Scoliosis

What is scoliosis?

Scoliosis is an abnormal side-to-side curvature of your spine. Your spine (backbone) naturally has a slight forward and backward curve. With scoliosis, your spine curves to the left and right into a C or S shape.

Most cases of scoliosis are mild, don’t cause symptoms and don’t need treatment. Severe cases can cause uneven posture and pain. Treatment may include wearing a brace or surgery.

What are the types of scoliosis?

There are three types of scoliosis:

• Idiopathic scoliosis: This is the most common type. “Idiopathic” means the cause is unknown. Research does indicate that it runs in families and has a genetic (hereditary) link.
• Congenital scoliosis: This is a rare spine abnormality that a healthcare provider may detect at birth. It occurs when vertebrae (the bones that make up your spine) don’t form as they should during embryonic development.
• Neuromuscular scoliosis: Abnormalities in the muscles and nerves that support your spine cause this type. It usually happens alongside neurological (nerve) or muscular conditions like an injury, cerebral palsy, spina bifida or muscular dystrophy.

You may hear your provider refer to scoliosis diagnosed during adulthood as adult-onset scoliosis or degenerative scoliosis. You may have had mild, undiagnosed scoliosis throughout your life. Symptoms can increase or appear as your body ages, which results in a late diagnosis. Specifically, adult-onset scoliosis happens when your disks and joints weaken or you lose bone density (osteoporosis).

Healthcare providers use different names to refer to idiopathic scoliosis according to when it’s diagnosed:

• Infantile scoliosis: Younger than age 3.
• Juvenile scoliosis: Age 4 through 10.
• Adolescent scoliosis: Age 11 through 18.
• Adult idiopathic scoliosis: Diagnosed any time after age 18 when skeletal growth is complete.

How common is scoliosis?

Scoliosis affects an estimated 2% of people around the world. In the United States, this equals over 6 million people.

What are the symptoms of scoliosis?

Scoliosis usually doesn’t cause symptoms, but they may include:

• Back pain.
• Difficulty standing upright.
• Core muscle weakness.
• Leg pain, numbness or weakness.

What are the signs of scoliosis?

Signs of scoliosis may include:

• Uneven shoulders.
• Shoulder blades that stick out.
• Head that doesn’t center above your pelvis.
• Uneven waist.
• Elevated hips.
• Constant leaning to one side.
• Uneven leg length.
• Changes in skin appearance or texture (dimples, hair patches, skin discoloration). These occur on your back along your spine.

If you notice any of these signs, contact a healthcare provider for a screening.

Over time, you may notice:

• Height loss.
• Uneven alignment of your pelvis and hips.

What part of the spine does scoliosis affect?

Scoliosis can affect any part of your spine. There are some differences according to age:

• Adolescents: Most cases occur in the thoracic spine (rib cage) area.
• Adults: The main concern is in the lumbar or lower spine. The lumbar spine is most susceptible to the changes seen with aging or degeneration, which increases symptoms like pain.

What causes scoliosis?

The cause of scoliosis varies depending on the type but may include:

• Vertebrae malformation during embryonic development.
• A genetic change.
• A spine injury.
• A tumor on your spine.
• A condition that affects your nerves or muscles.

Most often, though, healthcare providers can’t identify a specific cause (idiopathic scoliosis).

What are the risk factors for scoliosis?

You’re more at risk of developing scoliosis if you:

• Have a biological family history of scoliosis.
• Have an underlying condition or injury that affects your spine, muscles and nerves.

Scoliosis equally affects all genders and sexes, including people assigned male at birth (AMAB) and people assigned female at birth (AFAB). But people AFAB are more likely to need treatment due to the severity of the curve.

Is scoliosis genetic?

You’re more likely to develop scoliosis if someone in your biological family has the condition. But not all cases of scoliosis are genetic.

What are the complications of scoliosis?

Without treatment, severe cases of scoliosis can lead to:

• Long-lasting pain.
• Physical deformity.
• Organ damage.
• Nerve damage.
• Arthritis.
• Spinal fluid leakage.
• Difficulty breathing.

Contact emergency services if you have trouble breathing.

What is a scoliosis screening?

The first step of a scoliosis diagnosis is a scoliosis screening. You may remember getting a scoliosis screening during a pediatric wellness visit with your primary care physician or a school nurse. During a screening, a provider will ask you to:

• Remove your shirt to see your back.
• Stand up straight.
• Bend forward (like you’re touching your toes).

A screening helps your provider look at your posture, alignment and spinal curvatures. If the physician isn’t your primary care provider, they may recommend you visit one if the screening indicates you may have scoliosis.

Scoliosis screenings happen during childhood and adolescence to detect scoliosis early. An early diagnosis can help your provider offer more treatment options, if necessary.

How is scoliosis diagnosed?

A healthcare provider will diagnose scoliosis after a physical exam. They may perform a screening in their office, which will include having you stand up straight and then bend forward to touch your toes. Your provider will examine your back to check the shape of your spine and see how you move around. They’ll also check your nerves by testing your reflexes and muscle strength.

Before your healthcare provider can suggest a treatment plan, they’ll ask you questions about the following:

• Your medical history and family medical history.
• The date when you first noticed a change in your spine or the date of your initial screening.
• Symptoms (if you have any).
• Any bowel, bladder or motor symptoms, which may be signs of more serious nerve damage or pressure caused by scoliosis.

If needed, your provider may order imaging tests. X-rays taken from the front and side will show a full picture of your spine. Your provider can then determine if you have scoliosis and if so, to what degree. Other imaging tests may include an MRI (magnetic resonance imaging) or CT (computed tomography) scan.

