Scoliosis is a sideways curvature of the spine, different from the spine’s natural front-to-back curve. It is often mild and may not show symptoms, but it can cause back pain and poor posture. Most cases of scoliosis are diagnosed in adolescence by healthcare providers. Common treatment options for scoliosis include physical therapy, back braces, and surgery.

 

What is scoliosis?

Scoliosis is a condition where the spine curves abnormally sideways, forming a C or S shape. While the spine naturally has forward and backward curves, scoliosis causes it to bend left or right.

Most cases of scoliosis are mild, often showing no symptoms and requiring no treatment. However, severe scoliosis can lead to uneven posture and back pain. Treatment options for scoliosis may include wearing a back brace or surgery.

Types of scoliosis

There are three main types of scoliosis:

1. Idiopathic scoliosis: The most common type of scoliosis, with no known cause. It is believed to have a genetic link as it often runs in families.
2. Congenital scoliosis: A rare type of scoliosis detected at birth, caused by improper formation of the spine’s vertebrae during fetal development.
3. Neuromuscular scoliosis: This type is caused by muscle and nerve abnormalities that affect the spine. It is often associated with conditions like cerebral palsy, spina bifida, muscular dystrophy, or spinal injury.

Scoliosis diagnosed in adulthood is known as adult-onset scoliosis or degenerative scoliosis. Mild cases may go unnoticed until symptoms appear later in life, often due to the weakening of spinal joints and disks or reduced bone density, such as from osteoporosis.

Idiopathic scoliosis is classified by age at diagnosis:

• Infantile scoliosis: Diagnosed before age 3.
• Juvenile scoliosis: Diagnosed between ages 4 and 10.
• Adolescent scoliosis: Diagnosed between ages 11 and 18.
• Adult idiopathic scoliosis: Diagnosed after age 18, once bone growth is complete.

How common is scoliosis?

Scoliosis affects around 2% of the global population, which equates to over 6 million people in the United States.

Symptoms and Causes of Scoliosis

What are the symptoms of scoliosis?

While scoliosis often doesn’t cause noticeable symptoms, it can lead to:

• Back pain
• Difficulty standing upright
• Weak core muscles
• Leg pain, numbness, or weakness

What are the signs of scoliosis?

The common signs of scoliosis include:

• Uneven shoulders
• Protruding shoulder blades
• A head that is not centered above the pelvis
• Uneven waist
• Raised hips
• Constant leaning to one side
• Uneven leg length
• Changes in the skin along the spine, such as dimples, hair patches, or discoloration

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

Over time, you may also notice:

• Loss of height
• Misalignment of the pelvis and hips

What part of the spine does scoliosis affect?

Scoliosis can affect any area of the spine. The affected region often depends on age:

• Adolescents: Most scoliosis cases develop in the thoracic spine (mid-back, around the rib cage).
• Adults: The lumbar spine (lower back) is most commonly affected due to aging or degeneration, often leading to increased back pain.

What causes scoliosis?

The causes of scoliosis depend on the type and may include:

• Malformed vertebrae during embryonic development
• Genetic changes
• Spinal injuries
• Tumors on the spine
• Conditions that affect the nerves or muscles

In most cases, however, the exact cause is unknown, which is referred to as idiopathic scoliosis.

What are the risk factors for scoliosis?

You may have a higher risk of developing scoliosis if:

• You have a family history of scoliosis.
• You have an underlying condition or injury that affects the spine, muscles, or nerves.

Scoliosis affects all genders, including people assigned male at birth (AMAB) and assigned female at birth (AFAB). However, those AFAB are more likely to need treatment due to more severe spinal curves.

Is scoliosis genetic?

Scoliosis may have a genetic link, especially if someone in your biological family has it. However, not all scoliosis cases are caused by genetics.

What are the complications of scoliosis?

Without treatment, severe scoliosis can cause complications such as:

• Chronic back pain
• Physical deformities
• Organ damage
• Nerve damage
• Arthritis
• Spinal fluid leakage
• Difficulty breathing

Seek emergency help if scoliosis causes breathing problems.

