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.
Scoliosis may be divided into five principal types:
Progressive, severe scoliosis can produce three major problems:
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.
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, 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 your child has matured.
Children with curves less than 50 degrees typically grow up into adults with no significant problems related to scoliosis.
Scoliosis treatment is based on the degree of curvature of the spine, viewed from the front or back by X-ray. The following are general guidelines for treatment.
Reviewed by health care specialists at UCSF Benioff Children's Hospital.