“Scoliosis is going to crush her lungs!” is the great fear of every mother of a child with scoliosis as they stare at an x-ray with the spinal curvature intruding into what appear to be the patient’s lung fields.
Adult patients fear this for themselves, as well.
The concern is certainly genuine and real, but is it scientifically accurate? We hope to expose the truth behind this pressing question, as well as explore other possible causes of severe shortness of breath if you or your child have scoliosis.
Current Review of Literature on Shortness of Breath Due to Scoliosis
As with many conditions, the scientific study of any one particular aspect of a given condition can and do vary greatly; however, the scientific community generally accepts scoliosis can cause detectable shortness of breath in spinal curvatures reaching 50+ degrees and significant lung restriction in patients with curves greater than 90 degrees. [source]
Dr. Daniel G. Gelb, of the University of Maryland states, “Severe scoliosis can cause lung restriction. However, no (clinically) significant decrease in lung function is seen unless the curve reaches 80-90 degrees. It is very unusual for an adolescent curve to reach this magnitude. Scoliosis does not affect other organs such as the heart, liver, or intestines.”
I realize many of you reading this article are left thinking, “How do I know if scoliosis is affecting my lungs?” Please keep in mind, Cobb angle measurements are only one small part of evaluating the scoliosis condition; there are many other possible explanations for breathing problems with scoliosis beyond just the spinal curvature seen on x-ray.
Additional Things to Consider If You Have a Hard Time Breathing With Scoliosis
Comorbidities: Comorbidities are multiple health problems that contribute to the patient’s singular symptom or complaint. More than 1 in 12 people have asthma according to the American Lung Association that leads to chronic breathing problems. Adulthood asthma combined with a degenerative moderate-to-severe scoliosis may gradually create a physical and chronic obstructive pulmonary disease process, leading to significant breathing problems.
HNMT Genomic Variants: The Histamine N-Methyltransferace genomic functional group is commonly found in patients with idiopathic scoliosis. This gene codes for enzymes that break down and reduce histamine. Without adequate levels of this enzyme, histamine levels may build up over time and begin to have an effect on breathing similar to chronic allergies. It is very possible many people with scoliosis and breathing difficulties could suffer from this undetected genomic variant functional group that could easily be resolved with a natural nutrient intervention called “Hista-Block“.
Biomechanical Rib Cage Dysfunction: Obviously, the bending and twisting of the spine in patients with scoliosis will have a negative effect on the normal biomechanic, as well as the rib cage that is attached to the spine. Most patients refer to this as their rib hump, or “bump,” and it is sometimes accompanied with rib pain. The source of the rib pain is often muscular, but stuck joints, and even entrapped capsular ligaments, can create very real and significant discomfort. While inhaling, the rib cage expands up and out to lower pressure in the lungs and allow air to flow into the chest cavity. Restriction from stuck joints, or pain related to muscle spasms, may prevent the rib cage from fully expanding and thus decrease the patient’s ability to breath normally.
There is one study published in the Scientific Journal Chest in 2001 that evaluated the effect of spinal manipulation therapy, traction, and physical therapy — procedures which are also used as part of the ScoliSMART approach — on a middle-aged female with idiopathic scoliosis. It found there was a 7.5-cm gain in chest expansion over the course of treatment. This could be considered published proof that these methods can positively influence chest expansion.
Previous History of Bracing for Scoliosis: (Dr. Brain T. Dovorany) “Multiple studies have confirmed the negative impact rigid braces have on lung function, as they severely restrict the abdomen and chest wall. Studies performed by the Laboratory of Clinical Physiology, Ullevål Hospital, Sophies Minde Orthopaedic Hospital, Oslo, Norway involving the use of the Boston Brace (TLSO) demonstrated a significant decrease in pulmonary function both at rest and during exercise while wearing the Boston Brace (Note: The most commonly prescribed brace in the United States [view most common types of bracing]). The studies that were performed on children wearing the Boston Brace demonstrated a 30% decrease in VC (vital capacity) and a 45% decrease in ERV (expiratory reserve volume), the same type of decreases found in long-term smokers. Symptoms related to respiratory distress may include headaches, anxiety, sleep disturbance, nightmares, and cognitive dysfunction. Most studies indicated that the breathing and pulmonary testing returned to normal once the brace was removed, but you have to wonder what type of cellular damage or unknown structural changes may have occurred as a result of wearing a brace 23 hours a day over a period of years during times of peak growth.”