Scoliosis Diagnosis and Screening

What is a scoliosis screening?

A scoliosis screening is the first step in diagnosing scoliosis. It often occurs during childhood, either at a school health checkup or a pediatric wellness visit. During a scoliosis screening, the healthcare provider will:

• Examine your back (after you remove your shirt).
• Ask you to stand up straight.
• Have you bend forward, similar to touching your toes.

The provider will check for abnormal posture, spinal alignment, and curvature. If scoliosis is suspected, you may be referred to a primary care provider for further tests.

Early scoliosis screenings in childhood or adolescence allow healthcare providers to catch scoliosis early and provide more treatment options if necessary.

How is Scoliosis Diagnosed?

Scoliosis is diagnosed by a healthcare provider through a comprehensive physical examination. During this exam, the provider may ask you to stand straight and bend forward to touch your toes, allowing them to observe the curvature of your spine and evaluate your mobility. They will also assess your reflexes and muscle strength to check for any potential nerve issues.

Key Factors in Diagnosis

Before developing a treatment plan, your provider will inquire about:

• Medical and Family History: Any relevant past health issues.
• Onset of Symptoms: When you first noticed changes in your spine or underwent initial screenings.
• Current Symptoms: Any discomfort or pain you may be experiencing.
• Neurological Symptoms: Issues related to bowel, bladder, or motor functions, which might indicate nerve damage or pressure related to scoliosis.

If needed, your provider may order imaging tests. X-rays taken from the front and side provide detailed views of your spine, helping to confirm the presence of scoliosis and assess its severity. Additional imaging tests, such as MRI or CT scans, might also be necessary.

If treatment is indicated, your provider will refer you to an orthopedic spine specialist for further evaluation.

When is Scoliosis Diagnosed?

Scoliosis is most frequently diagnosed during adolescence, particularly between the ages of 10 and 15. However, adults can also receive a scoliosis diagnosis later in life, especially if a mild case went unnoticed during childhood. Age-related spinal degeneration can also contribute to the development of scoliosis in adults.

How is Scoliosis Measured?

Healthcare providers measure the spinal curve in degrees to determine the severity of scoliosis:

• No Scoliosis: Less than 10 degrees
• Mild Scoliosis: 10 to 24 degrees
• Moderate Scoliosis: 25 to 39 degrees
• Severe Scoliosis: 40 degrees or more

To measure the curve, your provider will use a device called a scoliometer, placed on your back. X-rays may be ordered for a more precise measurement of the spinal curvature.

Scoliosis Management and Treatment

How is Scoliosis Treated?

Not all cases of scoliosis necessitate treatment. If treatment is deemed necessary, your provider will consider several factors, including:

• Type of Scoliosis
• Degree of the Spinal Curve
• Family History of Scoliosis
• Patient Age
• Remaining Growth Years Before Skeletal Maturity

The primary goals of scoliosis treatment are to alleviate symptoms, prevent the progression of the spinal curve, and enhance spinal function, rather than solely focusing on straightening the spine.

Types of Scoliosis Treatment

Scoliosis treatment typically falls into two categories:

• Nonsurgical (Conservative) Treatment
• Surgical Intervention

Conservative Scoliosis Treatment

Most cases of scoliosis do not require surgery. Instead, healthcare providers typically recommend conservative treatment as the first line of action, which may include:

• Regular Check-Ups: Visiting a healthcare provider every six months to monitor the curvature of your spine.
• Pain Management: Using over-the-counter pain relievers or anti-inflammatories as needed or as directed by your provider.
• Exercise: Engaging in exercises to strengthen core muscles and enhance flexibility.
• Back Bracing: Wearing a back brace to provide support for your spine.
• Condition Management: Addressing any underlying health issues.

Your provider may also recommend physical therapy to help relieve pain and strengthen muscles. A physical therapist can assist with:

• Posture Improvement: Techniques to enhance your posture.
• Low-Impact Exercises: Activities such as swimming that are gentle on the body.
• Daily Stretching: Routines to improve flexibility.
• Activity Guidance: Recommendations for safe physical activity.

