Scoliosis
Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty, though it can develop at any age. While a normal spine appears straight when viewed from behind, a spine with scoliosis curves to the left or right in an “S” or “C” shape. The condition ranges from mild to severe, with approximately 2-3% of the population affected. Most cases are idiopathic (no known cause), though scoliosis can also result from neuromuscular conditions, congenital abnormalities, or degenerative changes in adults.
What is it?
Scoliosis involves an abnormal lateral (side-to-side) curvature of the spine combined with rotation of the vertebrae. The severity is measured by the Cobb angle—the degree of curvature on a spine X-ray. Curves less than 10 degrees are not considered true scoliosis but rather asymmetry. Mild scoliosis ranges from 10-25 degrees, moderate from 25-40 degrees, and severe scoliosis is greater than 40-50 degrees. The condition can affect any part of the spine but most commonly involves the thoracic (mid-back) or lumbar (lower back) regions, or both in a double curve pattern.
Scoliosis is classified into several types based on cause and age of onset: idiopathic scoliosis (80-85% of cases) has no identifiable cause and is subdivided into infantile (0-3 years), juvenile (4-10 years), and adolescent (11-18 years) types, with adolescent idiopathic scoliosis being most common; congenital scoliosis results from abnormal vertebral development before birth; neuromuscular scoliosis occurs due to conditions like cerebral palsy, muscular dystrophy, or spinal cord injury that affect muscle control; degenerative scoliosis (adult scoliosis) develops in older adults due to deterioration of spinal discs and joints; and syndromic scoliosis is associated with genetic conditions like Marfan syndrome or neurofibromatosis. Risk factors include family history (genetic predisposition), female gender (girls are more likely to have curves that progress and require treatment), and age (curves typically develop or worsen during growth spurts).
Important to Know
Mild scoliosis often causes no symptoms and may only be noticed through physical signs such as uneven shoulders, one shoulder blade more prominent than the other, uneven waist, one hip higher than the other, or the body leaning to one side. In adolescents, back pain is uncommon with idiopathic scoliosis. However, severe curves can cause more noticeable deformity, breathing difficulties if the ribcage is compressed, and back pain, particularly in adults with degenerative scoliosis. Very severe, untreated curves can affect heart and lung function. Diagnosis begins with physical examination including the Adams forward bend test, where the patient bends forward at the waist and the examiner looks for asymmetry. Standing full-spine X-rays confirm the diagnosis and measure the Cobb angle to determine severity. MRI may be ordered if there are concerning features suggesting an underlying spinal cord problem. Treatment depends on curve severity, age, and remaining growth potential. Observation with periodic X-rays is used for mild curves (under 25 degrees). Bracing is the primary treatment for moderate curves (25-40 degrees) in growing children and adolescents to prevent progression—braces don’t correct existing curves but can prevent worsening. Physical therapy and scoliosis-specific exercises may help with posture, strength, and pain management. Surgery (spinal fusion) is considered for severe curves over 40-50 degrees that continue to progress, particularly if they cause significant deformity, pain, or functional limitations. The prognosis varies—many people with mild scoliosis live normal, active lives without treatment, while those with severe curves may experience ongoing challenges even with treatment. Regular monitoring during growth years is essential to catch progression early.