What is scoliosis?

Scoliosis is a disorder that causes an abnormal curve of the spine, or backbone with rotation of the spine along its axis. The spine has normal curves when looking from the side, but it should appear straight when looking from the front. People with scoliosis develop additional curves to either side of the body, and the bones of the spine twist on each other, forming a “C” or an “S” shape in the spine.

What are risk factors for scoliosis?

Scoliosis is about two times more common in girls than boys. Scoliosis affects about 2% of females and 0.5% of males Being a female increases the risk of scoliosis, and females have a higher risk of worsening spine curvature than males. Although many individuals who develop the problem do not have family members with scoliosis, a family history of scoliosis increases the risk of the disease.

What causes scoliosis?

In most cases, the cause of scoliosis is unknown (known as idiopathic). More than 80% of people with scoliosis have idiopathic scoliosis, and the majority of those are adolescent girls; the most common location for scoliosis is in the thoracic spine. This type of scoliosis is described based on the age when scoliosis develops, as are other some other types of scoliosis.
• If the person is less than 3 years old, it is called infantile idiopathic scoliosis.
• Scoliosis that develops between 3-10 years of age is called juvenile idiopathic scoliosis.
• People who are over 10 years old (10-18 years old) have adolescent idiopathic scoliosis.
• Recently all types of Scoliosis presenting before 8 years has been termed as Early Onset Scoliosis.

There are other types of scoliosis:

Congenital: If the curve is present at birth, it is called congenital. In this type of scoliosis, there is a problem when the bones of the spine are formed. Either the bones of the spine fail to form completely or they fail to separate from each other during fetal development. This type of congenital scoliosis develops in people with other disorders, including birth defects or Marfan syndrome (an inherited connective tissue disease)

Neuromuscular: In this type of scoliosis, there is a problem with the nervous system or the muscular system as in, muscular dystrophy, cerebral palsy etc. People with these conditions often develop a long C-shaped curve and have weak muscles that are unable to hold them up straight. If the curve is present at birth, it is called congenital. This type of scoliosis is often much more severe and needs more aggressive treatment than other forms of scoliosis.
Degenerative: Unlike the other forms of scoliosis that are found in children and teens, degenerative scoliosis occurs in older peoples. It is caused by changes in the spine due to age related arthritis. Weakening of the normal ligaments and other soft tissues of the spine combined with abnormal bone spurs can lead to an abnormal curvature of the spine in association with factors like osteoporosis, vertebral compression fractures, and disc degeneration.

Functional: In this type of scoliosis, the spine is normal, but an abnormal curve develops because of a problem somewhere else in the body. This could be caused by one leg being shorter than the other or by muscle spasms in the back.

Other potential causes of scoliosis include spine tumours such as osteoid osteoma. This is a benign tumour that can occur in the spine and cause pain. The pain causes people to lean to the opposite side to reduce the amount of pressure applied to the tumour. This can lead to a spinal deformity.

What are scoliosis symptoms and signs?

The most common symptom of scoliosis is detection of an abnormal curve of the spine or abnormal posture like uneven waist often noticed by a friend or a family member or physician doing routine screening of children for school or sports. Those affected may notice that their clothes do not fit as they did previously. It can also be found on a routine school screening examination for scoliosis. The change in the curve of the spine typically occurs very slowly so it is easy to miss until it becomes a more severe physical deformity. Scoliosis may cause the head to appear off centre, leaning to one side or notice one hip or shoulder to be higher than the opposite side. If the scoliosis is more severe, it can make it more difficult for the heart and lungs to work properly. This can cause shortness of breath and chest pain on activities like playing and swimming. In most cases, scoliosis is not painful, but there are certain types of scoliosis than can cause back pain, rib pain, neck pain, muscle spasms, and abdominal pain.

What clinical tests to do spine specialists use to diagnose scoliosis?

Spine specialist will ask questions related to scoliosis etiopathology, including if there is any family history of scoliosis, or if there has been any pain, weakness, or other medical problems.The spine specialist will look at the symmetry of the body to see if the hips and shoulders are at the same height, leaning to one side, or if there is sideways curvature. The physical examination involves looking at the curve of the spine from the sides, front, and back. The person will be asked to undress from the waist up to better see any abnormal curves, physical deformities, or uneven waist. The person will then bend over trying to touch their toes referred to as the Adams forward bending test. This position can make the curve more obvious. Any skin changes will also be identified that can suggest scoliosis due to a birth defect. A doctor may check your range of motion, muscle strength, and reflexes. The clues to the amount of growth remaining are examined including signs of puberty such as the presence of breasts or pubic hair and whether menstrual periods have begun in girls. The more growth that a person has remaining increases the chances of scoliosis getting worse. As a result, the doctor may measure the person’s height and weight for comparison with future visits. A note is also made of the height of father, mother and siblings of the chid for an assessment of the amount of growth potential.

