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Scoliosis is a problem with
the curve in your
spine. Some curves in your spine are normal. But a few
people have spines that make a
large curve from side to side in the shape of the letter "S" or the letter
"C." If this curve is severe, it can cause pain and make breathing
The good news is that most cases of scoliosis are
mild. If found early, they can usually be prevented from getting worse.
In most cases, the cause of
scoliosis is not known. Scoliosis usually starts
Scoliosis that is severe enough to need treatment is most common in girls.
A curve in the spine may
get worse as your child grows, so it is important to find any problem
Scoliosis most often causes
no symptoms in your child until the spinal curve becomes large. You might
notice these early signs:
In adults, scoliosis may cause back pain and trouble
The doctor will check
to see if your child's back or ribs are even. If the doctor finds that one side
is higher than the other, your child may need an X-ray so the spinal curve can
Scoliosis is most serious in young children who are
still growing. A curve in the spine may get worse as your child grows.
So many experts believe screening your
child for scoliosis is important so that any curve in the spine can be found
early and watched closely.
Mild cases of scoliosis usually
do not need treatment. Your doctor will check the curve of your child's spine
every 4 to 6 months. If the curve gets worse, your child may need to wear a
brace until he or she has finished growing. In severe cases, or if bracing
doesn't help, your child may need to have surgery.
its treatment can be a severe strain on your child. Wearing a brace can feel
and look odd. It also limits your child's activity. Your child needs your
support and understanding to get through treatments successfully.
may be more likely to have scoliosis if someone in your family has had it and
if your child is a girl. Other things that increase the chance of scoliosis
Learning about scoliosis:
Living with scoliosis:
Health Tools help you make wise health decisions or take action to improve your health.
In most cases, the cause of
scoliosis is not known. This is called idiopathic
scoliosis. It develops mostly in children and teens and appears to be related
to several things, including genetics, as it often runs in families.
There are two types of scoliosis: nonstructural and structural.
Nonstructural (functional) scoliosis involves a curve in the
spine, without rotation, that is reversible because it is caused by a condition such as:
Structural scoliosis involves a
curve in the spine, with rotation, that is irreversible and is usually caused
by an unknown factor (idiopathic) or a disease or condition such as:
In adults, scoliosis may result from changes in the spine
due to aging (degenerative changes). These degenerative changes may be caused
In children and teens,
scoliosis typically does not cause symptoms and is not
obvious until the curve of the spine becomes moderate or severe. It may first become
noticeable to a parent who observes that the child's clothes do not fit right
or that hems hang unevenly. The child's spine may look crooked, or the ribs may
In a child who has scoliosis:
Most of the time scoliosis does not cause pain in children
or teens. When back pain is present with
scoliosis, it may be because the curve in the spine is causing stress and pressure on the spinal discs, nerves, muscles, ligaments, or facet joints. It is not usually caused by
the curve itself. Pain in a teen who has scoliosis may indicate another problem, such
as a bone or spinal tumor. If your child has pain associated with scoliosis, it
is very important that he or she see a doctor to find out what is causing the
Adults who have scoliosis may or may not have back pain. In
most cases where back pain is present, it is hard to know whether scoliosis is
the cause. But if scoliosis in an adult gets worse and becomes severe, it
can cause back pain and difficulty breathing.
other conditions, such as
kyphosis, cause symptoms similar to scoliosis.
Idiopathic scoliosis, the most
common type, does not have a known cause. Children who have this type of
scoliosis usually first develop symptoms in childhood.
Most cases of scoliosis are mild, involving small curves in the spine that do
not get worse. Small curves usually do not cause pain or other problems.
Usually a doctor examines the child every 4 to 6 months to watch for any
In moderate or severe cases of scoliosis, the curves
continue to get worse. During periods of growth, such as during the teenage
growth spurt, the curves may get worse. Mild to moderate curves often
stop progressing when the skeleton stops growing, while larger curves may get
worse throughout adulthood unless they are treated.
1 out of 10 children who are diagnosed with scoliosis require treatment (either
bracing or surgery).1
Things that may
point to the potential increase in a spinal curve include:
Girls are more likely than boys to have larger curves and
more severe scoliosis.
As scoliosis gets worse, the bones of the
spine rotate toward the inner part of the curve. If the upper part of the spine
is affected, the ribs may crowd together on one side of the body and become
widely separated on the other side. The curve may force the space between the
spinal bones to narrow. The spinal bones may also become thicker on the outer
edge of the curve.
