Scoliosis is a lateral (toward the side) curvature in the normally straight vertical line of the spine. When viewed from the side, the spine should show a mild roundness in the upper back and shows a degree of swayback (inward curvature) in the lower back. When a person with a normal spine is viewed from the front or back, the spine appears to be straight. When a person with scoliosis is viewed from the front or back, the spine appears to be curved.
There are many causes and types of scoliosis, including:
- Congenital scoliosis – Caused by a bone abnormality present at birth.
- Neuromuscular scoliosis – A result of abnormal muscles or nerves. Frequently seen in people with spina bifida or cerebral palsy or in those with various conditions that are accompanied by, or result in, paralysis.
- Degenerative scoliosis – This may result from traumatic bone collapse(from an injury or illness), previous major back surgery, or osteoporosis (thining of the bones).
- Idiopathic scoliosis – The most common type of scoliosis, idiopathic scoliosis, has no specific identifiable cause. There is, however, strong evidence that idiopathic scoliosis is inherited.
Approximately 2% to 3% of Americans at age 16 have scoliosis. Less than 0.1% have spinal curves measuring greater than 40 degrees, which is the point at which surgery becomes a consideration. Overall, girls are more likely to be affected than boys. Idiopathic scoliosis is most commonly a condition of adolescence affecting those aged 10 through 16. Idiopathic scoliosis may progress during the “growth spurt” years, but usually will not progress during adulthood.
Most often scoliosis curves are detected on school screening exams, by a child’s doctor, or by a parent. 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 stick out.
Scoliosis usually does not cause pain in children or teens. If back pain is present with scoliosis, it may be due to the curve in the spine, causing stress and pressure on the spinal discs, nerves, muscles, ligaments, or facet joints. 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 determine the cause.
The majority of adolescents with significant scoliosis with no known cause are usually observed at regular intervals. Once the diagnosis of scoliosis is made, then a careful bone exam will be done and an X-ray will be taken to evaluate the magnitude of the curve.
Treatments for scoliosis include:
- Braces – Bracing is the usual treatment choice for adolescents who have a spinal curve between 25 degrees to 40 degrees — particularly if their bones are still maturing and if they have at least 2 years of growth remaining.
- Surgery – Those who have curves beyond 40 degrees to 50 degrees are often considered for scoliosis surgery. The goal is to make sure the curve does not get worse, but surgery does not perfectly straighten the spine. Scoliosis surgery usually involves joining the vertebrae together permanently– called spinal fusion.
In young children, another technique that does not involve fusion may be used since fusion stops growth of the fused part of the spine. In this case, a brace must always be worn after surgery.
Some Signs to watch for may include:
- One shoulder may appear higher.
- One hip may appear higher than the other.
- The child’s head is not centered over his/her body.
- One shoulder blade may stick out more than the other.
- The ribs are higher on one side when the child bends forward from the waist.
- The waistline may appear flat on one side.