Scoliosis

Scoliosis is a condition characterized by an abnormal sideways curvature of the spine. While a healthy spine appears straight when viewed from behind, a spine with scoliosis forms an "S" or "C" shape. This three-dimensional deformity typically involves rotation of the vertebrae along with the lateral curve. Scoliosis can develop at any age but most commonly appears during the growth spurt just before puberty (10-15 years old). The severity of scoliosis varies widely, from mild curves requiring only monitoring to severe cases that can restrict lung function and require surgical intervention. Most cases (about 80%) are idiopathic, meaning the cause is unknown, though genetic factors likely play a role. Other types include congenital scoliosis (present at birth due to spinal malformations), neuromuscular scoliosis (resulting from conditions like cerebral palsy or muscular dystrophy), and degenerative scoliosis (developing in adulthood due to spine degeneration). Early detection and appropriate management are important for preventing progression and minimizing the impact on quality of life.

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What Causes It?

Idiopathic - Most cases (80-85%) have no identifiable cause, though genetic factors likely contribute.

Congenital - Present at birth due to abnormal vertebral development in the womb.

Neuromuscular - Results from conditions affecting the nerves and muscles, such as cerebral palsy, spina bifida, or muscular dystrophy.

Degenerative - Develops in adulthood due to deterioration of the spinal discs and joints, often associated with aging.

Traumatic - Can occur after significant injury to the spine.

Syndromic - Associated with genetic syndromes like Marfan syndrome or Ehlers-Danlos syndrome.

Leg length discrepancy - Significant difference in leg lengths can cause the spine to curve.

Poor posture - Contrary to common belief, poor posture or carrying heavy backpacks does not cause true structural scoliosis.

Family history - Having a close relative with scoliosis increases risk, supporting a genetic component.

Sex - Though both sexes develop mild scoliosis at similar rates, girls are 7-10 times more likely to develop curves that worsen and require treatment.

Age - Idiopathic scoliosis most commonly develops during growth spurts before and during puberty.

Signs & Symptoms

Uneven shoulders - One shoulder may appear higher than the other.

Uneven waistline - The waist may appear asymmetrical, with one hip higher than the other.

Prominent shoulder blade - One shoulder blade may protrude more than the other.

Uneven rib cage - One side of the rib cage may be more prominent, especially when bending forward.

Trunk shift - The upper body may appear off-center relative to the lower body.

Clothes that don't hang properly - Hemlines or sleeves may appear uneven.

Head not centered directly above the pelvis.

Back pain - More common in adults with scoliosis than in children or adolescents.

Breathing difficulties - In severe cases, reduced lung capacity due to restricted chest movement.

Fatigue - Can result from muscle imbalance and the extra energy required to maintain posture.

Leg length discrepancy - Apparent or real difference in leg lengths.

Note: Scoliosis typically develops gradually and often without pain, making regular screening important, especially during growth years.

How We Diagnose

Our specialists use advanced diagnostic methods to accurately identify and assess your condition

Physical Examination

The initial screening involves observing the spine from behind while standing and during the Adam's forward bend test, which makes spinal curvatures more visible. The doctor will check for asymmetry in shoulders, shoulder blades, waistline, and hips, as well as for rotation of the spine.

Scoliometer Measurement

A small tool placed on the back during the forward bend test to measure the angle of trunk rotation. A reading of 7 degrees or more typically warrants further evaluation with X-rays.

X-rays

The gold standard for diagnosing scoliosis, full-spine standing X-rays (anteroposterior and lateral views) allow measurement of curve angles using the Cobb method. A curve of 10 degrees or more confirms scoliosis, with further classification based on location and severity.

MRI (Magnetic Resonance Imaging)

May be ordered if there are unusual features to the curve, neurological symptoms, or pain, to rule out underlying conditions like spinal cord abnormalities, tumors, or syringomyelia (fluid-filled cavity in the spinal cord).

CT Scan (Computed Tomography)

Provides detailed images of the bony structures of the spine and may be used for pre-surgical planning or to evaluate complex congenital abnormalities.

Bone Density Test

Sometimes recommended for patients with scoliosis, particularly adults, as low bone density can influence treatment decisions and progression risk.

Pulmonary Function Tests

For patients with severe curves (typically over 60-70 degrees), breathing tests may be performed to assess if lung function is compromised.

Growth Assessment

For children and adolescents, evaluation of growth potential using bone age X-rays, Tanner staging, or other measures helps predict the risk of curve progression and guides treatment decisions.

Treatment Options

Personalized treatment plans tailored to your specific needs and condition

Observation

For mild curves (less than 25 degrees) or in skeletally mature individuals with stable curves, regular monitoring with physical exams and X-rays every 4-12 months may be sufficient. No specific treatment is needed if the curve remains stable, though some patients may benefit from physical therapy for symptom management.

Bracing

The primary non-surgical treatment for moderate curves (25-45 degrees) in growing children and adolescents. Modern braces are typically worn 16-23 hours daily until skeletal maturity is reached. Various types include thoracolumbosacral orthoses (TLSO) like the Boston brace, Charleston bending brace (nighttime only), and Rigo-Cheneau type braces. Bracing aims to prevent curve progression rather than to correct existing curvature.

Scoliosis-Specific Exercises

Specialized physical therapy approaches like Schroth method, Scientific Exercise Approach to Scoliosis (SEAS), or Side Shift therapy focus on posture correction, breathing techniques, and specific exercises tailored to the individual's curve pattern. May be used alone for mild curves or in conjunction with bracing or post-surgery.

