Scoliosis in Children
What is scoliosis?
A normal spine, when viewed from behind, appears straight. However, a spine affected
by scoliosis shows evidence of a lateral, or side-by-side curvature, with the spine
looking like an "S" or "C" and a rotation of the back bones (vertebrae). This gives
the appearance that the person is leaning to one side. Scoliosis is defined as a curvature
of the spine measuring 10° or greater.
Scoliosis is a type of spinal deformity and should not be confused with poor posture.
Spinal curvature from scoliosis may happen on the right or left side of the spine,
or on both sides in different sections. Both the thoracic (mid) and lumbar (lower)
spine may be affected by scoliosis.
What causes scoliosis?
In most cases, the cause of scoliosis is unknown—a condition called idiopathic scoliosis.
Scoliosis is more common in females than males.
The American Academy of Orthopaedic Surgeons, in cooperation with the Scoliosis Research
Society, describe three different types of scoliosis that can happen in children—congenital
(present at birth), neuromuscular, or idiopathic:
Congenital. This type of scoliosis happens during fetal development. It is often caused by one
of the following:
Failure of the vertebrae to form normally
Absence of vertebrae
Partially formed vertebrae
Lack of separation of the vertebrae
Neuromuscular. This type of scoliosis is associated with many neurological conditions. This especially
happens in those children who do not walk, such as the following:
Idiopathic. The cause of this type of scoliosis is unknown. There are three types of idiopathic
Infantile (This type of scoliosis happens from birth to age 3. The curve of the vertebrae
is typically to the left and it is more commonly seen in boys. Typically, the curve
resolves as the child grows.)
Juvenile (Juvenile scoliosis happens in children between ages 3 and 10.)
Adolescent (This type of scoliosis happens in children between ages 10 and 18. This
is the most common type of scoliosis and is more commonly seen in girls.)
Other causes of scoliosis may include:
What are the symptoms of scoliosis?
The following are the most common symptoms of scoliosis. However, each child may experience
symptoms differently. Symptoms may include:
Difference in shoulder height
The head is not centered with the rest of the body
Difference in hip height or position
Difference in shoulder blade height or position
When standing straight, difference in the way the arms hang beside the body
When bending forward, the sides of the back appear different in height
Back pain, leg pain, and changes in bowel and bladder habits are not commonly associated
with idiopathic scoliosis. A child experiencing these types of symptoms needs immediate
medical evaluation by a healthcare provider.
The symptoms of scoliosis may resemble other spinal conditions or deformities. Or,
they may be a result of an injury or infection. Always talk with your child's healthcare
provider for a diagnosis.
How is scoliosis diagnosed?
In addition to a complete medical history and physical exam, X-rays (a diagnostic
test that uses invisible electromagnetic energy beams to make images of internal tissues,
bones, and organs onto film) are the primary diagnostic tool for scoliosis. In establishing
a diagnosis of scoliosis, the healthcare provider measures the degree of spinal curvature
on the X-ray.
The following other diagnostic procedures may be performed for nonidiopathic curvatures,
atypical curve patterns, or congenital scoliosis:
Magnetic resonance imaging (MRI). This diagnostic procedure uses a combination of large magnets and a computer to produce
detailed images of organs and structures within the body.
Computed tomography (CT) scan. This is an imaging test that uses X-rays and a computer to make detailed images of
the body. A CT scan shows details of the bones, muscles, fat, and organs. CT scans
are more detailed than general X-rays.
Early detection of scoliosis is most important for successful treatment. Pediatricians
or family healthcare providers, and even some school programs, routinely look for
signs that scoliosis may be present.
What is the treatment for scoliosis?
Specific treatment of scoliosis will be discussed with you by your child's healthcare
provider based on:
Your child's age, overall health, and medical history
The cause of the scoliosis
The extent of the condition
Your child's tolerance for specific medicines, procedures, or therapies
Expectations for the course of the condition
Your opinion or preference
The goal of treatment is to stop the progression of the curve and prevent deformity.
Treatment may include:
Observation and repeated exams. Observation and repeated exams may be necessary to determine if the spine is continuing
to curve, and are used when a person has a curve of less than 25° and is still growing.
Progression of the curve depends upon the amount of skeletal growth, or the skeletal
maturity of the child. Curve progression usually slows down or stops after the child
Bracing. Bracing may be used when the curve measures more than 25° to 40° on an X-ray, but
skeletal growth remains. It may also be necessary if a person is growing and has a
curve between 20° and 29° that isn't improving. The type of brace and the amount of
time spent in the brace will depend on your child's condition.
Surgery. Surgery may be recommended when the curve measures 45° or more on an X-ray and bracing
isn't successful in slowing down the progression of the curve when a person is still
According to the National Institute of Arthritis and Musculoskeletal and Skin Disorders,
there is no scientific evidence to show that other methods for treating scoliosis
(for example, chiropractic manipulation, electrical stimulation, nutritional supplementation,
and exercise) prevent the progression of the disease.
What is the long-term outlook for a child with scoliosis?
The management of scoliosis is individualized for each child. It depends on his or
her age, amount of curvature, and amount of time remaining for skeletal growth. Scoliosis
will need frequent exams by your child's healthcare provider to monitor the curve
as your child grows and develops. Early detection is important. If left untreated,
scoliosis can cause problems with heart and lung function.