Topic Overview
What is scoliosis?
Scoliosis is a problem with
the curve in your
spine. Some curves in your spine are normal. But a few
people have spines that make a
large curve from side to side in the shape of the letter "S" or the letter
"C." If this curve is severe, it can cause pain and make breathing
difficult.
The good news is that most cases of scoliosis are
mild. If found early, they can usually be prevented from getting worse.
What causes scoliosis?
In most cases, the cause of
scoliosis is not known. Scoliosis usually starts
in childhood.
Scoliosis that is severe enough to need treatment is most common in girls.
A curve in the spine may
get worse as your child grows, so it is important to find any problem
early.
What are the symptoms?
Scoliosis most often causes
no symptoms in your child until the spinal curve becomes large. You might
notice these early signs:
- Your child has one shoulder or hip that looks
higher than the other.
- Your child's head does not look centered
over the body.
- Your child has one shoulder blade that sticks out
more than the other.
- Your child's waistline is flat on one side,
or the ribs look higher on one side when your child bends forward at the
waist.
In adults, scoliosis may cause back pain and trouble
breathing.
How is scoliosis diagnosed?
The doctor will check
to see if your child's back or ribs are even. If the doctor finds that one side
is higher than the other, your child may need an X-ray so the spinal curve can
be measured.
Scoliosis is most serious in young children who are
still growing. A curve in the spine may get worse as your child grows.
So many experts believe screening your
child for scoliosis is important so that any curve in the spine can be found
early and watched closely.
How is it treated?
Mild cases of scoliosis usually
do not need treatment. Your doctor will check the curve of your child's spine
every 4 to 6 months. If the curve gets worse, your child may need to wear a
brace until he or she has finished growing. In severe cases, or if bracing
doesn't help, your child may need to have surgery.
Scoliosis and
its treatment can be a severe strain on your child. Wearing a brace can feel
and look odd. It also limits your child's activity. Your child needs your
support and understanding to get through treatments successfully.
What increases the risk of scoliosis?
Your child
may be more likely to have scoliosis if someone in your family has had it and
if your child is a girl. Other things that increase the chance of scoliosis
include:
- One of the bones in your child's spine has
moved forward out of place compared to the rest of the spine.
- Your
child's arms or legs are missing or are abnormally short.
- Your
child has other problems with tissue growth that happened before birth.
Frequently Asked Questions
Learning about scoliosis: | |
Being diagnosed: | |
Getting treatment: | |
Ongoing concerns: | |
Living with scoliosis: | |
Cause
In most cases, the cause of
scoliosis is not known. This is called idiopathic
scoliosis. It develops mostly in children and teens and appears to be related
to several things, including genetics, as it often runs in families.
There are two types of scoliosis: nonstructural and structural.
Nonstructural (functional) scoliosis
Nonstructural (functional) scoliosis involves a curve in the
spine, without rotation, that is reversible because it is caused by a condition such as:
- Pain or a muscle spasm.
- A difference in leg
length.
Structural scoliosis
Structural scoliosis involves a
curve in the spine, with rotation, that is irreversible and is usually caused
by an unknown factor (idiopathic) or a disease or condition such as:
- Disorders that were present at birth
(congenital), such as
spina bifida, in which the spinal canal does not close
properly; or a disorder that affects the formation of bones. These curves can be harder to correct. They often get worse as the child grows, especially during
the teen years.
- Nerve or muscle
disorders, such as
cerebral palsy,
Marfan's syndrome, or
muscular dystrophy.
- Injuries.
- Infections.
- Tumors.
In adults, scoliosis may result from changes in the spine
due to aging (degenerative changes). These degenerative changes may be caused
by
osteoarthritis.
Symptoms
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.
In a child who has scoliosis:
- One shoulder may appear higher than the
other.
- One hip may appear higher than the other.
- The
child's head is not centered over his or 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
be flat on one side.
