What Is Scoliosis? Types, Causes, Diagnosis, Treatment

At your child’s last physical, their healthcare provider probably asked them to bend over and let their arms hang in front of them. Their provider wasn’t doing a flexibility check; they were screening for scoliosis. 

Scoliosis is a condition in which the spine curves, twists, or rotates in a way that it shouldn’t. If caught early and treated, it’s possible to keep scoliosis from getting worse, affecting spinal growth, and causing other health problems. 

In this article, we take a closer look at the different types, diagnosis, and treatment of scoliosis.

What are the different types of scoliosis?

There are many types of scoliosis, but they all cause the spine to curve in a way it shouldn’t. When examining someone’s spine, a healthcare provider is looking for that unusual curve. 

In order to properly diagnose and treat scoliosis, it’s important for a provider to know what exactly is causing the curve. Often, they can identify the type of scoliosis by asking about someone’s medical history and doing a complete physical exam. The major causes of scoliosis include:

• Juvenile idiopathic scoliosis: This is the most common cause of scoliosis. Often, when healthcare providers refer to scoliosis, they really mean juvenile idiopathic scoliosis. It happens in younger teenagers as they start going through puberty. As they grow, the spine begins to curve and rotate in a way it shouldn’t. It’s called “idiopathic” because researchers still don’t know what causes it. 

• Congenital scoliosis: Some children are born with one or more incompletely formed spinal vertebrae (the bones that make up the spine). When one of these bones isn’t completely formed, it will cause the spine to curve as it grows. Many children with congenital scoliosis also have other medical issues.

• Neuromuscular scoliosis: This occurs when a muscle problem leads to scoliosis. The back muscles hold the spine in place. If some muscles are weaker than others, they can pull on the spine and cause an abnormal curve. Neuromuscular scoliosis happens when children have certain medical conditions like cerebral palsy or muscular dystrophy. 

• Leg length discrepancy: Unlike the other types of scoliosis, someone with leg length discrepancy does not have a problem with the curve in their spine. In this case, the child actually has one leg that’s a little longer than the other, making it look like the spine is curved during the physical exam. Leg length discrepancy is treated differently than scoliosis. 

How is scoliosis diagnosed?

Healthcare providers screen children for scoliosis during physical exams, like those done for annual checkups. If the exam raises concern, the diagnosis will be confirmed with an X-ray. 

Screening for scoliosis during a physical exam

Some children have medical conditions that put them at risk for developing congenital or neuromuscular scoliosis. These children should be evaluated for scoliosis by their primary healthcare provider or orthopedist on a regular basis.

For everyone else, there is some controversy over whether or not screening for scoliosis is worthwhile. But many major medical organizations recommend that children get checked for scoliosis at least twice before puberty. Female children are 3 to 4 times more likely to need treatment for scoliosis, so some providers opt for yearly exams starting in the preteen years. 

Getting checked for scoliosis is straightforward, inexpensive, and painless. It involves three steps:

1. Back exam: A healthcare provider examines a child’s bare back while they’re standing up straight, with arms at their sides. The provider will make sure that the child’s shoulders and shoulder blades are at equal heights, that the tops of their hip bones are even, and that their arms are about the same length. 

2. The forward bend test: A child stands with their feet together and bends at the waist. (They don’t need to touch their toes: The goal is to get their back parallel to the ground.) Standing behind the child, a healthcare provider examines their back to see if one side is higher than the other. 

3. Scoliometer measurement: A scoliometer is an instrument that gives an approximate measurement of the curve of someone’s spine. A provider will place it on a child’s back during the forward bend test. A reading of more than 5 degrees raises concern for scoliosis.   

Confirming a diagnosis with a spine X-ray

If your child’s screening exam raises concern for scoliosis, their healthcare provider will order spine X-rays. A physical exam isn’t perfect, but with X-rays, it’s possible to measure the exact degree of the spine’s curve. The spine’s curvature is called the Cobb angle. The Cobb angle is important because it determines if, and how, scoliosis needs to be treated. 

A Cobb angle ranges in severity:

• Mild: between 10 to 20 degrees

• Moderate: between 20 to 40 degrees  

• Severe: more than 40 degrees

What is the treatment for scoliosis?

Treatment for scoliosis depends on your child’s Cobb angle. 

Children with mild scoliosis don’t need any treatment, but will need to be examined a few times a year to make sure their curve doesn’t get worse. While some children with mild scoliosis progress to moderate scoliosis, most don’t.

Children with moderate or severe scoliosis need treatment. Treatment for scoliosis includes a back brace or surgery:

• Back brace: Children with moderate scoliosis can be treated with a back brace. Children wear this brace until they finish their growth spurt. The brace keeps the curve from getting worse. Research has shown that children who wear a brace are less likely to need surgery.     

• Surgery: Children with severe scoliosis may need a procedure called a spinal fusion. This involves placing a rod and screws in the back so that the vertebrae grow together and stop the curve from worsening. Modern fusion techniques can also help straighten the spine. Surgery is a more invasive option and carries the risk of complications.

Ideally, scoliosis is detected early, while it’s still mild or moderate. With early detection and treatment, children can hopefully avoid severe scoliosis and the need for surgery. 

The good news is that most children with scoliosis have mild cases and don’t need treatment. For children who have more advanced scoliosis, treatment can prevent:

• Back pain

• Spinal deformities

• Trouble walking

• Scoliosis-related lung and heart problems

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Written by:

Brian Clista, MD

Dr. Clista is a board-certified pediatrician who works in private practice in Pittsburgh, Pennsylvania. He previously served as a National Health Service Corporation Scholar in the inner city of Pittsburgh for 11 years.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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