Overview of Scoliosis
Scoliosis is a sideways curve of the spine. Everyone has normal curves in the spine, and when looked at from behind, the spine appears straight. However, children and teens with scoliosis have an abnormal S-shaped or C-shaped curve of the spine. The curve can happen on either side of the spine and in different places in the spine. In most people, the cause of scoliosis is unknown.
For most children and teens, the cause of scoliosis is idiopathic. This means researchers and doctors do not know the cause. However, they think that a combination of factors plays a role in the development of the disease.
Doctors diagnose scoliosis by examining your child or teen and taking x-rays. This helps doctors develop a treatment plan, which depends on the location and severity of the curve. Children and teens with milder curves may just need to visit their doctor for regular check-ups. Others may require bracing or surgery.
With treatment, observation, and follow-up with the doctor, most children and teens have normal, active lives.
Who Gets Scoliosis?
Anyone can get scoliosis. However, idiopathic scoliosis, which is the most common type, usually occurs in children age 11 and older. Girls are more likely than boys to have this type of scoliosis. You are more likely to have scoliosis if your parent, brother, or sister has it.
Symptoms of Scoliosis
Most children and teens with mild scoliosis do not have symptoms or pain. Sometimes, the child, teen, or a family member may notice changes in posture, which may be a sign of scoliosis. Other signs may include the following.
- Top of shoulders are uneven.
- One shoulder blade (in the upper back) is more prominent or visible than the other.
- One hip appears higher than the other.
- One side of the rib cage is higher than the other when bending forward.
- If the scoliosis is progressing and the curve is more severe, the changes in the shape of the spine can lead to back pain. If the curve is severe, rarely, some children may develop difficulty breathing.
Causes of Scoliosis
In most cases, the cause of scoliosis is idiopathic (unknown). Researchers continue to study possible causes for idiopathic scoliosis and think that a combination of several factors may lead to the disorder. These include:
- Changes in cell structure.
For some children, scoliosis happens when another disease or disorder, or trauma causes the curving spine. These include:
- Congenital factors, which happen during the development of the spine when the baby is in the womb, leading to a curve in the spine.
- Genetic diseases, which happen when changes occur in one or more genes.
- Injury to the spine, usually from trauma to the spine or back.
- Neuromuscular diseases, which affect the nerves that send messages to muscles, leading to muscle weakness and loss.
- Tumor, which can cause physical changes to the spine.
Diagnosis of Scoliosis
Because most children and teens do not have symptoms, doctors may diagnosis scoliosis during a routine exam. Your child’s doctor may diagnose scoliosis by:
- Taking a medical history and family history, which may include asking about other medical problems that might be causing the curve in the spine.
- Completing a physical examination to evaluate your child’s posture and look for asymmetry in the trunk or shoulders, or if one side of the rib cage is higher than the other when your child bends forward.
- Taking x-rays. This is the most common test that doctors use to diagnose the disorder. An x-ray can evaluate and measure the curve of the spine. This information helps the doctor determine the severity of the curve and possible treatments.
Treatment of Scoliosis
Doctors recommend treatment for scoliosis based on:
- The locations of the curve.
- If the curve is mild, moderate, or severe.
- If the curve causes symptoms.
- If your child or teen is still growing.
The goals of your child’s treatment may include to:
- Stop or slow the curve in the spine from progressing.
- Prevent or decrease pain.
- Prevent or manage any respiratory problems that may develop due to the curve.
- Help improve posture.
- Help improve quality of life.
Your child’s doctor may recommend the following treatments:
- Observation. If the curve is mild and your child’s skeleton is still growing, the doctor may recommend monitoring the spine. This may include visits with the doctor every few months.
- Bracing. If the curve is moderate and your child or teen is still growing, your doctor may recommend using a brace to keep the curve from getting any worse. The goal of wearing a brace is to slow or stop the curves in the spine from increasing. The type of brace depends on the severity of the curve. The brace is fitted to your child or teen and should be worn every day for the full number of hours recommended by the doctor. Research shows that braces work well if your child or teen is still growing and they are worn as directed. Once your child or teen is done growing, your doctor may determine that the brace is no longer needed.
- Surgery. If your child or teen is still growing and the scoliosis continues to progress, your doctor may recommend surgery. The type of surgery depends on the location and severity of the curve. All surgeries have risks for complications. Talk to the surgeon about the risks and benefits of surgery. Types of procedures may include:
- Spinal fusion, which joins two or more vertebrae of the spine together. This can help straighten the curve. The surgeon may use metal rods and screws to help keep the spine straight while the spine heals.
- Insertion of an expandable rod, which a surgeon may recommend if your child or teen is still growing. This rod is lengthened by the surgeon at scheduled times as your child grows.
- Physical therapy. The doctor may recommend physical therapy to help strengthen muscles.
Research shows that alternative therapies such as chiropractic treatment, nutritional supplements, and electric stimulation do not help manage scoliosis or keep the curve from getting worse.
Who Treats Scoliosis?
The following health care providers may treat scoliosis in children and teens:
- Orthopaedists, who specialize in the treatment of and surgery for bone and joint diseases or injuries.
- Pediatricians, who diagnose and treat children.
- Physical therapists, who teach ways to build muscle strength.
- Primary care providers, such as a family physician.
Living With Scoliosis
The following tips may help your child or teen while living with scoliosis.
- Exercise programs have not been well studied but likely do not keep scoliosis from getting worse; however regular exercise helps your child or teen remain physically fit and strengthen muscle. Weight-bearing exercise, such as walking, running, or soccer, helps keep bones strong. Talk to your child’s doctor about participating in sports and activities.
- If your child or teen wears a brace, they may feel self-conscious or embarrassed. However, it is important that the brace is worn as directed to help improve symptoms and possibly prevent the need for surgery. If your child or teen refuses to wear their brace, talk to the doctor about other bracing or treatment options.
- Consider joining a community or online scoliosis support group for children, teens, or parents. Programs and support groups can help you and your child or teen cope with scoliosis and its treatment.
Research Progress Related to Scoliosis
The NIAMS continues to support research on scoliosis. Researchers focus on:
- Factors that may cause scoliosis, in an effort to identify targets for prevention and new treatments.
- Types and indications for using braces to treat scoliosis and prevent the curve from getting worse. Research includes studying compliance and timing for brace use.
- Impact of exercise and targeted physical therapy to treat or slow the progression of scoliosis.
- Long-term effects of scoliosis fusion and other surgical interventions.
- Impact of untreated scoliosis.