Bones, joints, and muscles

What is scoliosis?

The spine normally has curves that produce the inward sway of the lower back and the rounding of the shoulders. In scoliosis, however, the spine has abnormal curvature, deformity, and rotation; the spine curves from side to side. Think of scoliosis as the spine's turning on its axis like a corkscrew. On an x-ray, a scoliotic spine looke more like a "S" or a "C" than a straight line. Simply, scoliosis is curvature of the spine. Unlike poor posture, this type of curvature cannot be corrected by avoiding slouching and learning to stand straight.¹

Who gets scoliosis?

Scoliosis may have its onset during infancy, but it develops most frequently during adolescence.¹

Scoliosis affects approximately two percent of the population. Scoliosis is more common in females than in males, with females twice as likely to develop abnormal curvature of the spine. The most common form of scoliosis is idiopathic scoliosis.²

What causes scoliosis?

It's unclear what causes idiopathic scoliosis, but because scoliosis runs in families, it's thought to develop when certain hereditary factors are present. If you have a family history of scoliosis, you are 20 times more likely to develop it, and you should be examined for scoliosis. Idiopathic scoliosis usually develops in middle or late childhood, before puberty, and it is more common in girls than in boys. Although idiopathic scoliosis can occur in children with cerebral palsy, muscular dystrophy, spina bifida and other medical conditions, it is also found in otherwise healthy children.³

While scoliosis occurs more commonly during childhood, adults can also develop the condition. Adult scoliosis may actually be the progression of scoliosis that began in childhood and was not diagnosed or treated. A slight or moderate curve has progressed in the absence of treatment. Other cases of adult scoliosis, however, may be caused by degenerative changes. Osteoperosis in older adults, for example, can lead to other spinal deformities such as kyphosis (round back; also sometimes called a dowager's hump). If allowed to progress, severe cases of adult scoliosis can result in chronic back pain, deformity, and respiratory problems.⁴

Signs and symptoms of scoliosis

Because idiopathic scoliosis is rarely painful during early childhood, it can often go undetected. Therefore, parents should watch for the following signs and symptoms of idiopathic scoliosis:⁵

• uneven shoulders or waist
• prominent shoulder blade(s)
• elevated hips
• leaning to one side

If your child exhibits one or more of the above signs, consult your physician, pediatrician, or orthopedist.

Treatment of scoliosis

Scoliosis causes asymmetry in the shoulders, trunk, and waistline. This is because some of the bones in a scoliotic spine may have rotated slightly. This rotation may make a person's shoulders or hips appear uneven. In mild cases of scoliosis, these irregularities are barely noticeable, whereas in severe cases, there is noticeable disfigurement, back pain, and fatigue. In some cases, scoliosis may be associated with heart failure.⁶

Fortunately, the majority of scoliosis cases require nothing more than regular medical checkups to monitor progression of the curve. This involves observing the curvature through regular examination and repeated x-rays. Where the spine is still growing, as in adolescence, an orthopedic back brace may be used keep the curve from getting worse. The brace is used in combination with follow-up x-rays.⁷ While the prospect of having to wear a brace may seem scary and unappealing to your child, it should be noted that children undergoing treatment with back braces can continue to participate in a full range of physical and social activities.⁸ You may wish to buy a copy of Judy Blume's Deenie to read with your child.

Physical therapy and treatments such as electrical muscle stimulation, back exercises, and manipulation of the spine have not been shown to be effective in the treatment of scoliosis.

In cases where back braces have failed or in which it is necessary to halt further progression of the curve, more aggressive treatments such as corrective surgery may be necessary. Surgery has been found to be both safe and highly effective.⁷

Surgery helps ease discomfort and postural fatigue while improving undesired appearance. The most common surgical treatment of scoliosis involves spine fusion using special stainless steel rods and hooks in addition to a bone graft. The rods are attached to the spine with hooks and the curved portion of the spine is carefully straightened. Following this, small strips of bone graft are then placed over the spine to fuse it into a straight position. As the bone graft heals, the spine becomes solid and is no longer prone to abnormal curvature. That part of the spine which has not been fused will remain flexible, allowing near normal movement and flexibility.⁹

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1. Scoliosis. Your Orthopedic Connection. American Academy of Orthopedic Surgeons. (2000)
2. Treatment of Scoliosis. Southern California Orthopedic Institute. (2003)
3. Scoliosis. Your Orthopedic Connection. American Academy of Orthopedic Surgeons. (2000)
4. Scoliosis. Your Orthopedic Connection. American Academy of Orthopedic Surgeons. (2000)
5. Treatment of Scoliosis. Southern California Orthopedic Institute. (2003)
6. Treatment of Scoliosis. Southern California Orthopedic Institute. (2003)
7. Treatment of Scoliosis. Southern California Orthopedic Institute. (2003)
8. Scoliosis. Your Orthopedic Connection. American Academy of Orthopedic Surgeons. (2000)
9. Treatment of Scoliosis. Southern California Orthopedic Institute. (2003)