Most of the time scoliosis does not cause pain in children
or teens. When back pain is present with
scoliosis, it may be because the curve in the spine is causing stress and pressure on the spinal discs, nerves, muscles, ligaments, or facet joints. It is not usually caused by
the curve itself. 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 find out what is causing the
pain.
Adults who have scoliosis may or may not have back pain. In
most cases where back pain is present, it is hard to know whether scoliosis is
the cause. But if scoliosis in an adult gets worse and becomes severe, it
can cause back pain and difficulty breathing.
Some
other conditions, such as
kyphosis, cause symptoms similar to scoliosis.
What Happens
Idiopathic scoliosis, the most
common type, does not have a known cause. Children who have this type of
scoliosis usually first develop symptoms in childhood.
Most cases of scoliosis are mild, involving small curves in the spine that do
not get worse. Small curves usually do not cause pain or other problems.
Usually a doctor examines the child every 4 to 6 months to watch for any
changes.
In moderate or severe cases of scoliosis, the curves
continue to get worse. During periods of growth, such as during the teenage
growth spurt, the curves may get worse. Mild to moderate curves often
stop progressing when the skeleton stops growing, while larger curves may get
worse throughout adulthood unless they are treated.
Only about
1 out of 10 children who are diagnosed with scoliosis require treatment (either
bracing or surgery).1
Things that may
point to the potential increase in a spinal curve include:
- The age of the child and the development stage, or maturity, of
his or her skeleton when scoliosis is diagnosed. The less mature the skeleton
is when scoliosis starts, the greater the chance that scoliosis will get worse.
Skeletal age, as determined by the
Risser sign, is also used to find out the risk that
the curve will get worse.
- The size of the curve. The larger the
curve, the greater the risk that it will get worse.
- The location and shape of the curve. Curves in the upper back are
more likely to get worse than curves in the lower back.
Girls are more likely than boys to have larger curves and
more severe scoliosis.
As scoliosis gets worse, the bones of the
spine rotate toward the inner part of the curve. If the upper part of the spine
is affected, the ribs may crowd together on one side of the body and become
widely separated on the other side. The curve may force the space between the
spinal bones to narrow. The spinal bones may also become thicker on the outer
edge of the curve.
In severe curves, misshapen ribs may reduce the
amount of air the lungs can hold and may cause the heart to work harder to pump
blood through the compressed lung tissue. Over time, this can lead to
heart failure.
Although it is uncommon,
babies can be born with scoliosis (congenital) or can develop it during the
first 3 years of their lives (infantile scoliosis). Scoliosis that is present
at birth or that develops in infants may be worse in the long run than
scoliosis that develops later in life. This is because the more growing the
skeleton has to do, the worse the curve may get. But in some cases
congenital curves do not get worse. And some curves that are present during
infancy get better on their own without treatment.
What Increases Your Risk
Things that increase a
person's risk for
scoliosis include:
- Family history. Scoliosis is known to run in
families. Children—especially daughters—of women who have scoliosis are at
increased risk for having scoliosis.2
- Being female. Girls are more likely than boys to have a significant curve that requires
treatment.
Scoliosis is more common in people who have:
- A spinal bone that is pushed forward (forward
displacement), usually in the lower back
(spondylolisthesis).
- Missing or abnormally short arms or
legs.
- Other disorders related to tissue development while in the
womb.
When To Call a Doctor
Call your doctor to
have your child evaluated for
scoliosis if:
- You observe a curve in your child's
spine.
- You notice that something about your child's posture looks
unusual, such as ribs that stick out, one shoulder that is higher than the
other, one hip that is higher than the other, or an uneven
waistline.
- You observe that your child's clothes don't fit properly
or that his or her hems don't hang evenly.
- A school screening
program recommends that your child see a doctor.
Watchful waiting
If you suspect that your child has a spinal
curve, ask a health professional to look at it, either through a school
screening program or during a doctor visit. Early detection could lead to early
treatment and could prevent a curve from getting worse.