If your provider determines that you have scoliosis that requires treatment, they’ll refer you to an orthopaedic spine specialist.

When is scoliosis diagnosed?

A scoliosis diagnosis is most common during adolescence, between ages 10 and 15.

As you age, your spine curves (degeneration). For this reason, adults can get a scoliosis diagnosis later in life. This usually happens if scoliosis is mild and goes undetected during childhood.

How is scoliosis measured?

A healthcare provider will measure the curve of your spine in degrees. They’ll rate the severity based on the degree of the curve:

• No scoliosis diagnosis: Less than 10 degrees.
• Mild scoliosis: Between 10 to 24 degrees.
• Moderate scoliosis: Between 25 to 39 degrees.
• Severe scoliosis: More than 40 degrees.

This is similar to how you measure angles with a protractor in geometry class. Your provider will use a device called a scoliometer to measure the curve by placing the tool on your back. They may also order an X-ray of your spine to measure the curve.

How is scoliosis treated?

Treatment for scoliosis isn’t necessary for all cases.

If your provider recommends treatment, they’ll consider several factors:

• The type of scoliosis.
• The degree of the curve.
• Your family history of scoliosis.
• Your age.
• The number of remaining growth years until skeletal maturity.

Treatment focuses on relieving symptoms and not necessarily straightening the curve. The goal is to decrease symptoms and curve progression and improve the function of your spine.

There are two types of treatment for scoliosis:

• Nonsurgical (conservative) treatment.
• Surgery.

Conservative scoliosis treatment

Most cases of scoliosis don’t require surgery. Instead, providers recommend conservative treatment first, which may include:

• Visiting a healthcare provider regularly (usually every six months) to monitor the degree of the curve.
• Taking over-the-counter pain relievers or anti-inflammatories (as needed or as directed by your provider).
• Exercising to strengthen your core muscles and improve flexibility.
• Wearing a back brace to support your spine.
• Managing any underlying conditions.

Your provider may recommend physical therapy. This can help you strengthen your muscles and relieve pain. Your physical therapist may help you with the following:

• Improving your posture.
• Low-impact exercises, such as swimming.
• Daily stretching.
• Physical activity guidance.

Scoliosis surgery

Surgery may be an option to treat some types of scoliosis that don’t respond to conservative treatment. Your provider may recommend surgery to:

• Stabilize your spine.
• Restore balance.
• Relieve pressure on nerves.

There are different techniques your surgeon may use to treat scoliosis, including:

• Spinal fusion: To stabilize your spine, your surgeon will fuse the bones of your spine together. Then, they’ll use metal braces to hold your spine in place.
• Expandable rod: A surgeon will insert an expandable rod along the vertebrae to support a child’s growing spine. They’ll adjust the length of the rod as a child grows.

Advances in surgical techniques and computer-assisted technologies make less invasive approaches possible and recovery time quicker.

Are there complications of scoliosis surgery?

Scoliosis surgery is a safe procedure, but complications are possible and may include:

• Infection.
• Bleeding.
• Blood clots.
• Nerve damage.
• Limited movement.

Can scoliosis be prevented?

There’s no known way to prevent scoliosis.

If you have scoliosis, a healthcare provider might recommend strengthening your back and abdominal muscles with stretching and exercises. These can help prevent the curve in your spine from getting worse.

What can I expect if I have scoliosis?

Though scoliosis is often asymptomatic, symptoms may appear as your body ages and natural spine degeneration occurs. A healthcare provider can help you manage symptoms if they become bothersome.

Scoliosis can change the way your body looks depending on the degree of the spinal curve. This might be challenging for your emotional well-being. A mental health professional can help you manage how you feel about your body.

What’s the outlook for scoliosis?

The outlook for scoliosis can vary depending on the type and severity. Most people can live normally, without any changes to their routines.

What physical activities are safe with scoliosis?

Talk to your healthcare provider or physical therapist about what activities are safe to do. Most people with scoliosis can participate in physical activities and exercise. Routine movement can reduce the severity of symptoms. If an activity causes pain, listen to your body and stop.

Can playing sports make scoliosis worse?

Most cases of scoliosis are diagnosed during adolescence. This is the time when many children are eager to jump into team sports and athletic programs. As a parent or caregiver, you might wonder what activities are safe for your child.

Luckily, playing sports won’t make scoliosis worse. In fact, participating in sports that promote flexibility and core strength can reduce your child’s symptoms.

Sports that can help scoliosis include:

• Swimming: It can increase core strength, as it requires your child to use all of their muscles at once.
• Gymnastics: It can boost your child’s flexibility and improve core strength.

Should certain sports be avoided with scoliosis?

Talk to your child’s healthcare provider about what’s safe for them. Most sports, even weightlifting, are generally fine. However, if your child had back surgery, they should avoid contact sports. These include hockey, lacrosse, wrestling and football.

When should I see a healthcare provider?

Contact a healthcare provider if:

• You believe you have signs or symptoms of scoliosis.
• Your treatment doesn’t seem to be working.
• Your symptoms get worse.

As a parent or caregiver, it’s important to contact a pediatrician if:

• A routine screening suggests your child may have scoliosis.
• Your child has signs or symptoms of scoliosis.
• Treatment isn’t helping your child or their symptoms get worse.
• You have a biological family history of scoliosis and want to keep an eye on your child’s development.

What questions should I ask my healthcare provider?

• What type of scoliosis do I/does my child have?
• What type of treatment do you recommend?
• Do I/does my child need surgery?
• Are there side effects of the treatment?
• Should I/my child see a physical therapist?
• What types of physical activities are safe?