Scoliosis: Setting The Record Straight
Medically reviewed by Carmen Fookes, BPharm. Last updated on May 10, 2021.
Living With Scoliosis? You Are Not Alone
The term Scoliosis is used to describe any abnormal, sideways curvature of the spine. It is not a disease. It is not caused by your child carrying too heavy a backpack or by poor nutrition. Scoliosis is a common condition that affects six to nine million people in the United States.
Scoliosis is not synonymous with disablement. In fact, most people manage to live a relatively normal life. And with several support groups available, you need not feel alone in your journey.
What Exactly Is Scoliosis?
When viewed from the back, the spine is straight in most people. In people with scoliosis, the spine can curve in a number of different ways, for example:
- To the left as a single curve: levoscoliosis
- To the right as a single curve: dextroscoliosis
- To both the left and the right (shaped like the letter S).
Any part of the spine can be bent, but the most common areas are the thoracic (chest area) or lumbar (lower back) regions. The severity of the curvature varies from person to person.
Why Is Scoliosis A Problem?
Most cases of scoliosis in children are mild and do not need treatment. Many instances will resolve by themselves as the child grows.
For more severe cases, or to stop the condition from getting worse in children at risk of curvature progression, doctors may recommend a back brace or even surgery. If left untreated, severe scoliosis can lead to serious spine, chest, pelvis, heart, and lung damage, and can affect appearance.
Girls with scoliosis have a much greater risk of developing osteoporosis, a condition that results in weak bones that can break easily, later in life.
To Screen Or Not To Screen
Screening for scoliosis through schools is not routine and has, in the past, been controversial. Approximately half of all U.S. states currently legislate school screening.
But at least four expert professional organizations (The Scoliosis Research Society, American Academy of Orthopedic Surgeons, Pediatric Orthopedic Society of North America, and the American Academy of Pediatrics), support school screening. In a 2018 update to the 2004 US Preventive Services Task Force (USPSTF) recommendation on screening for idiopathic scoliosis in asymptomatic adolescents, the USPTF concluded that there is not enough evidence to determine if the benefits outweigh any harms of screening adolescents aged 10 to 18 years without any symptoms of scoliosis for scoliosis. This was a change from their previous recommendation in 2004 that recommended against routine screening.
Early detection of spine curvature allows for non-surgical management of scoliosis which may prevent curvature progression. Early detection also means surgical correction for severe deformities can be considered earlier. Targeted screening of underserved populations is likely to be more beneficial than universal screening.
Screening is definitely valuable for children with certain risk factors (for example, girls whose mothers have scoliosis). Other parents should always discuss the benefits and risks of screening for scoliosis with their child's doctor.
Symptoms of scoliosis can be subtle. Our spine naturally curves and flexes to allow us to bend and twist. Get your doctor to check your child's spine for scoliosis if you notice any of the following:
- Their head is not centered directly above their pelvis
- Their shoulders are uneven or one of their shoulder blades stick out
- Their rib cage is uneven at the bottom
- Their waist is uneven
- Their hips are raised or unusually high
- Your child tends to lean to one side
- You have noticed skin changes over their spine (dimples, hairy patches, or color abnormalities).
Around 50% of people with scoliosis complain of lower back pain; however, back pain is not always a sign of scoliosis.
Arriving At A Diagnosis Of Scoliosis
Before a doctor will diagnose scoliosis they will look at a person's relevant medical history to determine if any birth defects, trauma, or medical problems may have caused the spine to curve.
A thorough visual examination is used to assess bone structure and alignment of the shoulders, back, chest, pelvis, legs, and feet, and to detect any skin changes over the spine.
Most screening tests are noninvasive. The forward bend test is commonly used in the U.S. to screen for scoliosis. It involves a visual inspection of the spine while standing, and then again while the patient bends forward from the waist with arms hanging and palms touching. The angle of their trunk rotation may be measured using a scoliometer. Anyone with a trunk rotation of more than 5° to 7° is usually referred for an X-ray evaluation.
Other screening tests, such as a humpometer, the plumb line test, and Moiré topography (which creates a 3-dimensional image of the surface of a patient's back) may also be considered.
If an X-ray evaluation is not conclusive, an MRI scan may also be performed.