In severe curves, misshapen ribs may reduce the
amount of air the lungs can hold and may cause the heart to work harder to pump
blood through the compressed lung tissue. Over time, this can lead to
Although it is uncommon,
babies can be born with scoliosis (congenital) or can develop it during the
first 3 years of their lives (infantile scoliosis). Scoliosis that is present
at birth or that develops in infants may be worse in the long run than
scoliosis that develops later in life. This is because the more growing the
skeleton has to do, the worse the curve may get. But in some cases
congenital curves do not get worse. And some curves that are present during
infancy get better on their own without treatment.
Things that increase a
person's risk for
Scoliosis is more common in people who have:
Call your doctor to
have your child evaluated for
If you suspect that your child has a spinal
curve, ask a health professional to look at it, either through a school
screening program or during a doctor visit. Early detection could lead to early
treatment and could prevent a curve from getting worse.
results of a school screening program suggest that your child may have a spinal
curve, follow up with your doctor. Most curves that are found through school
screening programs are normal variations in the spine or mild scoliosis, and
these curves usually require only regular observation.
The following health professionals could identify and
A doctor who specializes in surgery of the bones (orthopedic surgeon) may be consulted if the person has
a large curve. The orthopedic surgeon will evaluate the curve and may recommend
bracing or surgery.
A health professional who fits people with
specially designed assistive devices (orthotist) can build and fit a custom
To prepare for your appointment, see the topic Making the Most of Your Appointment.
testing usually begins with a
history and physical exam. This includes the
forward-bending test, a simple test in which the child bends forward at the
waist, arms hanging loosely and palms touching, and the examiner looks for
unevenness in the child's back or ribs. A
scoliometer can be used to measure and estimate the
rotation of the spinal curve.
If the findings of the history and
physical exam show a significant spinal curve, an
X-ray of the spine may be taken to get a more precise
measurement of the spinal curve.
Skeletal age, as determined by
the Risser sign, is also a helpful measure to find out
the risk that the curve will get worse.
If someone in your family
has scoliosis, your children should be checked regularly.
Neurological testing may be done on children who have scoliosis to
see if they have certain disorders that are often associated with
scoliosis, such as
cerebral palsy or
Screening means doing a
simple test to see whether further testing might be needed.
Some states require screening for scoliosis by law.
But experts don't agree with whether or not to screen for scoliosis.3, 4 Screening can lead to early treatment and may prevent curves from getting worse, but screening can also lead to more testing or treatment for children who would not have needed it.
Some experts believe that children (especially daughters) of women who have scoliosis should be screened for scoliosis regularly throughout their late
childhood and teen years.2
If you are concerned about screening for scoliosis, talk to your child's doctor.
The goal of treatment for
scoliosis is to prevent the spinal curve from getting
worse and to correct or stabilize a severe spinal curve. Fortunately, few people who have spinal curves require treatment.
The type of treatment depends on the cause of
scoliosis. Scoliosis that is caused by another condition (nonstructural
scoliosis) usually improves when the condition, such as muscle
spasms or a difference in leg length, is treated. Scoliosis that is caused by a
disease or by an unknown factor (structural scoliosis) is more likely than nonstructural scoliosis to need
Treatment is based on the age of the person, the size
of the curve, and the risk of progression. The risk of progression is based on
age at diagnosis, the size of the curve (as measured using
X-rays of the spine), and skeletal age (which can be
determined by the
Most cases of scoliosis are mild
and do not require treatment.
The timing of surgery for scoliosis
in children is controversial. Spinal fusion stops the growth of the fused part of the spine,
so some experts believe that surgery should be
delayed until the child is at least 10 years old and preferably 12. But even after surgery the
rest of the spine will continue to grow normally in children who are still
cannot be prevented. Treatment is aimed at preventing the curve from getting
If your child or teen has been
diagnosed with mild
scoliosis, it is important that a doctor check the child's spine every 4 to 6
months to see whether the curve is getting worse. Most spinal
curves do not progress to the point where treatment is needed. But it is
important to check for curve progression, because early treatment can often stop
for moderate or severe scoliosis can dramatically impact your child's life. If
your child has scoliosis, it is important that your family be sensitive to the
difficulty of having scoliosis and
wearing a brace. A scoliosis clinic, where other
children are being treated, can provide a supportive environment for your
Adults who have scoliosis may
have back pain. In addition to medicine, other steps that help to maintain or
promote good health, such as regular exercise and proper back care, may help
relieve back pain for some adults.
