Q: What is Scoliosis and how is it treated?

Ask Our Expert About Scoliosis

About Our Expert

Jeffrey R. McConnell, M.D.

A: Scoliosis is defined as a lateral curvature of the spine. Instead of the spine being straight it assumes an “S” shape. The scoliosis curve actually occurs in three dimensions and it is the rotation of the spine that causes the characteristic changes observed during a physical examination. No one’s spine is perfectly straight; therefore a curve of 10 degrees or more, as measured by X-ray, is considered to be a true scoliosis.

Scoliosis can be caused by a variety of underlying conditions, however the most common type of scoliosis is known as “Idiopathic”. This means that the exact cause is unknown. There are plenty of theories as to how scoliosis occurs and scientific studies continue to find the cause. Idiopathic scoliosis does not occur at birth, but develops during early adolescence. Idiopathic scoliosis is actually a quite common musculoskeletal condition, being present to some degree in 24 out of 1000 young people. Scoliosis occurs slightly more often in girls and there is approximately a 30% chance of developing scoliosis if your mother or father had it. Scoliosis is not a painful condition although some children with the condition will have an occasional mild backache.

Scoliosis is diagnosed by physical examination and X-ray. Most cases of scoliosis are discovered around the time of a child’s most rapid period of growth or “growth spurt”. This is the time when most school screening examinations for scoliosis are performed. The examination of a child with scoliosis may show an asymmetry of the trunk with prominence of the ribs on one side in the upper spine or in the muscles of the lower back. The upper body may be shifted or offset to one side making one hip appear higher than the other. One shoulder may be elevated or the shoulder blade on one side may stick out more than the other. Most importantly, the physical examination is used to exclude other, less common, causes for curvature of the spine. X-rays of the spine are used to confirm the diagnosis of scoliosis and to measure the degree of curvature. X-rays also exclude other possible causes for a spinal curvature such as malformations of the vertebra that occur with congenital scoliosis.

Most cases of scoliosis do not require treatment. The majority of scoliosis curves do not progress or worsen significantly during the remaining growth of teenage years. After skeletal maturity, individuals with curves that remain at 30 degrees or less can expect their curves not to progress as an adult. Those with curves more than 30 degrees may show slow progression during their adult years. Long-term follow-up studies over 50 years indicate that most individuals with scoliosis do well despite their curvature and are not disabled and end up in a wheelchair.

Bracing can be used as a means to halt or slow the progression of a scoliosis curve during the remaining growth of a child. The effectiveness of bracing is controversial, however it appears to work best for younger (ages 8 – 12), skeletally immature, children with lots of growth potential left who have modest (20 - 25 degree) curves that demonstrate progression. While exercise is important for the health of any spine, it does not change the degree of curvature. Spinal manipulation or traction does not improve scoliosis either. Surgery is reserved for the minority of individuals with scoliosis curves that progress to 45 – 50 degrees or more and that result in bodily changes that the individual considers cosmetically unpleasing. Modern techniques and spine instrumentation make scoliosis surgery much safer, and it produces better results than it did years ago. Surgery involves fusing or welding vertebra together and placing rods with hooks, screws or wires to straighten the spine. The goal of surgery is to prevent further progression of the curve, straighten and rebalance the spine, and improve cosmetic appearance.

A child with idiopathic scoliosis should never be considered “abnormal” or disabled. There is no reason to place limitations on a child with scoliosis. A spine with scoliosis is not weaker or more prone to injury than a spine without scoliosis. Adolescents with scoliosis may participate in any physical activity or competitive sports. Carrying heavy school backpacks do not cause or worsen scoliosis. Scoliosis is not made worse by pregnancy nor does it interfere with the ability to deliver children. Most cases of scoliosis do not require treatment. Some cases of scoliosis may progress in adulthood but most individuals with the condition do well long term. A small number of cases of idiopathic scoliosis progress to a significant degree where the individual may wish to consider surgical intervention. Modern scoliosis surgery allows for safer and more effective correction of the curve.

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