Scoliosis - Causes, Symptoms And Treatment

Overview

Scoliosis is a condition characterized by an abnormal lateral curvature of the spine. While a healthy spine appears straight when viewed from the front, scoliosis causes it to curve to the side—either in a C-shape or S-shape. In some cases, the vertebrae also rotate, creating a corkscrew-like twist.

What is Scoliosis?

Scoliosis is diagnosed when the spinal curvature exceeds 10 degrees. It can range from mild to severe and may develop at any age, though it most often appears during puberty during a rapid growth spurt. The condition may be idiopathic (no known cause), or occur due to neuromuscular disorders like cerebral palsy or muscular dystrophy, as well as congenital spinal malformations.

Common signs include:

• Uneven shoulders or hips
• A visible curve in the back
• Leaning to one side when standing
• Ribs protruding more on one side

While many cases are mild and don’t require treatment, monitoring is essential—especially during growth years. If the curve worsens, it may restrict lung function due to reduced space in the chest cavity.

Causes of Scoliosis

In most cases, the exact cause of scoliosis is unknown. This type is known as idiopathic scoliosis, and it accounts for approximately 70–80% of all cases. Idiopathic scoliosis is most often detected during adolescence and has no clearly identifiable underlying condition.

For the remaining cases, scoliosis can be classified based on whether the curvature is non-structural or structural:

Non-Structural Scoliosis (Functional)

In non-structural scoliosis, the spine itself is normal, and the curvature is temporary—typically caused by an external factor. Once the underlying issue is treated, the curve often resolves. Common causes include:

• Muscle spasms
• Leg length discrepancy (one leg longer than the other)
• Inflammation, such as from appendicitis

Structural Scoliosis

Structural scoliosis is more serious and involves a permanent curvature of the spine. The spine itself is abnormally shaped and does not straighten with changes in posture. Causes may include:

• Congenital scoliosis: Caused by malformations of the spine during fetal development. It may be detected at birth or during childhood.
• Neuromuscular conditions: Such as muscular dystrophy and cerebral palsy, which affect muscle control and spinal alignment.
• Genetic disorders: Conditions like Marfan syndrome and Down syndrome may be associated with scoliosis.
• Spinal trauma or infections: Injuries or infections affecting the spine can result in permanent curvature.
• Degenerative scoliosis: Occurs in adults due to age-related spinal wear and tear, such as arthritis or disc degeneration.
• Tumors or growths: Rarely, masses in or near the spine can lead to structural scoliosis.

Early detection and proper classification of the cause can help guide effective treatment and long-term management.

Who Might Be at Risk for Scoliosis?

Scoliosis can affect people of all ages, but certain factors may increase the likelihood of developing the condition:

• Age: Scoliosis often appears during growth spurts, typically between ages 10 and 16. However, it can also develop in infants or adults due to degenerative changes.
• Gender: Both boys and girls can develop scoliosis, but girls are more likely to have curves that worsen and require treatment.
• Family History: Having a close family member with scoliosis can increase the risk, although many people with scoliosis have no family history.

Symptoms of Scoliosis

Scoliosis symptoms often become noticeable during childhood or adolescence and may first be observed by parents, teachers, or sports coaches. In many cases, scoliosis causes visible changes in posture and alignment. Symptoms can vary depending on the severity of the spinal curve and the age of the individual.

Common Signs in Children and Adolescents:

• Uneven shoulders
• One shoulder blade that appears more prominent
• Uneven waistline or hips (one hip higher than the other)
• The body leans to one side
• Ribs protruding more on one side due to spinal rotation
• Spine appears curved when viewed from behind

As the spinal curve worsens, the spine may also begin to twist or rotate, leading to more pronounced rib asymmetry.

Symptoms in Infants:

• A noticeable curve in the baby’s body posture while sleeping
• A bulge or protrusion on one side of the chest
• Delayed physical development may sometimes be noticed

Symptoms in Adults:

• Chronic or mild back pain, particularly in individuals with a history of scoliosis
• Visible postural imbalances (e.g., uneven shoulders or hips)
• In severe cases, complications such as chest pain and shortness of breath may occur due to reduced lung or heart capacity

When Severe:

In advanced scoliosis, the curvature may affect the rib cage, leading to restricted lung function and reduced heart capacity. This can result in:

• Difficulty breathing
• Fatigue during physical activity
• Chest tightness or pain

Note: Early detection and treatment are crucial to prevent worsening of the curve and long-term complications.

Diagnosis of Scoliosis

Diagnosing scoliosis typically begins with a physical examination and may be followed by imaging tests to confirm the presence and severity of the spinal curvature.

1. Physical Examination

Your doctor will start by visually inspecting the spine. A common test involves asking the patient (often a child or adolescent) to bend forward at the waist to a 90-degree angle while keeping the arms relaxed and hanging down. This position helps the doctor check for asymmetry, such as a prominent rib cage or uneven shoulders, which may indicate scoliosis.

2. Neurological Examination

To rule out neurological causes or complications, the doctor may evaluate:

• Reflexes
• Muscle strength
• Sensation in the arms and legs (to detect numbness or tingling)
• Balance and coordination

This helps determine if scoliosis is linked to conditions such as muscle weakness, nerve compression, or other neurological disorders.

3. Imaging Tests

• X-rays: The primary imaging tool used to confirm scoliosis. It shows the degree of spinal curvature and helps assess how far the condition has progressed.
• MRI or CT Scan: If there’s concern about an underlying cause like a spinal tumor, infection, or neurological issue, the doctor may order advanced imaging to examine the spinal cord and surrounding structures in greater detail.

