What Is Scoliosis?

Scoliosis is a sideways curve of the spine forming an S- or C-shape. An estimated 2% to 3% of the population has scoliosis. The condition is usually detected in childhood or adolescence, when the spinal vertebrae are still growing.

Mild scoliosis may not cause symptoms, but more severe cases can cause back pain, uneven shoulders or hips, or difficulty breathing. There are several types of scoliosis, and the cause is not always known. Treatment depends on your age and the type and severity of scoliosis.

Types of Scoliosis

Scoliosis is classified into different types based on the cause, age of onset, and location of the curvature. Knowing which type of scoliosis you have helps healthcare providers develop an appropriate treatment plan.

Idiopathic Scoliosis 

Idiopathic scoliosis is the most common type. About 80% of all scoliosis cases are idiopathic, meaning there is no known cause. Genetics may play a role, as this type tends to run in families. Most cases develop in children ages 10 or older. 

Idiopathic scoliosis is grouped into three types, based on age at diagnosis:

• Infantile scoliosis: 3 years or younger
• Juvenile scoliosis: 4-10 years
• Adolescent scoliosis: 11-18 years

Congenital Scoliosis 

Congenital scoliosis occurs at birth when one or more spinal vertebrae do not form or separate properly as an embryo develops. About one in 10,000 newborns are born with this type of scoliosis. Children with congenital scoliosis may have additional health issues, such as heart or kidney problems. 

Neuromuscular Scoliosis 

Neuromuscular conditions that affect the nerves and muscles and impair the body's ability to support the spine, such as muscular dystrophy and cerebral palsy, can cause neuromuscular scoliosis. This type of scoliosis often progresses quicker than others. The curvature is also longer than other types of scoliosis and involves the entire spine.

Degenerative Scoliosis

Different from the three types of scoliosis that develop before or during childhood, degenerative scoliosis affects the lower back (the lumbar spine) usually in people 65 or older. The curvature is often minor and any pain that comes with it would begin slowly and be in response to activity.

Scoliosis Symptoms 

Scoliosis symptoms vary depending on the severity and location of the curve. Many children and adolescents have no noticeable signs or symptoms. 

Signs and symptoms of scoliosis can include:

• Uneven shoulders, rib cages, and hips, with one appearing higher than the other 
• One shoulder blade sticking out more than the other 
• A visible curve in the spine
• The body leaning to one side when standing or sitting 
• Back pain 
• Fatigue or weakness after standing or sitting for a long time 
  

In more severe cases, some people with scoliosis have difficulty breathing because the curvature of the spine can restrict lung capacity and make it harder to take a deep breath. 

What Causes Scoliosis? 

Scoliosis can occur due to various factors, but in most cases, the cause is unknown (idiopathic). Researchers believe genetics may play a role in idiopathic scoliosis, as the condition often runs in families.

Other types of scoliosis have specific underlying causes. For instance, abnormalities in the development of the spine as a baby grows in the womb causes congenital scoliosis. And in the case of neuromuscular scoliosis, medical conditions that make it difficult for people to control the muscles that support the spine can lead to abnormal curvature.

Aging and problems in another part of the body can sometimes cause an ordinarily straight spine to develop a curve. Degenerative scoliosis occurs when joints and spinal discs become damaged from wear and tear. Less commonly, adults may also develop scoliosis after becoming paralyzed or having trauma or a spinal surgery.

Risk Factors

Anyone can develop scoliosis at any age, but certain risk factors can increase the risk, including: 

• Family history: About 30% of people with idiopathic scoliosis have a family member with the condition.
• Age: Signs and symptoms usually begin in childhood or adolescence.
• Sex: Girls are more likely to develop scoliosis and have a higher risk of a more severe curve.
• Certain conditions: Marfan syndrome, Ehlers-Danlos syndrome, and other genetic conditions that affect your collagen and bones have been found to be associated with scoliosis. Certain neurologic conditions, such as spinal cord injury, are also associated with scoliosis.

How Is Scoliosis Diagnosed?  

Small scoliosis curves often go unnoticed until they are detected at a checkup with a pediatrician or during school screenings. To diagnose scoliosis, healthcare providers perform a physical exam, evaluate medical and family history, and order imaging tests. 

Physical Examination 

During a physical exam, your healthcare provider will evaluate your posture as you stand and sit; look for uneven shoulders, hips, and ribs; and ask you to bend forward to check for a noticeable curve in the spine. They may use a scoliometer, a tool used to measure the degree of the spinal curve.