Surgical Treatment

Considered for severe curves (typically over 45-50 degrees) or progressive curves despite bracing. The standard procedure is spinal fusion with instrumentation, though newer techniques like vertebral body tethering or growing rods (for young children) aim to preserve spine growth and mobility. Surgery aims to correct the deformity, prevent progression, and maintain balanced posture.

Pain Management

For adults with degenerative scoliosis or adolescents with painful curves, various approaches may include physical therapy, medication (NSAIDs, muscle relaxants), injection therapies (epidural or facet injections), or complementary treatments like acupuncture or massage therapy.

Complementary Approaches

Some patients explore options like chiropractic care, yoga adapted for scoliosis, Pilates, or the CLEAR method. While these may help with symptoms and body awareness, they have not been proven to prevent curve progression and should complement, not replace, evidence-based medical care.

Home Remedies

Scoliosis-Specific Exercises

Practice exercises prescribed by a physical therapist trained in scoliosis-specific techniques. These might include asymmetrical breathing exercises, posture training, and movements that counteract your specific curve pattern. Consistency is key for effectiveness.

Core Strengthening

Develop a strong core to support your spine with exercises like modified planks, bird-dog, and gentle stability ball exercises. Always perform these with proper form and guidance from a healthcare professional to avoid exacerbating the curve.

Posture Awareness

Practice good posture throughout the day by keeping your ears, shoulders, and hips aligned. Use posture reminders or apps, strategically placed mirrors, or periodic self-checks to maintain awareness of your alignment.

Ergonomic Adjustments

Modify your home, school, or work environment to support good posture. Use a supportive chair with proper lumbar support, position computer screens at eye level, and ensure work surfaces are at appropriate heights to prevent excessive bending or twisting.

Sleep Positioning

Use supportive mattresses and pillows that maintain spine alignment during sleep. Some find that sleeping on the back with a small pillow under the knees, or on the side with a pillow between the knees, helps reduce nighttime discomfort.

Heat and Cold Therapy

For pain relief, apply a heating pad to tight muscles for 20 minutes to increase blood flow and reduce muscle tension. Cold packs can help reduce inflammation and pain after activity. Always use a cloth barrier to protect your skin.

Brace Compliance Strategies

If prescribed a brace, develop routines to improve consistency in wearing it. Use timers, charts, or apps to track brace time. Wear moisture-wicking shirts under the brace to improve comfort, and gradually increase wearing time to adapt.

Stress Reduction

Practice stress-management techniques such as deep breathing, meditation, or gentle yoga, as stress and tension can exacerbate muscle imbalances and pain associated with scoliosis.

Prevention Tips

Attend all scheduled follow-up appointments for monitoring, especially during growth periods.

Follow through with recommended X-rays to track curve progression, typically every 4-12 months depending on age and curve status.

Comply with brace wearing schedules if prescribed, as consistent use is crucial for effectiveness.

Maintain a healthy weight, as excess weight can increase strain on the spine and potentially worsen symptoms.

Practice good posture and body mechanics during daily activities, though this won't prevent progression of true structural scoliosis.

Stay physically active with appropriate exercises that strengthen core muscles and promote overall fitness.

Continue scoliosis-specific exercises as recommended by your physical therapist or doctor.

Maintain good nutrition with adequate calcium and vitamin D for bone health.

Communicate openly with healthcare providers about any new or changing symptoms.

For young patients, consider screening siblings, as scoliosis can run in families.

For adults with scoliosis, manage risk factors for bone loss such as smoking and excessive alcohol consumption.

Consider bone density testing, particularly for adult women with scoliosis approaching or after menopause.

Monitor for signs of progression, such as changes in appearance, new pain patterns, or clothes fitting differently.

Educate yourself about your specific type of scoliosis and stay informed about management options.

Surgical Solutions

Advanced surgical procedures performed by our expert specialists

Posterior Spinal Fusion with Instrumentation

The most common surgical approach for adolescent idiopathic and adult scoliosis. Through an incision on the back, the surgeon places screws into the vertebrae connected by rods to straighten the spine. Bone graft material is added to help the vertebrae fuse together over time. This permanently prevents curve progression but eliminates motion in the fused segments. Modern techniques aim to fuse the minimum number of vertebrae necessary to correct the deformity.

Anterior Spinal Fusion

Performed through incisions on the side or front of the body, this approach may be used for certain thoracolumbar or lumbar curves. It often allows fusion of fewer vertebrae than posterior fusion, potentially preserving more spinal motion. This technique may be combined with posterior fusion for complex curves or in revision surgeries.

Growth-Friendly Instrumentation

For young children with significant curves who still have substantial growth remaining. Options include growing rods (traditional or magnetically controlled) that can be lengthened periodically, or the Shilla growth guidance system that allows the spine to grow while controlling the curve. These approaches aim to manage the deformity while allowing continued spinal and thoracic growth.

Vertebral Body Tethering (VBT)

A newer, motion-preserving option for selected patients with growth remaining. Screws are placed on the convex side of the curve and connected with a flexible cord that is tensioned to partially correct the curve. As the child grows, continued asymmetric growth further corrects the curve. This FDA-approved procedure preserves more spinal mobility than fusion but has specific indications and is not suitable for all curve types.

Apical Vertebral Body Resection

For very severe, rigid curves that don't correct with standard approaches. This complex procedure involves removing portions of the vertebrae at the apex of the curve to achieve greater correction. It carries higher risks but may be necessary for curves over 100 degrees or those with significant rigidity.

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