Scoliosis

What is scoliosis?

A normal spine, when viewed from behind, looks straight. But a spine affected by scoliosis shows a side-to-side curvature, with the spine looking like an S or C. The back bones (vertebrae) may also be rotated. This makes it look like the person is leaning to 1 side. Scoliosis is defined as a curvature of the spine measuring 10° or greater.

Scoliosis is not due to poor posture.

Spinal curvature from scoliosis may occur on the right, left, or both sides of the spine. Both the middle (thoracic) and lower (lumbar) spine may be affected by scoliosis.

What causes scoliosis?

In most cases, the cause of scoliosis is not known. This is called idiopathic scoliosis. In other cases, scoliosis may be caused by a breakdown of the spinal discs. This can occur with arthritis or osteoporosis. Or it may be a hereditary condition that runs in families.

The abnormal curves of the spine are defined according to their cause:

• Nonstructural scoliosis. This is also called functional scoliosis. In this condition, a normal spine is curved due to 1 or more problems. For example, the leg lengths may be different. Or there may be an inflammatory problem. This type of scoliosis is often short-term. It goes away when the underlying problem is treated.

• Structural scoliosis. The possible causes of structural scoliosis include:

  • Unknown (idiopathic scoliosis)

  • Disease that is neuromuscular, metabolic, rheumatoid, or other type

  • Birth defect

  • Injury

  • Infection

  • Abnormal growth

What are the symptoms of scoliosis?

These are the most common symptoms of scoliosis:

• Difference in shoulder height

• Head is off-center from the rest of the body

• Difference in hip height or position

• Difference in shoulder blade height or position

• When standing straight, difference in the way the arms hang beside the body

• When bending forward, the sides of the back look different in height

Get medical care right away if you have back pain, leg pain, or changes in bowel and bladder habits. These are not often seen with idiopathic scoliosis.

The symptoms of scoliosis may look like other health problems. Always see your healthcare provider for a diagnosis.

How is scoliosis diagnosed?

A healthcare provider will ask about your health history. They will give you a physical exam. You will have X-rays. These are the main tool for diagnosing scoliosis. The healthcare provider measures the degree of spinal curvature on the X-ray.

Other tests may be done for nonidiopathic curvatures, abnormal curve patterns, or congenital scoliosis. These include:

• MRI. MRI uses a combination of large magnets and a computer to produce detailed images of organs and structures within the body.

• CT scan. A CT scan uses X-rays and computer technology to make detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

Early detection of scoliosis is most important for successful treatment.

How is scoliosis treated?

The goal of treatment is to stop the progression of the curve and prevent deformity. Treatment may include:

• Observation and repeated exams. This may be needed to determine if the spine is continuing to curve. It's used when a person has a curve less than 25° that is still growing.

• Bracing. Bracing may be used when the curve measures more than 25° to 30° on an X-ray, but skeletal growth remains. It may also be needed if a person is growing and has a curve between 20° and 29° that isn't improving or that is advancing. The type of brace and the amount of time spent in the brace will depend on the severity of the condition.

• Surgery. Surgery may be advised when the curve measures 45° or more on an X-ray and bracing isn't successful in slowing down the progression of the curve when a person is still growing. Certain symptoms, such as loss of bladder or bowel control, may also need surgery.

There's no scientific evidence to show that other methods for treating scoliosis (for example, chiropractic manipulation, electrical stimulation, nutritional supplementation, or exercise) prevent the progression of the disease. Talk with your healthcare provider before starting, or paying for, a nontraditional treatment for scoliosis.

Key points about scoliosis

• Scoliosis is a sideways curvature of the spine measuring 10° or greater.

• In most cases, the cause of scoliosis is not known. In some cases, scoliosis may be caused by a breakdown of the spinal discs. This can occur with arthritis, osteoporosis, or as a hereditary condition that runs in families.

• Symptoms include a difference in shoulder height, difference in hip height or position, and the head being off-center from the rest of the body.

• In addition to a full health history and physical exam, X-rays are the main tool for diagnosing scoliosis.

• Treatment may include observation and repeated exams, bracing, and surgery.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new directions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is advised and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.