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Scoliosis

What is scoliosis?

Illustration of a normal spinal column
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A normal spine, when viewed from behind, appears straight. However, a spine affected by scoliosis shows evidence of a lateral, or side-to-side curvature, with the spine looking like an "S" or "C" and a rotation of the back bones (vertebrae), giving the appearance that the person is leaning to one side. According to the Scoliosis Research Society, scoliosis is defined as a curvature of the spine measuring 10 degrees or greater.

Scoliosis is a type of spinal deformity and shouldn't be confused with poor posture.

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

What causes scoliosis?

Illustration demonstrating thoracic and lumbar scoliosis
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In more than 80% of cases, the cause of scoliosis is unknown — a condition called idiopathic scoliosis. In other cases, scoliosis may develop as a result of degeneration of the spinal discs, as seen with arthritis, osteoporosis, or as a hereditary condition that tends to run in families.

The abnormal curves of the spine are classified according to their cause, including the following:

  • Nonstructural scoliosis (also called functional scoliosis). In this condition, a structurally normal spine appears curved due to 1 or more underlying conditions (for example, difference in leg length or an inflammatory condition). This type of scoliosis is generally temporary and is often relieved when the underlying condition is treated.

  • Structural scoliosis. The possible causes of structural scoliosis are numerous, including:

    • Of unknown origin (idiopathic structural scoliosis)

    • Disease (for example, neuromuscular, metabolic, connective tissue, or rheumatoid disease)

    • Birth defect

    • Injury

    • Infection

    • Abnormal growth

What are the symptoms of scoliosis?

The following are the most common symptoms of scoliosis. However, each individual may experience symptoms differently. Symptoms may include:

  • Difference in shoulder height

  • The head isn't centered with 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 appear different in height

Back pain, leg pain, and changes in bowel and bladder habits aren't commonly associated with idiopathic scoliosis. A person experiencing these types of symptoms requires immediate further medical evaluation by a doctor.

The symptoms of scoliosis may resemble other spinal conditions or deformities, or may be a result of an injury or infection. Always consult your doctor for a diagnosis.

How is scoliosis diagnosed?

In addition to a complete medical history and physical examination, X-rays (a diagnostic test that uses invisible electromagnetic energy beams to produce images of bones on to film) are the primary diagnostic tool for scoliosis. In establishing a diagnosis of scoliosis, the doctor measures the degree of spinal curvature on the X-ray.

The following other diagnostic procedures may be performed for nonidiopathic curvatures, atypical curve patterns, or congenital scoliosis:

  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets and a computer to produce detailed images of organs and structures within the body.

  • Computed tomography (CT) scan. This diagnostic imaging procedure uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows 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?

Specific treatment of scoliosis will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • The underlying cause of the scoliosis

  • Extent of the condition

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

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

  • Observation and repeated examinations. Observation and repeated examinations may be necessary to determine if the spine is continuing to curve, and are used when a person has a curve less than 25 degrees and is still growing.

  • Bracing. Bracing may be used when the curve measures more than 25 degrees to 30 degrees on an X-ray, but skeletal growth remains. It may also be necessary if a person is growing and has a curve between 20 degrees and 29 degrees that isn't improving. 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 recommended when the curve measures 45 degrees 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.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, there's no scientific evidence to show that other methods for treating scoliosis (for example, chiropractic manipulation, electrical stimulation, nutritional supplementation, and exercise) prevent the progression of the disease.