Scoliosis

Scoliosis is an abnormal lateral curvature of the spine, often presenting as an "S" or "C" shape when viewed from behind. It can affect people of all ages and ranges from mild to severe, with significant cases potentially impacting lung and heart function.

Scoliosis alters the normal load distribution across the spine, which over time can accelerate Degenerative Disc Disease and Facet Disease at the curves' apex and adjacent levels. In adult degenerative scoliosis, the progressive curvature can also contribute to Spinal Stenosis and Foraminal Stenosis as the spine twists and narrows the nerve channels.

Causes

Idiopathic scoliosis.

The most common form of scoliosis has no identifiable cause and is referred to as idiopathic. Adolescent idiopathic scoliosis, which develops during the growth spurt before puberty, accounts for the majority of cases. It is more common in girls and tends to run in families.

Other causes

Scoliosis can also result from neuromuscular conditions such as cerebral palsy or muscular dystrophy, congenital vertebral abnormalities present at birth, degenerative changes in adulthood, or as a consequence of spinal injury or infection.

Symptoms

Many people with mild scoliosis have no symptoms. Visible signs may include uneven shoulders, a prominent shoulder blade, an uneven waist, or one hip appearing higher than the other. In more significant curves, patients may experience back pain, fatigue, and in severe cases, reduced lung capacity and difficulty breathing.

Diagnosis

A physical examination includes the Adam's forward bend test, which can reveal asymmetry in the rib cage or lower back. Standing X-rays of the full spine are used to measure the degree of curvature using the Cobb angle method.

A cervical or lumbar spine MRI may be ordered to evaluate for underlying spinal cord abnormalities such as Syringomyelia or tethered cord, particularly in younger patients or atypical curve presentations.

Curve Classification

Scoliosis severity is classified based on the Cobb angle measured on X-ray.

• Mild: Cobb angle less than 25 degrees — typically monitored without active treatment.
• Moderate: Cobb angle between 25 and 40 degrees — bracing may be recommended in growing patients.
• Severe: Cobb angle greater than 40–50 degrees — surgical intervention may be considered.

Treatments

Treatment is tailored to the patient's age, skeletal maturity, curve magnitude, and likelihood of progression.

Mild curves in growing children are typically monitored with periodic X-rays every 4–6 months to track any changes. Activity restrictions are generally not necessary.

Bracing: For moderate curves in skeletally immature patients, a brace such as the Boston brace may be prescribed to prevent further progression. Bracing does not correct an existing curve but can halt its advancement during growth.

Physical therapy

Scoliosis-specific exercises, such as the Schroth method, are designed to strengthen spinal muscles, improve posture, and reduce pain. While they do not reverse curvature, they can improve function and quality of life.

Surgical treatment

Surgery is considered for severe or rapidly progressing curves, particularly when conservative measures have failed or when there is risk of cardiopulmonary compromise. Spinal fusion is the most common procedure, using rods, screws, and bone grafts to straighten and permanently stabilize the spine.

Related Spine Conditions

• Degenerative Disc Disease
• Spinal Stenosis
• Facet Disease
• Foraminal Stenosis
• Spondylolisthesis
• Back to all Spine Conditions