When back pain is present with
scoliosis, it may be that the curve in the spine is causing stress and pressure on the spinal discs, nerves, muscles, ligaments, or facet joints. It is not usually caused by
the curve itself. Some people may use nonprescription medicines such as aspirin
and ibuprofen to treat back pain. While these medicines may relieve symptoms of
back pain temporarily, they do not heal scoliosis or back injuries, nor do they
stop the pain from coming back.
Surgery may be used to treat severe
scoliosis. The goal of surgery is to improve a severe
spinal curve. The result will not be a perfectly straight spine, but the goal
is to balance the spine and to make sure the curve does not get worse. Surgery
usually involves stabilizing the spine and keeping the curve from getting worse
by permanently joining the vertebrae together.
Things that are
considered before surgery include:
Surgery may be considered if:
The main type of surgery for scoliosis involves attaching
rods to the spine and doing a
spinal fusion. Spinal fusion is used to stabilize and reduce
the size of the curve and stop the curve from getting worse by permanently
joining the vertebrae into a solid mass of bone.
are sometimes used, including
instrumentation without fusion, which
attaches devices such as metal rods to the spine to stabilize a spinal curve
without fusing the spine together. This is only done in very young
children when a fusion, which stops the growth of the fused part of the spine,
is not desirable. The child usually has to wear a brace full-time after having
Surgical treatment in children and teens usually requires
several days in the hospital and limitations on activity for approximately a
year. In adults, the average hospital stay is longer.
have surgery for scoliosis that results from changes in the spine due to aging
(degenerative scoliosis) are more likely than children to have significant
complications. Even though surgery usually reduces their pain, other
complications may occur, such as
pseudoarthrosis and wound infections.
Treatment other than surgery
There is no evidence that corrective exercises, electrical
stimulation, or spinal manipulation are effective treatments for
The American Academy of Orthopaedic Surgeons (AAOS)
provides information and education to raise the public's awareness of
musculoskeletal conditions, with an emphasis on preventive measures. The AAOS
website contains information on orthopedic conditions and treatments, injury
prevention, and wellness and exercise.
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health—from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research.
The NIAMS website provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases.
The Scoliosis Research Society (SRS) fosters optimal
care for people with any disorder that may affect the shape, alignment, or
function of the spine. The SRS accomplishes this through
education, research, advocacy, and ethical practice.
Staheli LT (2006). Scoliosis section of Spine and pelvis. In Practice of Pediatric Orthopedics, pp. 210–219. Philadelphia: Lippincott Williams and Wilkins.
Hu SS, et al. (2006). Scoliosis section of Disorders, diseases and injuries of the spine. In HB Skinner, ed., Current Diagnosis and Treatment in Orthopedics, 4th ed., chap. 5, pp. 255–269. New York: Lange Medical/McGraw-Hill.
U.S. Preventive Services Task Force (2004). Screening for idiopathic scoliosis in adolescents: Recommendation statement. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ). Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsaisc.htm.
Richards BS, Vitale M (2007). SRS/AAOS Position statement: Screening for idiopathic scoliosis in adolescents. An information statement. Available online: http://www.aaos.org/about/papers/position/1122.asp.
Other Works Consulted
American Academy of Orthopaedic Surgeons and American
Academy of Pediatrics (2010). Scoliosis. In JF
Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 1164–1169.
Rosemont, IL: American Academy of Orthopaedic Surgeons.
Negrini S, et al. (2010). Braces for idiopathic scoliosis in adolescents (Review). Cochrane Database of Systematic Reviews (1).
Polousky JD (2011). Orthopedics. In WW Hay Jr et al., eds., Current Diagnosis and Treatment: Pediatrics, 20th ed., chap. 24, pp. 778–795. New York: McGraw-Hill.
Rowe DE (2003). The Scoliosis Research Society Brace Manual. Available online: http://www.srs.org/professionals/education_materials/SRS_bracing_manual/section1.pdf.
Weinstein SL, et al. (2003). Health and function of patients with untreated idiopathic scoliosis: A 50-year natural history study. JAMA, 289(5): 559–567.
Yawn BP, et al. (1999). A population-based study of school scoliosis screening. JAMA, 282(15): 1427–1432.
July 21, 2011
John Pope, MD - Pediatrics & Robert B. Keller, MD - Orthopedics
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