Scoliosis

Scoliosis means abnormal curvature of the spine greater than 10 degrees, as measured on an X-ray. Anything less than 10 degrees is considered normal variation in a normal individual. The curvature takes place in three dimensions.

Normally, the spine is straight when looking at a person from the front or back. When looking at a person from the side, the spine is curved. There is a gentle bending forward of the spine in the chest and a bending backward, called lordosis, between the chest and the pelvis.

In scoliosis, the spine appears S-shaped when looking at the front or back. When looking at the side, the normally curved spine typically straightens out. In addition, the spine twists on its axis, pushing the ribs and flanks backward and forward to produce a prominence, or hump.

Forms of Scoliosis

Scoliosis may be divided into five principal types:

Idiopathic Scoliosis — This is the most common form of scoliosis. The term idiopathic means "the cause is unknown," and affected children are otherwise healthy and normal. The bones of the spine show no abnormality on X-rays or when looking at them directly in the operating room. While the overall incidence is equal in girls and boys, progressive or severe idiopathic scoliosis is about six to seven times more common in girls than in boys.
Congenital Scoliosis — Congenital scoliosis means the child was born with the condition, and it is caused by an abnormality of one or more vertebrae. The vertebrae don't form properly, which can be seen on X-rays and when looking at them directly in the operating room.
Neuromuscular Scoliosis — This is scoliosis that occurs in children who have a disease of the nervous system, such as cerebral palsy.
Syndromic Scoliosis — This type of scoliosis occurs in children with a syndrome, such as Marfan syndrome, or one of the skeletal dysplasias such as achondroplasia.
Postural Scoliosis — Also known as "hysterical scoliosis," postural scoliosis may be a result of pain, as the child tilts sideways to alleviate the pain. It can be reversed by relieving the pain or by having the child lie flat. X-rays don't show any abnormality of the vertebrae.

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Signs and Symptoms
Diagnosis
Treatment

Progressive, severe scoliosis can produce three major problems:

If the part of the spine that's in the chest, called the thoracic spine, curves more than 90 percent, the volume of the chest can be reduced so much that the function of the heart and lungs may be compromised. The heart may have to work harder to pump the normal volume of blood, or the child may have difficulty breathing.
Severe curvature of the lower half of the spine that connects the chest with the pelvis, known as the lumbar spine, may push the contents of the abdomen against the chest and interfere indirectly with heart and lung function. Curvature of the lumbar spine may also alter sitting balance and posture.

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Scoliosis can be diagnosed with a physical examination by a school nurse, pediatrician or orthopedic surgeon. The principal sign is asymmetry of the back, as the spine bends sideways and twists. Most commonly, this is detected by noticing a hump on the ribs or flank, between the ribs and hip, after asking the child to bend forward. The tilt produced in the back can be measured in degrees by a level; seven degrees or more is considered significant for scoliosis.

Other signs of scoliosis include elevation of one shoulder compared with the other, tilting of the pelvis — which may make one leg appear shorter than the other — and a difference in the contours of the flanks.

The next step after the physical examination is an X-ray of the spine.

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There's no clear evidence that untreated scoliosis, or scoliosis treated with bracing or spinal fusion, will increase the risk of back pain or arthritis in the long term.

The younger a child, or the more she or he has to grow, the greater the risk of scoliosis progressing. After puberty and growth, curves less than 50 degrees are not likely to get worse. For this reason, the ultimate goal of scoliosis management is to keep curves under 50 degrees until the child has matured. Children with curves less than 50 degrees typically grow up into adults with no significant problems related to scoliosis.

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Reviewed by health care specialists at UCSF Benioff Children's Hospital.
Last updated June 17, 2010

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