Scoliosis

What scoliosis is

Viewed from behind, a healthy spine is straight. In scoliosis it curves to one side, often in an S or C shape, and the vertebrae rotate. The rotation pushes the ribs backward on one side, causing the rib hump. Curves are named by location: thoracic (upper back), thoracolumbar, or lumbar (lower back). The most common pattern in adolescents is a right thoracic curve.

Types of scoliosis

Symptoms

In adolescents, scoliosis is usually painless. Signs are uneven shoulders, a prominent shoulder blade, an uneven waist or hips, and a rib hump on bending. The page on signs of scoliosis explains how to check at home.

Adults more often have:

• back pain and stiffness
• leg pain, numbness or heaviness on walking from nerve compression (spinal stenosis)
• loss of height and a sense of leaning forward or sideways
• with very large thoracic curves (over 70 to 80 degrees), reduced lung capacity and breathlessness

Diagnosis

• Examination: posture, the forward bend test, a scoliometer reading, leg lengths and a neurological exam.
• Standing X-ray of the whole spine: measures the Cobb angle, the angle between the most tilted vertebrae at the top and bottom of the curve.
• Risser sign and other growth markers: on X-ray of the pelvis or hand, showing how much growth remains. Curves progress most during rapid growth.
• MRI: if there are red flags such as pain, neurological signs, an unusual curve pattern or early onset, to look for spinal cord problems.

Severity by Cobb angle

Treatment

Observation

Curves under about 20 to 25 degrees in growing children are monitored with clinical checks and X-rays every 4 to 12 months. Low-dose imaging systems reduce radiation.

Bracing

For growing children with curves of about 25 to 40 degrees, a rigid brace (usually a thoracolumbosacral orthosis) is worn under clothing. A major US trial (BrAIST) found that bracing significantly reduced the number of curves progressing to the surgical range, and the more hours a day the brace was worn, the better it worked. A brace is typically prescribed for 13 to 20 or more hours a day until growth stops. Bracing does not straighten the curve permanently; its goal is to stop it getting worse.

Physical therapy and exercise

Scoliosis-specific exercises (such as the Schroth method) may improve posture, core strength and, in some studies, slow progression in mild curves. General exercise and sports are encouraged, including with a brace.

Surgery

Spinal fusion is considered for curves over about 45 to 50 degrees in adolescents, or curves that keep progressing. Rods and screws straighten the spine and the vertebrae fuse into a solid block. Most teens return to school in 2 to 4 weeks and to most sports within 6 to 12 months. Fusion limits movement in the fused segment, but most people bend well using the unfused parts.

Vertebral body tethering is a newer option for some growing children: a flexible cord on the outside of the curve allows correction with growth while preserving more motion. Long-term results are still being studied.

For young children with severe early-onset scoliosis, growing rods or casting control the curve while allowing the spine and lungs to develop.

Adult scoliosis

Treatment focuses on pain and function: physical therapy, pain relief, injections for nerve pain, and bone-strengthening treatment for osteoporosis. Surgery (decompression with or without fusion) is considered for severe pain, nerve compression or progressive deformity.

Complications

• curve progression, especially during growth, and for curves over 50 degrees, slowly in adulthood
• back pain, more common in adulthood
• reduced lung function with very large thoracic curves
• self-image concerns and stress in teenagers, which support and counseling can help

Outlook

Most people with scoliosis lead normal, active lives, including sport, careers and pregnancy. Curves under 30 degrees at the end of growth rarely progress. Curves over 50 degrees tend to increase by about a degree a year in adulthood and need follow-up.

Frequently asked questions

What is scoliosis?

Scoliosis is a sideways curve of the spine of at least 10 degrees, with rotation of the vertebrae. Most cases appear in adolescence and have no known cause. Mild curves are common and often need only monitoring.

How is scoliosis treated?

Treatment depends on the size of the curve and remaining growth. Small curves are monitored. Moderate curves in growing children are treated with a brace. Severe or progressive curves may need spinal fusion surgery. Adults with pain receive physical therapy and pain management.

Can scoliosis get worse in adults?

Yes. Curves over about 50 degrees at skeletal maturity often progress slowly, around 1 degree a year. Adults can also develop new degenerative scoliosis after 50 from disc and joint wear. Regular follow-up helps detect changes.

Does a scoliosis brace straighten the spine?

No. A brace aims to stop a curve from getting worse while a child is still growing. It works best when worn for the prescribed number of hours each day. The curve usually stays about the same after bracing ends.

Can you live a normal life with scoliosis?

Yes. Most people with scoliosis work, exercise, play sports and have children normally. Even after spinal fusion, most people return to an active life. Large curves need monitoring for pain and, rarely, breathing problems.