What radiological and lab tests do spine specialists use to diagnose scoliosis?

If the doctor believes a patient has scoliosis X-rays are obtained, usually whole spine AP and lateral (at first visit, for further follow up visits usually AP is enough). The doctor can make measurements from them to determine how large a curve is present. This can help decide what treatment, if any, is necessary. Measurements from future visits can be compared to see if the curve is getting worse. It is important that the doctor knows how much further growth the patient has left. Additional X-rays of the hand, wrist, or pelvis can help determine how much more the patient will grow. If a doctor finds any changes in the function of the nerves, he or she may order other imaging tests of your spine, including an MRI or CT scan to look more closely at the bones and nerves of the spine.

What types of specialists treat scoliosis?

Usually a trained spine surgeon. In addition, a rehabilitation specialist, physical therapist, neurologist or an occupational therapist may be consulted as part of the treatment team.

What are the treatment options for scoliosis?

The treatment of Scoliosis cannot be generalised. The management is based on the type of scoliosis, the severity of the curve and the chances of the curve getting worse. There are three main categories of treatment: observation, bracing, and surgery.
Treatment of idiopathic scoliosis usually is based on the age when it develops.
In many cases, infantile idiopathic scoliosis will improve without any treatment. X-rays can be obtained and measurements compared on future visits to determine if the curve is getting worse. Bracing is not normally effective in these people, but casting has been tried.
Juvenile idiopathic scoliosis has the highest risk for getting worse of all the idiopathic types of scoliosis. Bracing can be tried early if the curve is not very severe. The goal is to prevent the curve from getting worse until the person stops growing. Since the curve starts early in these people, and they have a lot of time left to grow, there is a higher chance for needing more aggressive treatment or surgery.

Adolescent idiopathic scoliosis is the most common form of scoliosis. If the curve is small when first diagnosed, it can be observed and followed with routine X-rays and measurements. If the curve or Cobb angle stays below about 20-25 degrees (Cobb method or angle, is a measurement of the degree of curvature), no other treatment is needed. The patient may return to see the doctor every three to four months to check for any worsening of the curve. Additional X-rays may be repeated each year to obtain new measurements and check for progression of the curve. If the curve is between 25-40 degrees and the patient is still growing, a brace may be recommended. Bracing is not recommended for people who have finished growing. If the curve is greater than 40 degrees, then surgery may be recommended.

Functional scoliosis is caused by an abnormality elsewhere in the body. This type of scoliosis is treated by treating that abnormality, such as a difference in leg length. A small wedge can be placed in the shoe to help even out the leg length and prevent the spine from curving.
Neuromuscular scoliosis is caused by an abnormal development of the bones of the spine. These types of scoliosis have the greatest chance for getting worse. Observation and bracing do not normally work well for these people. Most of these people will eventually need surgery to stop the curve from getting worse.


  • Scoliosis is an abnormal curve in the spine.
    There are several types of scoliosis based on the cause and age when the curve develops; most patients have no known cause termed as Idiopathic Scoliosis.
    The most common symptom of scoliosis is curvature of the spine.
    Scoliosis risk factors include age (9- to 15-year-olds), female sex, and family history.
    Diagnosis is done by the physical exam and by imaging techniques such as X-rays.
    Depending on the severity of the curve and the risk for it getting worse, scoliosis can be treated with observation, bracing, or surgery.
    Trained Spine surgeons are often consulted for treatment.
    Most scoliosis surgeons agree that children who have very severe curves (45-50° and higher) will need surgery to lessen the curve and prevent it from getting worse.
    The operation for scoliosis is a spinal fusion. The basic idea is to realign and fuse together the curved vertebrae so that they heal into a single, solid bone.
    The prognosis for an individual with scoliosis ranges from mainly good to fair, depending on how early the problem is diagnosed and treated. Screening is one of the key elements for early detection.

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