When Scoliosis Breathing Problems Become Deadly
Cor Pulmonale: Cor Pulmonale is pulmonary hypertension related to the underlying lung disorder, in which the right ventricle of the heart becomes enlarged and thickened, eventually resulting in heart failure. The lungs are not fully developed in humans until about age 5, so if the patient develops severe scoliosis prior to full lung development, they could develop Cor Pulmonale. Patients who develop severe scoliosis after the lungs are fully developed (approximately age 5) are not at risk for developing Cor Pulmonale.
Cor Pulmonale is potentially fatal by the time the patient reaches their teenage years if it goes undiagnosed and/or untreated. Symptoms of Cor Pulmonale include shortness of breath, tiredness, lightheadedness, and increased heart rate (even during rest).
Does Scoliosis Fusion Surgery Improve Breathing?
A fairly extensive amount of time, money, and effort has gone into investigating the effects of scoliosis fusion surgery on pulmonary function. As with any scientifically studied topic, results and conclusions will vary, but it is generally accepted that surgical intervention will not improve breathing or pulmonary function unless the patient had very low function prior to the surgery. In fact, virtually all the studies found pulmonary function actually decreased immediately after scoliosis fusion surgery for a period of anywhere between 2 months to 2 years before returning to pre-operative levels. These findings call into question the medical necessity of recommending surgical intervention for scoliosis less than 80 degrees if the patient’s pulmonary function is not significantly impaired by the condition, nor significantly improved from the procedure. In fact, a group of orthopedic surgeons investigated this very question and published their findings (below).
First, the necessity of correcting AIS with expensive implants should be reconsidered. Whereas a traditional notion is that curve progression has a negative impact on the young with AIS, the natural history of AIS is more optimistic than imagined. Based on an average of 50 years of follow-up of 117 untreated patients with AIS, Weinstein et al demonstrated the productive and health natural history of AIS per se. Even if a curve progressed to some critical extent, the deformity did not affect the daily life and welfare of these patients. Consistent with that line of evidence, Yaszay et al noted that only severe thoracic curve >80° affects pulmonary function, with thoracic kyphosis as a predictor. Moreover, a cross-sectional cohort (ScoliGeneS) study from Sweden noted that adults with idiopathic scoliosis have similar physical activity levels compared with healthy control patients. Strikingly, adults who are treated surgically have slightly lower physical activity levels than patients who are not treated.
Second, the adverse effects of surgical treatment with spinal implants should be considered. There are not only adverse events intraoperatively, such as the need for blood transfusion or massive bleeding, but also major health effects, including radiation exposure from repeated whole-spine radiographs and increased cancer risk and mortality. Moreover, the lifelong preservation of metal implants triggers both local and systemic reactions, with increased metal irons in serum and hair. Collectively, we suggest that surgical treatment for AIS be reconsidered for the welfare of adolescents rather than distributors.
What We Know About Shortness of Breath, Breathing, Pulmonary Function, and Rib Pain as It Relates to Scoliosis
- Very severe scoliosis can cause significant lung restriction in curves over 80 degrees.
- Scoliosis patients experiencing breathing difficulties with curvatures less than 80 degrees should consider other possible causes for their symptoms.
- Rib and chest pain related to scoliosis and breathing difficulties may stem from biomechanical rib cage dysfunction, causing restriction to chest wall expansion. Research indicates this may respond well to a scoliosis-specific rehabilitation program that includes spinal manipulation.
- Patients with severe scoliosis prior to the age of 5 years old are at risk for developing Cor Pulmonale, which can be fatal in later years without treatment.
- Scoliosis fusion surgery does not improve pulmonary function or breathing in patients with severe scoliosis unless the patient had significantly decreased lung volume prior to the surgery. In most cases, surgical intervention further decreased lung function for a period of 2 months to 2 years before returning to pre-surgical levels.
- The medical necessity for fusion surgery for scoliosis has not been established, and these findings call into question the current surgical threshold (50 degrees). Published literature suggests increasing the surgical threshold to 80 degrees and higher if the goal of surgery is to improve or maintain significant pulmonary function in patients with severe scoliosis.