Scoliosis Surgery

For certain types of scoliosis that do not respond to conservative treatments, surgery may be recommended. Your provider may suggest surgery to:

• Stabilize the Spine: To provide long-term support.
• Restore Balance: To improve overall spinal alignment.
• Relieve Nerve Pressure: To reduce discomfort and improve function.

Common surgical techniques include:

• Spinal Fusion: This procedure involves fusing the bones of the spine together for stabilization, using metal braces to hold everything in place.
• Expandable Rod Insertion: A rod is inserted along the vertebrae to support a growing child’s spine, which can be adjusted as they grow.

Recent advancements in surgical techniques and computer-assisted technologies allow for less invasive procedures, resulting in faster recovery times.

Complications of Scoliosis Surgery

Although scoliosis surgery is generally safe, there can be complications, including:

• Infection
• Bleeding
• Blood Clots
• Nerve Damage
• Limited Movement

Can Scoliosis Be Prevented?

Currently, there is no known way to prevent scoliosis. However, if you have scoliosis, your healthcare provider may recommend strengthening your back and abdominal muscles through targeted stretching and exercises. This approach can help prevent the curvature of your spine from worsening.

Outlook / Prognosis

What Can I Expect If I Have Scoliosis?

While scoliosis is often asymptomatic, symptoms may develop as you age and experience natural spinal degeneration. If symptoms become bothersome, a healthcare provider can help you manage them.

Scoliosis can affect your body’s appearance depending on the degree of the spinal curve, which may impact your emotional well-being. If you find this challenging, a mental health professional can assist you in managing your feelings about your body.

What’s the Outlook for Scoliosis?

The prognosis for scoliosis varies based on the type and severity of the condition. Most people can live normal lives without significant changes to their routines.

Living With Scoliosis

What Physical Activities Are Safe With Scoliosis?

It’s important to consult your healthcare provider or physical therapist to determine which activities are safe for you. Most individuals with scoliosis can participate in physical activities and exercise. Regular movement can help reduce symptom severity. If any activity causes pain, it’s important to listen to your body and stop.

Can Playing Sports Make Scoliosis Worse?

Many cases of scoliosis are diagnosed during adolescence, a time when children are eager to participate in team sports and athletic programs. As a parent or caregiver, you may wonder which activities are safe for your child.

Fortunately, playing sports generally won’t worsen scoliosis. In fact, participating in sports that promote flexibility and core strength can alleviate your child’s symptoms. Beneficial sports include:

• Swimming: This activity strengthens the core as it engages all muscle groups.
• Gymnastics: This sport enhances flexibility and core strength.

Should Certain Sports Be Avoided with Scoliosis?

Discuss safe sports options with your child’s healthcare provider. Most sports, including weightlifting, are generally acceptable. However, if your child has had back surgery, they should avoid contact sports like hockey, lacrosse, wrestling, and football.

When Should I See a Healthcare Provider?

Contact a healthcare provider if you:

• Suspect you have signs or symptoms of scoliosis.
• Find that your treatment isn’t effective.
• Notice that your symptoms are worsening.

As a parent or caregiver, it’s crucial to reach out to a pediatrician if:

• A routine screening suggests your child may have scoliosis.
• Your child exhibits signs or symptoms of scoliosis.
• Treatment isn’t helping your child, or their symptoms are worsening.
• You have a family history of scoliosis and want to monitor your child’s development.

What Questions Should I Ask My Healthcare Provider?

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

A Note from Cleveland Clinic

It’s understandable to feel concerned if your child comes home with a note indicating a screening for scoliosis or if a healthcare provider has identified bone degeneration affecting your posture and height. Most cases of scoliosis are mild, and treatment may not always be necessary. Often, nonsurgical options like wearing a brace are sufficient. However, surgery is a safe option for treating severe curves. Your provider will advise you on whether treatment is necessary and how to care for yourself or your child following a scoliosis diagnosis.