Scoliosis

Overview

Scoliosis is a sideways curve in the spine.  Typically, it occurs during the growth spurt that happens before puberty.

The cause of scoliosis in most adolescents is unknown.

Most cases of scoliosis are mild, but it can progress over time as an adolescent grows. If your child has a mild case of scoliosis, he or she will be monitored with X-rays over time. If your child has severe cases, surgery may be necessary.

Scoliosis causes

While the exact cause of scoliosis is unknown, it tends to run in families. Other causes of scoliosis include:

• Congenital birth defects that affect the spine bones.
• Infection in the spine.
• Spine injury.
• Neuromuscular conditions.

Scoliosis symptoms

There are a variety of signs or symptoms of scoliosis, including:

• Uneven shoulder or waist
• A shoulder that is more prominent than the other
• A hip that is higher than the other

If your case worsens, your spine may also rotate or twist as well as curving to the side. If this occurs, your ribs on one side of your body may appear to stick out farther on one side.

Scoliosis complications

Complications that can arise from more severe cases of scoliosis include:

• Damage to the lungs and the heart.
• Back conditions or issues.
• Disfigured appearance. As the condition intensifies, your hips and shoulders may become uneven as your bones shift.

Scoliosis risk factors

There are a variety of factors that can increase your risk of developing scoliosis, including:

• Symptoms of scoliosis typically start during the growth spurt before puberty.
• Females are more likely to develop more severe cases of scoliosis.
• Some children with scoliosis have parents with the condition.

Scoliosis prevention

While scoliosis cannot be prevented.

Scoliosis diagnosis

Your (or child's) doctor can diagnose scoliosis. During a clinic visit, your doctor will take a full medical history, perform a physical exam, and order diagnostic testing such as an X-ray, spinal radiograph, CT scan, or MRI.

During the physical exam, your doctor will have you or your child bend forward with your feet together and arms down. Your doctor will be able to quickly identify any abnormality curves in your spine during this exam.

Diagnostic imaging is necessary to determine the type and severity of the deformity. Typically, an X-ray can confirm the diagnosis. In some cases, an MRI or a CT scan may be used.

The Cobb Method is used to measure your curve and determine the severity of your case by the number of degrees. If you have a curve greater than 10 degrees, you will be diagnosed with scoliosis. If you have a curve of greater than 25 to 30 degrees, it is considered significant scoliosis. If you have a curve of more than 45 to 50 degrees, it is considered severe.

Scoliosis treatment

If you have been diagnosed with scoliosis, your doctor will take into consideration the following factors when developing your treatment plan:

• Females are most likely to develop scoliosis.
• Maturity of your (or your child’s) spine. Is the spine still growing?
• Degree of the curve. How severe is the curve? Is it impacting your (or your child’s) lifestyle?
• Curve location. Where the curve is located can impact how the condition progresses.
• Chance of progression. When did the curve begin? If the curve started before the teenage years, it is likely to progress further.

Depending upon the evaluation of these factors, your doctor may recommend observation, braces, or surgery for treatment.

Observation

In many cases, the curve in a child is mild and will not need immediate treatment. Your doctor may request follow-up appointments every four to six months during the teenage years.

In adults, your doctor may recommend a follow-up visit every five years unless symptoms are progressing.

Braces

If your child has moderate scoliosis, your doctor may prescribe a brace to help prevent progression of the curve. Most braces are worn all day and night. The brace is most effective when worn continuously. When a child's' bones stop growing, braces are typically discontinued.

Surgery

Surgery may be necessary for patients with severe scoliosis. The goal of surgery is to reduce the severity of the spinal curve and prevent progression. Spinal fusion is the most commonly used scoliosis surgery.

During spinal fusion, your orthopedic surgeon will connect two or more bones in the spine together, so they are unable to move. The spine is held straight with metal rods, hooks, screws or wires while the bones fuse.

If your child has a severe case that is progressing rapidly, your doctor may impact a rod that can adjust in length as your child grows.

When to Seek Care

If you or your child have symptoms of scoliosis, schedule an appointment with your doctor as soon as possible.

Next Steps

Before your appointment with your doctor, write down your symptoms, when they started, important family medical history notes, and any other questions you want to ask your doctor.

If you or your child has been diagnosed with scoliosis, follow your doctor and physical therapist's instructions carefully. Provide emotional support and resources to your child, so they can learn to cope with the diagnosis. If your symptoms are worsening, call your doctor as soon as possible.