If the
results of a school screening program suggest that your child may have a spinal
curve, follow up with your doctor. Most curves that are found through school
screening programs are normal variations in the spine or mild scoliosis, and
these curves usually require only regular observation.
Who to see
The following health professionals could identify and
monitor scoliosis:
A doctor who specializes in surgery of the bones (orthopedic surgeon) may be consulted if the person has
a large curve. The orthopedic surgeon will evaluate the curve and may recommend
bracing or surgery.
A health professional who fits people with
specially designed assistive devices (orthotist) can build and fit a custom
brace.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Scoliosis
testing usually begins with a
history and physical exam. This includes the
forward-bending test, a simple test in which the child bends forward at the
waist, arms hanging loosely and palms touching, and the examiner looks for
unevenness in the child's back or ribs. A
scoliometer can be used to measure and estimate the
rotation of the spinal curve.
If the findings of the history and
physical exam show a significant spinal curve, an
X-ray of the spine may be taken to get a more precise
measurement of the spinal curve.
Skeletal age, as determined by
the Risser sign, is also a helpful measure to find out
the risk that the curve will get worse.
If someone in your family
has scoliosis, your children should be checked regularly.
Neurological testing may be done on children who have scoliosis to
see if they have certain disorders that are often associated with
scoliosis, such as
cerebral palsy or
muscular dystrophy.
Early detection
Screening means doing a
simple test to see whether further testing might be needed.
Some states require screening for scoliosis by law.
But experts don't agree with whether or not to screen for scoliosis.3, 4 Screening can lead to early treatment and may prevent curves from getting worse, but screening can also lead to more testing or treatment for children who would not have needed it.
Some experts believe that children (especially daughters) of women who have scoliosis should be screened for scoliosis regularly throughout their late
childhood and teen years.2
If you are concerned about screening for scoliosis, talk to your child's doctor.
Treatment Overview
The goal of treatment for
scoliosis is to prevent the spinal curve from getting
worse and to correct or stabilize a severe spinal curve. Fortunately, few people who have spinal curves require treatment.
The type of treatment depends on the cause of
scoliosis. Scoliosis that is caused by another condition (nonstructural
scoliosis) usually improves when the condition, such as muscle
spasms or a difference in leg length, is treated. Scoliosis that is caused by a
disease or by an unknown factor (structural scoliosis) is more likely than nonstructural scoliosis to need
treatment.
- Nonsurgical treatment. This includes either routine
exams by a doctor to check for any curve
progression or the use of a brace to stop a spinal curve from getting
worse. Children typically have these checkups about every 4 to 6 months. Adults are usually checked about once each year.
- Surgical treatment. Surgery can be used to insert
implants to hold the spine in place or fuse the spine together so that the
curve cannot get worse.
Treatment is based on the age of the person, the size
of the curve, and the risk of progression. The risk of progression is based on
age at diagnosis, the size of the curve (as measured using
X-rays of the spine), and skeletal age (which can be
determined by the
Risser sign).
- Mild curves are usually checked by the doctor every 4 to 6 months until the bones stop growing, to be sure the curves aren't getting worse.
- Moderate curves may need to be braced until the bones stop growing, to keep the curves from getting worse.
- Severe curves or moderate curves that are getting worse may need surgery.
What to think about
Most cases of scoliosis are mild
and do not require treatment.
The timing of surgery for scoliosis
in children is controversial. Spinal fusion stops the growth of the fused part of the spine,
so some experts believe that surgery should be
delayed until the child is at least 10 years old and preferably 12. But even after surgery the
rest of the spine will continue to grow normally in children who are still
growing.
Prevention
Scoliosis
cannot be prevented. Treatment is aimed at preventing the curve from getting
worse.
