Idiopathic scoliosis, which makes up over 80% of all cases, has no known cause — but that doesn't mean we don't know much about the condition or its treatment. Below is an up-to-date summary of facts to answer the question of what is scoliosis.
What Is Scoliosis?
Scoliosis is a condition that causes the spine to abnormally curve sideways, into an “S” or “C” shape. Scoliosis affects 2-3 percent of the population, or an estimated six to nine million people in the United States and is surprisingly common, impacting infants, adolescents, and adults of all races, classes, and genders.
Approximately one out of every six children diagnosed with scoliosis will have a curve that requires active treatment, sometimes involving surgery. Early diagnosis is the key to taking important first steps to providing treatment that may prevent more serious problems.
How Common Is Scoliosis?
Scoliosis occurs most often in children age 10 to 14, affecting females 7 times more frequently than males. Scoliosis is a broad term that may describe a spinal curve of 10 degrees or higher. The curve occurs at different points of the spine in each case but generally develops in one of four common curve patterns. It may or may not tilt the pelvis.
Scoliosis causes a bent spine, curvy spine, or even an S-shaped spine. Scoliosis may only have a curve on one side, elevate one shoulder, or make one shoulder blade prominent, but it is not life-threatening after the age of 5, prompting many doctors to conclude it does not require treatment.
The spine condition is progressive in many cases; however, we know more about and how to treat scoliosis symptoms now than ever before.
What Is the Main Cause of Scoliosis?
Is scoliosis hereditary? Is scoliosis genetic? Curvature of the spine (scoliosis meaning "crookedness") has been documented in medical records dating back to 450 BC and, until recently, has been considered and treated exclusively like an abnormal curvature of the spine — but a growing and overwhelming volume of evidence supports curves of the spine are so much more than just a curved spine.
Adolescent idiopathic scoliosis stems from a family history of genetic variant patterns that affect neurotransmitter production and hormone metabolism which combine to create an incorrect "posture memory" of spine alignment during periods of rapid growth. These clinical findings are the suspected causes of scoliosis and result in a twisted spine. Non-invasive, home-collected saliva and urine samples can be analyzed to help determine if scoliosis in children who are still growing could become severe or possibly get worse as they grow.
What Scoliosis Looks Like
Scoliosis patients lose some degree of curvature in their necks, resulting in forward head posture. The sideways curve of a scoliosis spine is greater than 10 degrees. It causes the rib cage to twist and the normal curve of the spine to flatten. A scoliosis curve looks flat where the spine is normally curved when viewed from the front or side. It appears twisted where there is typically no twist when viewed from the top down.
Understanding the faulty "postural memory" of a scoliosis spine on an x-ray is similar to watching the wind outside a window; you cannot actually see the wind, yet you can tell the direction and force in which it is blowing by the way it affects the grass, trees, and leaves.
There are four types of scoliosis:
1. Idiopathic Scoliosis
The most common type of scoliosis, idiopathic means of unknown origin. Depending on the age of onset, it may be infantile (birth to 3 years), juvenile (age 3 to 8), adolescent (age 9 to 18), or adult scoliosis (after age 18)
2. Congenital Scoliosis
A rare form of scoliosis, affecting one in 10,000 babies in utero
3. Neuromuscular or Syndromic Scoliosis
Developed by children who have neuromuscular disorders like muscular dystrophy or cerebral palsy
4. Degenerative Scoliosis
Adult scoliosis: a degenerative condition that typically occurs after age 40
What Are the Early Signs of Scoliosis?
Catching scoliosis early is critical because once a curve measures 25 degrees or more, there is a 68 percent chance scoliosis may get worse. You may detect signs of mild idiopathic scoliosis in its early stages by observing five different points on your child's body.
Eye line: Are your child's eyes level or is the eye line tilted?
Shoulder level: Do your child's shoulders hang evenly or is one higher than the other?
Hips: Are your child's hips even or is one hip higher or more pronounced?
Forward head posture: When you look from the side, does your child's mid-ear line up with the tip of the shoulder?
Head to hip line: Would a line from the center of your child's eyes line up horizontally to the center of the hips?
You may also use a detection method called Adam's forward bend test. Have your child do a full forward bend to see if the rib cage (shoulder blade) sticks out on one side, especially on the right side. If your child appears out of line using any of these views, he or she may have a spinal curvature. A trained posture analysis expert will help you determine if your child needs early-stage scoliosis intervention. Make sure any evaluation for scoliosis includes a standing full spine x-ray.
Scoliosis often is associated with family history. Although progressive scoliosis of the spine afflicts girls more often, your boys will be just as likely to develop it. Remind your pediatrician to check your children for scoliosis, especially if it runs in the family. Many parents are opting for genetic testing for scoliosis in children who are still growing. This very simple and safe saliva test may predict if patients are at higher risk for severe scoliosis, differentiate different types of scoliosis, determine their need for treatment, and possibly even predict symptoms of scoliosis.
What Will Happen If Scoliosis Is Not Treated?
Typically, a doctor who only measures a Cobb angle will recommend no treatment — just observation — for a curve measuring less than 24 degrees, hoping it won't get any worse. They may recommend a rigid spinal brace for up to 23 hours a day for a curve measuring 25 to 39 degrees. Fusion surgery may be recommended for people with curves measuring over 50 degrees using the Cobb angle.
Quick Facts About Scoliosis
Scoliosis is prevalent, affecting about 3% of the population in the US.
- It is the most common spinal deformity.
- In the vast majority of cases, scoliosis has no identifiable cause—this is termed idiopathic scoliosis.
- It usually starts between the ages of 10 to 15, though it is also possible to have scoliosis as an infant or to develop scoliosis as an adult.
- Scoliosis is diagnosed in both males and females.
- Females are significantly more likely to have scoliosis curves that progress and need either bracing and/or surgery to reduce the curvature.