Medical History 

A thorough review of your medical history can help your healthcare provider look for or rule out other conditions that may be causing a curve in your spine. They will ask about your family's medical history, including whether anyone has scoliosis. 

Imaging Tests

If your healthcare provider detects a curve in your spine during the physical exam, your healthcare provider will order imaging tests to confirm a scoliosis diagnosis. This may include: 

• X-ray: This imaging with provide pictures of the spine to visualize the degree of curvature (Cobb angle). A Cobb angle greater than 10 degrees indicates scoliosis.
• Computed tomography (CT) scan: These images are created using X-ray results. A CT scan can show the shape and size of the spinal canal, as well as what's inside it and around it. 
• Magnetic resonance imaging (MRI): This produces more detailed images of the spinal vertebrae to look for abnormalities in the spinal cord and helps diagnose specific types of scoliosis, such as degenerative scoliosis. 
  

Children born with congenital scoliosis may require additional imaging tests to check for kidney or heart problems, such as an ultrasound of the heart (echocardiogram) or kidneys or bladder (renal ultrasound).

Treatments for Scoliosis  

While there is no cure for scoliosis, several treatment options can help slow or prevent curve progression, manage or prevent pain and breathing difficulties, and improve your posture and quality of life. The specific treatment recommended depends on your age, the location and severity of the spinal curve, and whether you have symptoms.

Observation 

If you have mild scoliosis, your healthcare provider may take a watchful waiting approach and monitor your condition with regular checkups to see if your curve is progressing. 

Bracing

While bracing does not correct an existing spinal curve, it may help prevent the curvature from worsening. A brace is most effective when worn during childhood or adolescence, when the spine is still growing. 

Surgery 

Severe scoliosis may require surgery to correct the curvature. The type of surgical procedure performed depends on the severity and location of the curve. Surgical procedures to treat scoliosis include:

• Spinal fusion: This involves fusing (connecting) two or more vertebrae to stabilize the spine and prevent further curvature.
• Osteotomy: This involves removing and realigning spinal vertebrae to reduce the degree of curvature. Metal rods, screws, and plates hold the vertebrae in place to help vertebrae fuse and heal. 
• Vertical expandable prosthetic titanium rib (VEPTR): Expandable metal rods, called growth rods, are placed alongside the spine and attached to curved vertebrae using screws or hooks. The rods help straighten the spine gradually and are adjusted over time to accommodate a child's growth.

Physical Therapy 

Physical therapy (PT) for scoliosis focuses on improving spinal mobility, pain relief, and preventing further curvature progression. Your physical therapist will develop a tailored exercise and stretching program based on your needs. PT programs usually include strength training, range of motion exercises, and education and training on proper posture and body mechanics to improve spinal alignment.

How to Prevent Scoliosis 

As most cases of scoliosis are idiopathic and have no known cause, there is really no known way to prevent scoliosis. 

If you have scoliosis, scoliosis-specific exercises may help slow or prevent curve progression. Scoliosis exercises focus on improving your posture and building core muscle strength to support the spine. Your healthcare provider can recommend a scoliosis-specific exercise program for your specific needs.

Braces can also prevent further curvature.

Related Conditions

People with scoliosis are at an increased risk of developing several other conditions:

• Anxiety and depression: Research shows that young people with adolescent idiopathic scoliosis have a higher risk of developing mental health disorders like anxiety and depression.
• Osteoporosis: Bone mineral density is significantly lower in people with scoliosis, increasing the risk of osteoporosis. Up to 38% of adolescents with idiopathic scoliosis have osteoporosis, which causes weaker bones and an increased risk of fractures.
• Gastroesophageal reflux disease (GERD): A 2021 study found that people with scoliosis are at an increased risk of developing GERD. Researchers believe that the abnormal curvature of the spine can weaken the lower esophageal sphincter, allowing stomach acid to flow back up into the esophagus.
• Headaches: Scoliosis can strain the neck muscles over time, causing frequent tension headaches. Scoliosis is also associated with reduced cerebrospinal fluid flow to the brain, increasing the risk of spinal headaches.
  

Living With Scoliosis  

With appropriate treatment and management, most people with scoliosis can live active, healthy lives. Regular monitoring and scoliosis-specific exercises may be sufficient for people with mild scoliosis to manage symptoms and prevent further curve progression. In more severe cases, bracing or surgery may be necessary to improve your quality of life. 

Living with scoliosis can be emotionally and physically taxing. Seeking support from family, friends, and healthcare providers can help you manage the emotional aspects of scoliosis. If you or your child has scoliosis, you may find it valuable to join a support group to connect with others with the condition.