Home Treatment
If your child or teen has been
diagnosed with mild
scoliosis, it is important that a doctor check the child's spine every 4 to 6
months to see whether the curve is getting worse. Most spinal
curves do not progress to the point where treatment is needed. But it is
important to check for curve progression, because early treatment can often stop
it.
Impact of scoliosis on a child or teen
Treatment
for moderate or severe scoliosis can dramatically impact your child's life. If
your child has scoliosis, it is important that your family be sensitive to the
difficulty of having scoliosis and
wearing a brace. A scoliosis clinic, where other
children are being treated, can provide a supportive environment for your
child.
Adult scoliosis
Adults who have scoliosis may
have back pain. In addition to medicine, other steps that help to maintain or
promote good health, such as regular exercise and proper back care, may help
relieve back pain for some adults.
Medications
When back pain is present with
scoliosis, it may be that the curve in the spine is causing stress and pressure on the spinal discs, nerves, muscles, ligaments, or facet joints. It is not usually caused by
the curve itself. Some people may use nonprescription medicines such as aspirin
and ibuprofen to treat back pain. While these medicines may relieve symptoms of
back pain temporarily, they do not heal scoliosis or back injuries, nor do they
stop the pain from coming back.
Surgery
Surgery may be used to treat severe
scoliosis. The goal of surgery is to improve a severe
spinal curve. The result will not be a perfectly straight spine, but the goal
is to balance the spine and to make sure the curve does not get worse. Surgery
usually involves stabilizing the spine and keeping the curve from getting worse
by permanently joining the vertebrae together.
Things that are
considered before surgery include:
- The person's age.
- The size,
direction, and location of the spinal curve(s).
- Whether other
treatment (such as bracing) has failed.
Surgery may be considered if:
- A child has a moderate spinal curve.
- The curve is
expected to get worse. In children, a curve may progress because a child has
not finished growing. In adults, a large curve may
continue to get worse.1
- Bracing cannot be
used or does not work.
Surgery choices
The main type of surgery for scoliosis involves attaching
rods to the spine and doing a
spinal fusion. Spinal fusion is used to stabilize and reduce
the size of the curve and stop the curve from getting worse by permanently
joining the vertebrae into a solid mass of bone.
Other techniques
are sometimes used, including
instrumentation without fusion, which
attaches devices such as metal rods to the spine to stabilize a spinal curve
without fusing the spine together. This is only done in very young
children when a fusion, which stops the growth of the fused part of the spine,
is not desirable. The child usually has to wear a brace full-time after having
this surgery.
What to think about
The timing of surgery for scoliosis
in children is controversial. Spinal fusion stops the growth of the fused part of the spine,
so some experts believe that surgery should be
delayed until the child is at least 10 years old and preferably 12. But even after surgery the
rest of the spine will continue to grow normally in children who are still
growing.
Surgical treatment in children and teens usually requires
several days in the hospital and limitations on activity for approximately a
year. In adults, the average hospital stay is longer.
Adults who
have surgery for scoliosis that results from changes in the spine due to aging
(degenerative scoliosis) are more likely than children to have significant
complications. Even though surgery usually reduces their pain, other
complications may occur, such as
pseudoarthrosis and wound infections.
Other Treatment
Treatment other than surgery
for
scoliosis includes:
- Observation. In a child who is still growing, a
mild spinal curve may require only regular checkups
every 4 to 6 months to see whether the curve is getting
worse.
- Wearing a brace.
Bracing (orthotic) treatment may be used for a child who has a moderate curve. Bracing may prevent the curve from
getting worse as the child grows. Brace treatment is usually continued until
the skeleton stops growing.
There is no evidence that corrective exercises, electrical
stimulation, or spinal manipulation are effective treatments for
scoliosis.
