Scoliosis is a curvature of the spine, most often found in childhood or adolescence. This article covers how common it is, its main types, the signs to watch for and the management options depending on age and the size of the curve.
What is scoliosis, and how common is it?
The MSD Manual defines scoliosis as an abnormal sideways curvature of the spine. In adolescents, idiopathic scoliosis is diagnosed when the Cobb angle measured on an X-ray is at least 10 degrees, with no underlying congenital or neuromuscular abnormality (American Family Physician).
Roughly 1 to 3% of children aged 10 to 16 are affected according to the MSD Manual, and about 3% of children and adolescents according to the Revue du Praticien. Boys and girls are affected about equally often, but girls are around 10 times more likely to have a curve that progresses to the point of needing a brace or surgery.
What are the different types of scoliosis?
According to the NHS, the cause is unknown in about 8 out of 10 cases: this is idiopathic scoliosis. It is not caused by poor posture, exercise or diet, although a family predisposition is possible. The other forms are:
- congenital: the bones of the spine did not form normally before birth;
- neuromuscular: linked to a nerve or muscle disorder, such as cerebral palsy or muscular dystrophy;
- degenerative: caused by wear and tear of the spine in older people.
Idiopathic scoliosis is classified by age at onset: infantile, childhood and adolescent (MedlinePlus).
Which signs suggest scoliosis?
Mild scoliosis often causes no symptoms. Visible signs include one shoulder higher than the other, uneven hips, an asymmetrical rib cage or clothes that hang unevenly. Back pain may appear, especially in adults (NHS, MSD Manual).
During the examination, the doctor asks the person to bend forward (Adams test): the deformity then becomes more visible, notably a bump on one side of the back, the rib hump. According to American Family Physician, this forward bend test has a sensitivity of at least 92% for thoracic curves greater than 20 degrees; it is less reliable for lumbar curves.
How is the diagnosis confirmed?
A spine X-ray is the reference test: it shows the curve and allows the Cobb angle to be measured, drawn between the most tilted vertebrae at the top and bottom of the curve (MSD Manual). MedlinePlus points out that the real curve may be larger than the physical examination suggests. Depending on the case, an MRI or CT scan may complete the assessment.
This measurement is what distinguishes true scoliosis from a simple back asymmetry: only a doctor, after an examination and an X-ray, can tell. Regular monitoring is then organised to check whether the curve is progressing.
What treatment depends on age and Cobb angle?
The NHS notes that treatment depends on age, severity and the risk of worsening, and that many people need no treatment at all. The risk of progression is higher with a larger curve, a young age at diagnosis, a growth spurt and a high thoracic curve (MSD Manual). According to American Family Physician, for a growing adolescent:
- less than 20 degrees: monitoring, with an X-ray every six months for angles of 10 to 19 degrees;
- 20 to 39 degrees: specialist opinion to consider a brace, sometimes combined with physiotherapy;
- 40 degrees or more: surgical opinion.
In the BrAIST trial, more than 70% of adolescents who wore a brace avoided a curve of 50 degrees or more, compared with 48% with observation alone. The value of specific rehabilitation remains debated depending on the source, and the NHS states that it has not been established that back exercises improve scoliosis.
Surgery consists of spinal fusion (joining the vertebrae with a metal rod) for moderate to severe cases. In adults it is only very occasionally needed, mainly for pain; painkillers and injections are the first options (NHS).
Screening, activity and when to see a doctor
Positions on school screening differ: American Family Physician reports that the USPSTF and the AAFP consider the evidence insufficient between the ages of 10 and 18, whereas the AAOS, SRS, POSNA and AAP support it. Parents can nonetheless look at their child’s back and raise any concern with a doctor.
See a doctor if you or your child have uneven shoulders or back, persistent pain or breathing difficulty, or if the curve worsens after growth has finished (NHS). The NHS adds that most people with scoliosis lead a normal life, including sport, unless a doctor advises otherwise.
Further reading at La Rose Clinic
Frequently asked questions
Is scoliosis caused by bad posture?
No. The NHS states that idiopathic scoliosis is not linked to posture, exercise or diet; the cause remains unknown in about 8 out of 10 cases.
Does scoliosis affect girls more?
Boys and girls are affected about equally often, but girls are around 10 times more likely to have a curve that progresses to the point of needing a brace or surgery.
Does everyone need a brace or surgery?
No. Many curves only need monitoring. A brace is considered for intermediate curves in a growing child, and surgery for more marked curves.
Can you play sport with scoliosis?
Generally yes: according to the NHS, most people lead a normal life, including sport, unless a doctor advises otherwise.
References
- Scoliosis (nhs.uk)
- Scoliose (Manuel MSD, version grand public) (msdmanuals.com)
- Adolescent Idiopathic Scoliosis: Common Questions and Answers (aafp.org)
- Scoliosis (MedlinePlus) (medlineplus.gov)
- Scoliose de l’enfant et de l’adolescent (larevuedupraticien.fr)
This article is for information only. It does not replace a medical consultation: if in doubt, talk to your doctor.
