Scoliosis: Causes, Symptoms and Treatment

What is scoliosis?

Scoliosis is a curvature of the spine. While it is common to have a small curve of the spine, larger curvatures can potentially cause health issues. Scoliosis affects up to three percent of children.

What causes scoliosis?

There are many things that can cause scoliosis. Scoliosis is largely inherited—even if your immediate family does not have scoliosis, the genes can be passed down.

What are the types of scoliosis?

There are several types of scoliosis.

• Idiopathic scoliosis is the most common, and this is seen in patients without an underlying cause. We think most of these cases are genetic.  
• Neuromuscular scoliosis is associated with underlying conditions like cerebral palsy or spina bifida, conditions that the patient and/or family usually know they have. Neuromuscular scoliosis can also be caused by a compression or tethering of the spinal cord, and scoliosis may be the only symptom of this problem until later, when nerve problems arise.
• Patients with abnormally loose ligaments can also develop scoliosis.
• Another type of scoliosis is called congenital scoliosis, and this occurs when the bones of the spine are not formed normally in the womb. These curvatures can present in very young children and progress very rapidly.

What are the symptoms of scoliosis?

Scoliosis may not have many symptoms. Particularly early on, pain is not necessarily a feature of scoliosis. The patients or their families may notice that their hips or shoulders are uneven, or that their rib cage sticks out more on one side than the other. The asymmetry of the chest wall, as a result of the curvature, can often make one breast look larger or smaller than the other in teenage girls.

How is scoliosis diagnosed?

Many pediatricians conduct simple, non-invasive tests to look for signs of scoliosis at children’s wellness visits. If scoliosis is suspected, an Xray is usually ordered to confirm the diagnosis and determine if any treatment is needed.

What are the risks of scoliosis?

For mild cases of scoliosis, there are few risks. Larger curvatures can potentially impact the stiffness of the rib cage, placing more stress on the heart and lungs. Large curvatures in the lower part of the spine occasionally will increase the risk of pain.

How is scoliosis treated?

The treatment of scoliosis depends on three things: the cause of the scoliosis, the size of the curvature, and the amount of growth the patient has remaining. Scoliosis is measured in degrees; more than 10 degrees of curvature is called scoliosis, less is normal. Small curvatures (0-20°) will only worsen if the child is growing. These patients are usually treated with observation to make sure the curve doesn't get any bigger. In patients who have at least a year or two of growth remaining and whose curvatures are intermediate (between 25° and 45°), bracing is often used to prevent the curvature from worsening. Very large curvatures (over 50°) will tend to get worse even in adulthood. These patients often have surgery to prevent a severe curvature developing which might cause problems later in life.

Scoliosis-specific physical therapy has regained interest among practitioners. Initially developed by Dr. Katharina Schroth in Germany, this treatment seeks to teach the patient to stabilize or correct their curvatures through daily exercises. A highly trained physical therapist who is certified in these techniques attempts to teach the patient to realign their spine. This is different from regular physical therapy; our physicians work with the only two physical therapists in Rhode Island who are certified in these techniques by the Barcelona School of Schroth physical therapy.

The treatment of congenital scoliosis, as well as early onset scoliosis, which is defined as a curvature in a child under 10 years old, is highly specialized and may require early surgery in children of a very young age, cast treatment, or other personalized treatment plans.

Seeking a surgeon with experience in all of the sub-types of scoliosis, as well as all of the surgical options, is crucial to prevent future problems. If addressed early, treatment such as bracing, physical therapy, and observation have the potential to avoid the need for a later surgery. A pediatric orthopedic surgeon who has been trained in these techniques is usually the most appropriate provider to manage the care of these children.

The Pediatric Orthopedics division at Hasbro Children’s Hospital treats all forms of scoliosis and includes experts in all types of treatment, including nonsurgical and surgical approaches to care. Visit our website to learn more about how we care for patients with scoliosis.