-known cause, but there are atypical types that tend to be more severe and are more closely associated with neurological problems.

Neuromuscular scoliosis is a complex type because it’s caused by the presence of a larger neurological or muscular condition such as spina bifida, muscular dystrophy, cerebral palsy, or spinal muscular atrophy; the scoliosis develops as a secondary complication of the disruption in communication between the brain, muscles, and nerves that shape posture and movement (8).

As the scoliosis is caused by the presence of an underlying neurological or muscular condition, the larger condition has to be addressed to impact the scoliosis, and this complicates the treatment process; symptoms are shaped largely by severity and the degree of nerve involvement.

Neuromuscular scoliosis doesn’t just affect the spine’s alignment, but also muscle strength, mobility, and balance (8).

Common symptoms of neuromuscular scoliosis include muscle weakness, loss of balance, and altered neuromuscular control, and contribute to poor spinal health and the development of an abnormal spinal curvature (8).

Like typical types of scoliosis, neuromuscular scoliosis can also progress with growth and/or the worsening of the underlying condition (2, 8).

Conclusion

So can scoliosis cause neurological problems? Scoliosis can affect the central nervous system through compression, and this is most likely in cases of severe scoliosis, adult scoliosis, and neuromuscular scoliosis.

In addition, as scoliosis disrupts overall spinal health, it can contribute to a number of other spinal conditions/issues capable of further impacting the spinal cord such as spinal stenosis and disrupting the flow of cerebrospinal fluid in and around the brain and spinal cord.

The best way to minimize the potential effects of scoliosis, including nerve involvement, is through a proactive and customized treatment plan.

Scoliosis treatment is shaped around patient age, severity, type, curve location, and experienced scoliosis symptoms, and neurological problems are most closely associated with severe scoliosis, adult scoliosis, and neuromuscular scoliosis.

While treatment results can never be guaranteed, ScoliCare treatment plans are customized and integrative, combining the potential of multiple scoliosis-specific treatment modalities so balance can be restored to the spine and body and compressed nerves are relieved of pressure.

References:

1. Lenz, M., Oikonomidis, S., Harland, A. et al. Scoliosis and Prognosis—a systematic review regarding patient-specific and radiological predictive factors for curve progression. Eur Spine J 30, 1813–1822 (2021). https://doi.org/10.1007/s00586-021-06817-0
2. Negrini, S., Donzelli, S., Aulisa, A. G., Czaprowski, D., Schreiber, S., de Mauroy, J. C., … & Zaina, F. (2018). 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis and spinal disorders, 13(1), 3
3. Wang, J., Zhang, J., Xu, R. et al. Measurement of scoliosis Cobb angle by end vertebra tilt angle method. J Orthop Surg Res 13, 223 (2018). https://doi.org/10.1186/s13018-018-0928-5
4. Johari J, Sharifudin MA, Ab Rahman A, Omar AS, Abdullah AT, Nor S, Lam WC, Yusof MI. Relationship between pulmonary function and degree of spinal deformity, location of apical vertebrae and age among adolescent idiopathic scoliosis patients. Singapore Med J. 2016 Jan;57(1):33-8. doi: 10.11622/smedj.2016009. PMID: 26831315; PMCID: PMC4728701
5. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. In brief: How does the nervous system work? [Updated 2023 May 4]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279390/
6. Zaina, F., Marchese, R., Donzelli, S., Cordani, C., Pulici, C., McAviney, J., & Negrini, S. (2023). Current knowledge on the different characteristics of back pain in adults with and without scoliosis: a systematic review. Journal of Clinical Medicine, 12(16), 5182.
7. Smith JS, Fu KM, Urban P, Shaffrey CI. Neurological symptoms and deficits in adults with scoliosis who present to a surgical clinic: incidence and association with the choice of operative versus nonoperative management. J Neurosurg Spine. 2008 Oct;9(4):326-31. doi: 10.3171/SPI.2008.9.10.326. PMID: 18939917
8. Murphy RF, Mooney JF 3rd. Current concepts in neuromuscular scoliosis. Curr Rev Musculoskelet Med. 2019 Jun;12(2):220-227. doi: 10.1007/s12178-019-09552-8. PMID: 30941730; PMCID: PMC6542926

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