Treatment for Scoliosis

The treatment for scoliosis depends on multiple factors including the age of the patient, severity of the spinal curve, location of the curve, and whether the condition is progressing. Not all cases require intervention—mild scoliosis can often be managed with regular monitoring. However, moderate to severe scoliosis may require bracing or surgery.

1. Observation and Monitoring

In children with mild scoliosis (spinal curve less than 25 degrees), treatment may not be necessary. However, regular monitoring every 4–6 months is essential to check if the curve is worsening—especially during growth spurts.

Doctors consider the following factors before deciding on treatment:

• Age and growth stage: Younger children who are still growing are at higher risk of progression.
• Gender: Girls are more likely than boys to develop worsening curves.
• Curve severity: Larger or S-shaped curves (double curves) are more likely to worsen.
• Curve location: Thoracic (mid-back) curves are more prone to progression than lumbar curves.

2. Bracing

Bracing is recommended for children or adolescents with moderate curves (typically 25–40 degrees) who are still growing. While braces do not correct scoliosis, they help prevent further progression of the spinal curvature.

Common Braces:

• TLSO (Thoracolumbosacral Orthosis): A custom-molded plastic brace that fits under the arms and around the torso. It is comfortable and nearly invisible under clothing.
• Milwaukee Brace: A full-torso brace with a neck ring, used when TLSO is ineffective.

Braces are most effective when worn full-time and may be discontinued once the child has stopped growing—often marked by signs such as the onset of menstruation in girls or facial hair growth in boys.

3. Casting (for Infants)

In infants with scoliosis, serial casting may be used instead of bracing. Casts help guide the spine’s growth into a normal position and are changed regularly as the baby grows. This non-surgical approach is performed under general anesthesia and uses plaster of Paris or synthetic material.

4. Surgery

Surgical intervention is considered when the spinal curve is:

• Greater than 45–50 degrees
• Progressing rapidly despite bracing
• Causing functional or cosmetic issues

a. Spinal Fusion

This is the most common surgical treatment for scoliosis. It involves:

• Fusing two or more vertebrae together
• Inserting rods, screws, or wires to hold the spine in a straighter position while the bone fuses

This prevents further curvature and helps stabilize the spine. Fusion surgery typically requires a hospital stay of 7–10 days and a recovery period of 6–12 weeks.

b. Growing Rods for Young Children

For younger children with severe scoliosis, growing rods may be surgically placed along the spine. These rods can be lengthened every 6 months as the child grows. Once growth is complete, a final fusion surgery is often performed.

c. Shape Memory Alloy (SMA) Staples

This innovative technique uses C-shaped titanium alloy staples that compress when warmed to body temperature, helping correct the curve over time without fusion. This method maintains spinal flexibility and normal growth, and has been successfully performed at Apollo Hospitals.

5. Advanced Techniques

Apollo Hospitals has pioneered modern scoliosis correction procedures in India:

• Stapling technique to allow controlled curve correction during growth
• Use of Nitinol SMA implants for non-fusion correction in younger patients

6. Physical Therapy and Exercises

While exercises alone cannot cure scoliosis, they play a supportive role in:

• Improving posture
• Strengthening spinal muscles
• Enhancing overall mobility

Physical therapy may be advised post-bracing or post-surgery to maintain spinal alignment and improve quality of life.

Post-Surgical Recovery and Follow-up

• ICU stay for 24 hours post-surgery
• Full hospital stay of around 10 days
• Return to school in 6–8 weeks
• Return to sports in approximately 12 months
• Bracing may be required for 6 months after surgery for additional support
• Follow-up visits every 6 months for rod lengthening or curve monitoring

Can Scoliosis Be Prevented?

Scoliosis is generally not preventable, especially in the most common form known as idiopathic scoliosis, which has no known cause and is often linked to genetic factors. In fact, around 80% of scoliosis cases fall into this category. That means the condition is not caused by poor posture, sports injuries, or carrying heavy school bags—despite common myths.

Common Myths About Scoliosis (Not True)

• Scoliosis is caused by sitting with poor posture
• Carrying a heavy backpack leads to scoliosis
• Children can "outgrow" scoliosis without treatment
• Physical activities or minor childhood injuries trigger the condition

These assumptions are incorrect and can delay appropriate diagnosis and care.

What Can Be Done?

While scoliosis cannot be prevented, certain measures can support early detection and overall spinal health:

1. Early Screening

• School-based screening programs around age 10–12 help detect early signs of scoliosis.
• Regular checkups during growth spurts are vital, especially if there is a family history of the condition.

2. Healthy Lifestyle

• Physical activity and sports do not cause scoliosis—in fact, they help improve strength, flexibility, and posture.
• Encourage children and teens to remain active and engaged in fitness routines and stretching.

3. Emotional Support

Being diagnosed with scoliosis—especially during adolescence—can affect a child’s self-esteem and mental well-being. Emotional and family support play a critical role in helping them adapt to braces or treatment plans and maintain confidence in social situations.

Final Takeaway

While you cannot prevent scoliosis, you can manage it effectively. With early detection and timely medical intervention, most children with scoliosis can lead normal, active, and fulfilling lives. If you notice uneven shoulders, hips, or posture in your child, consult a doctor promptly for evaluation. Untreated scoliosis can lead to long-term complications, including breathing difficulty, heart strain, and chronic pain.

If you suspect scoliosis in your child,

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at Apollo Hospitals today.