Scoliosis In Children
Scoliosis in children is classified as either:
- Idiopathic - meaning no identifiable cause
- Congenital - resulting from malformation of one or more vertebrae during embryonic development
- Neuromuscular - as a result of a condition such as cerebral palsy, muscular dystrophy, spina bifida, or spinal cord trauma.
Idiopathic scoliosis accounts for over 80% of cases. Most cases are diagnosed in children aged between 10 to 18 years and are termed Adolescent Idiopathic Scoliosis (AIS). For a diagnosis of AIS, the degree of curvature of the spine must be at least 10° (called the Cobb angle). AIS affects around 1% to 3% of children in the United States.
Scoliosis In Adults
Scoliosis diagnosed in adults reflects either undiagnosed or untreated childhood scoliosis, or a deterioration of the spine with age as a result of wear and tear. Infections and previous spine trauma can also play a part.
Unlike children, almost all areas of the spine are affected, including the bones in the neck. Scoliosis in adults is typically discovered when pain or discomfort requires a physician visit. Sufferers may also complain of pain radiating down their legs.
Treatment usually focuses on restoring function and alleviating pain in combination with correcting the curvature of the spine if possible.
Action Or Wait And See
For many people (particularly children) a wait-and-see approach to treatment is the most common management option.
Children's spines are still growing and changing, and there is a high chance that the spine will correct itself or the angle of curvature lessen as the child matures. Overall treatment depends on the degree, extent and location of curvature, whether or not it affects a person's lifestyle, and the possibility of curve progression.
Children who have large curves prior to their adolescent growth spurt are more likely to experience curve progression.
Observe, Brace Or Operate?
The main treatment options are observation, bracing, or (rarely) surgery.
Observation with regular monitoring to check for curve progression (frequency dependent on age) is the best approach to mild curves.
Back braces are only effective in children or adolescents who have not reached skeletal maturity to stop curve progression; but may need to be worn 16 to 23 hours per day until growth stops.
Surgery is usually only considered with curvatures greater than 40 degrees in children, or greater than 50 degrees in adults with signs of progression.
Degenerative Scoliosis: Gaining On Pain
Perhaps the most troublesome symptom in adults with degenerative scoliosis is back pain.
Medications to treat the pain caused by degenerative scoliosis are almost identical to those used to treat the pain caused by osteoarthritis and include:
Helping You To Help Yourself: What YOU Can Do
Improving your core strength and mobility will go a long way to helping your scoliosis and relieving any back pain you may be experiencing.
Ask your provider about specific exercises you can do for scoliosis, such as wall straightening, side-stretches, bended-knee sit-ups, or push-ups. Weight loss is also beneficial.
Water therapy takes advantage of your body's natural buoyancy in water to counteract the effect of gravity, putting less stress on your joints as you exercise. Adjustments by a qualified chiropractor or osteopathic physician help to keep joints mobile and reduce pain.
Finished: Scoliosis: Setting The Record Straight
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- Position Statement - Screening for the Early Detection for Idiopathic Scoliosis in Adolescents. Revised 09/02/2015. SRS/POSNA/AAOS /AAP Position Statement. Scoliosis Research Society https://www.srs.org/about-srs/news-and-announcements/position-statement---screening-for-the-early-detection-for-idiopathic-scoliosis-in-adolescents
- Horne JP, Flannery R, Usman S. Adolescent Idiopathic Scoliosis: Diagnosis and Management. Am Fam Physician. 2014 Feb 1;89(3):193-198. http://www.aafp.org/afp/2014/0201/p193.html
- Scoliosis. Content from Mayo Clinic on Drugs.com. https://www.drugs.com/mcd/scoliosis
- US Preventive Services Task Force. Screening for Adolescent Idiopathic Scoliosis: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(2):165–172. doi:10.1001/jama.2017.19342
- Płaszewski M, Grantham W, Jespersen E. Screening for scoliosis - New recommendations, old dilemmas, no straight solutions. World J Orthop. 2020;11(9):364-379. Published 2020 Sep 18. doi:10.5312/wjo.v11.i9.364
- Screening for Adolescent Idiopathic Scoliosis: Recommendation Statement. U.S. Preventive Services Task Force. May 2018. https://www.aafp.org/afp/2018/0515/od1.html