Other Places To Get Help
Organizations
| American Academy of Orthopaedic Surgeons
(AAOS) |
| 6300 North River Road |
| Rosemont, IL 60018-4262 |
| Phone: | (847) 823-7186 |
| Fax: | (847) 823-8125 |
| Email: | orthoinfo@aaos.org |
| Web Address: | www.orthoinfo.aaos.org |
| |
The American Academy of Orthopaedic Surgeons (AAOS)
provides information and education to raise the public's awareness of
musculoskeletal conditions, with an emphasis on preventive measures. The AAOS
website contains information on orthopedic conditions and treatments, injury
prevention, and wellness and exercise. |
|
| KidsHealth for Parents, Children, and
Teens |
| Nemours Home Office |
| 10140 Centurion Parkway |
| Jacksonville, FL 32256 |
| Phone: | (904) 697-4100 |
| Web Address: | www.kidshealth.org |
| |
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health, from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest. |
|
| National Institute of Arthritis and Musculoskeletal and
Skin Diseases (NIAMS), National Institutes of Health |
| 1 AMS Circle |
| Bethesda, MD 20892-3675 |
| Phone: | 1-877-22-NIAMS (1-877-226-4267) toll-free |
| Phone: | (301) 495-4484 |
| Fax: | (301) 718-6366 |
| TDD: | (301) 565-2966 |
| Email: | niamsinfo@mail.nih.gov |
| Web Address: | www.niams.nih.gov |
| |
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research. The NIAMS website provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases. |
|
| Scoliosis Research Society |
| 555 East Wells Street |
| Suite 1100 |
| Milwaukee, WI 53202-3823 |
| Phone: | (414) 289-9107 |
| Fax: | (414) 276-3349 |
| Email: | info@srs.org |
| Web Address: | www.srs.org |
| |
The Scoliosis Research Society (SRS) fosters optimal
care for people with any disorder that may affect the shape, alignment, or
function of the spine. The SRS accomplishes this through
education, research, advocacy, and ethical practice. |
|
References
Citations
- Staheli LT (2006).
Scoliosis section of Spine and pelvis. In Practice of Pediatric Orthopedics,
pp. 210–219. Philadelphia: Lippincott Williams and
Wilkins.
- Hu SS, et al. (2006). Scoliosis section of Disorders,
diseases and injuries of the spine. In HB Skinner, ed., Current Diagnosis and Treatment in Orthopedics, 4th ed., chap. 5, pp. 255–269.
New York: Lange Medical/McGraw-Hill.
- U.S. Preventive Services Task Force (2004). Screening for idiopathic scoliosis in adolescents: Recommendation statement. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ). Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsaisc.htm.
- Richards BS, Vitale M (2007). SRS/AAOS Position statement: Screening for idiopathic scoliosis in adolescents. An information statement. Available online: http://www.aaos.org/about/papers/position/1122.asp.
Other Works Consulted
- American Academy of Orthopaedic Surgeons and American
Academy of Pediatrics (2010). Scoliosis. In JF
Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 1164–1169.
Rosemont, IL: American Academy of Orthopaedic Surgeons.
- Negrini S, et al. (2010). Braces for idiopathic scoliosis in adolescents (Review). Cochrane Database of Systematic Reviews (1).
- Polousky JD (2011). Orthopedics. In WW Hay Jr et al., eds., Current Diagnosis and Treatment: Pediatrics, 20th ed., chap. 24, pp. 778–795. New York: McGraw-Hill.
- Rowe DE (2003). The Scoliosis Research Society Brace Manual. Available online: http://www.srs.org/professionals/education_materials/SRS_bracing_manual/section1.pdf.
- Weinstein SL, et al. (2003). Health and function of
patients with untreated idiopathic scoliosis: A 50-year natural history study.
JAMA, 289(5): 559–567.
- Yawn BP, et al. (1999). A population-based study of
school scoliosis screening. JAMA, 282(15):
1427–1432.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | John Pope, MD - Pediatrics |
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| Specialist Medical Reviewer | Robert B. Keller, MD - Orthopedics |
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| Last Revised | November 19, 2012 |
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