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Scoliosis

Led by the highly specialized orthopedic surgeons at HSS Spine and the Lerner Children's Pavilion, HSS is recognized as a world leader in the management of complex spinal deformities in both children and adults.

 

What is scoliosis?

Scoliosis is a condition of the spine in which the spine curves sideways in an "S" shape, either to the right or left side. This different from the condition known as kyphosis, where the spine has an abnormal, forward-oriented curvature.

X-ray image showing scoliosis in the thoracic and lumbar spine.

X-ray image showing side view of patient with kyphosis in the thoracic spine.

Anteroposterior (front-to-back) view of the spine (in standing position, demonstrating scoliosis in the thoracic and lumbar spine.

Lateral (outer side) view of the spine in standing position, demonstrating kyphosis (forward curvature) in the thoracic spine.

Scoliosis animation video

View an animation on adult and juvenile scoliosis.

Thumbnail image of scoliosis animation.

What are the different types of scoliosis?

There are three basic types of scoliosis: idiopathic, congenital and neuromuscular.

  • Idiopathic scoliosis is where the cause or origin is unknown. This is the most common type.
  • Congenital scoliosis is where the bones in the spine are abnormally curved at birth.
  • Neuromuscular scoliosis is where the curvature is a symptom of a separate, systemic condition, such as cerebral palsy, muscular dystrophy, or paralysis.

These conditions are all types of what is termed "structural scoliosis," where incorrectly formed bones create an S-curve in the spine that is fixed and cannot be straightened by adjusting body position. "Nonstructural scoliosis" (also known as "functional scoliosis") is where the curvature is temporary and not caused by a malformed vertebare in the spine but by a separate condition that affects posture, such as skeletal dysplasia or a limb length discrepancy.

Scoliosis can affect the spine in any of its three major sections:

  • cervical spine (neck)
  • thoracic spine (chest and upper back region)
  • lumbar spine (lower back)

Illustration of spinal column, lateral (side) view and posterior (rear) view, showing the cervical, thoracic and lumbar sections, along with the sacrum and cocyx.
Diagram showing the sections of the healthy spine, with the neck (cervical) section at the top, followed below by the thoracic and lumbar sections, the sacrum and the coccyx (tailbone). The curvature shown in the left image is the normal curve of the spine when it is viewed from the side (not scoliosis).

Quick facts about scoliosis

  • Scoliosis affects girls much more than boys, by a ratio of about 8 to 1.
  • 2% of teenagers get scoliosis.
  • 5% of children or adolescents with scoliosis require bracing or surgery.
  • 30% of scoliosis patients have a family hisory of scoliosis.
 

Who gets scoliosis?

Scoliosis is primarily diagnosed in children and adolescents, although it can develop in adults later in life. Adolescent idiopathic scoliosis is the type of scoliosis seen most frequently by spine surgeons and comprises 80% of all spinal deformities.

What is adolescent idiopathic scoliosis?

Adolescent idiopathic scoliosis a condition that develops in children between the ages of 10 and 18, in which the spine is curved sideways in one or more areas with no known cause. It affects girls more frequently than boys.

Can adults get scoliosis?

Yes. Although scoliosis develops most frequently in childhood or adolescents, adults may also be diagnosed with scoliosis. In adults, it may be due either to the progression of a curve that existed in their youth, or as a result of a degenerative spine condition or osteoporosis.

Learn more about adult scoliosis by reading Scoliosis In Adults: Symptoms, Diagnosis and Treatments.

X-rays 1 and 2 of 4: Progression of adult scoliosis from age 14 to age 46.

X-rays 3 and 4 of 4: Progression of adult scoliosis from age 14 to age 46.
Progression of adult scoliosis from age 14 (top left) to age 46 (lower right).

What are the symptoms of scoliosis?

A sideways curvature of the spine is the key symptom of all forms of scoliosis. This is usually revealed when a shoulder, waist, hip other body part on one side is higher than the other. Scoliosis rarely causes pain in children an adolescents. Back pain, however, is a common symptom for people who develop scoliosis as an adult.

When a child or teenager with scoliosis does experience back pain, this is usually a sign that they have some additional condition.

How is scoliosis diagnosed?

Typically, scoliosis is first noticed by a child’s pediatrician, family member or school nurse. As an initial screening method, healthcare professionals use the Adams forward-bending test to look for the presence of any asymmetry of the torso or shoulder blades, or for protrusion of the shoulder blades. The medical evaluation for scoliosis includes a physical exam and spinal imaging.

Photo of a patient doing Adams forward-bending test, revealing pronounced curvature of the spine.
This photo shows a pronounced curve, revealed during an Adams forward-bending test.

A doctor may also use scoliometer to measure the amount of trunk inclination (the curve) or rotation (twisting of the spine). A child or adolescent with a curvature measuring 7 degrees or greater will be referred to an orthopedist for further evaluation and monitoring. A diagnosis for scoliosis is made when the curvatue that exceeds 10 degrees.

Radiological imaging

To assess the curve further, X-ray images or low-dose radiation EOS images are taken from the front and side views.

Parents who are concerned about exposing their child to radiation during medical imaging should consult a doctor to learn whether EOS imaging is an appropriate alternative to traditional X-rays. EOS imaging has several safety and diagnostic advantages, especially for children or teens who may need to have multiple images taken over time to monitor the progression of their scoliosis. These include:

  • radiation levels significantly lower than that of traditional X-rays
  • simultaneous image captures of full-body frontal and side views in less than twenty seconds.
  • two dimensional (2D) and three-dimensional (3D) orthopedic images can be produced to assist with diagnosis and treatment

eos low-dose radiation imaging of scoliosis
EOS images of a patient with scoliosis: 2D anteroposterior (front-to-back) and lateral (outer side) X-ray views, and 3D anteroposterior rendering of the spine and pelvis.

How is scoliosis treated?

Treatments may be surgical or nonsurgical, and they also vary depending on the type of scoliosis a person has, and the age at which they develop it.

Treatment for adolescent idiopathic scoliosis determined by the degree of the spinal curve at the time of diagnosis and by the anticipated progression of that curve. Mild cases may not require any treatment. More significant cases may be treated nonsurgically, using braces, or with spine fusion surgery.

Nonsurgical treatment of adolescent idiopathic scoliosis

For curves measuring less than 25 degrees, the orthopedist may recommend frequent monitoring to see if additional intervention becomes necessary.

Young people with curves between 25 and 45 degrees may be candidates for treatment with bracing. While bracing does not correct the curve, it has been shown to stop progression in up to 75% of patients. Bracing is considered a success when progression is halted and maintained within 6 degrees of the original measurement of the curve.

In most cases, patients wear a brace for 22 to 23 hours a day, removing it only for hygiene and sports activities. However, some patients may only require the use of a brace at night.

A variety of braces are available and selection is based on how many curves are present and where on the spine the curve or curves are. Some models provide support at the pelvis, front, back, and neck, where others provide support throughout the torso and underarms.

While many braces are rigid, flexible braces have been developed in recent years. This type of brace, which is only appropriate in patients with single curves, is worn as a vest and allows the patient to participate in some sports activities

Photo of a patient wearing a rigid, flexible brace, front view. Photo of a patient wearing a rigid, flexible brace, rear view.
A patient wearing a rigid, flexible brace, allowing participation is some sports activities.

Patients continue to wear the brace until they have stopped growing and skeletal maturity is reached. At that point, A weaning process follows in which the number of hours the brace is worn per day is gradually reduced over a period of six months to a year. This allows the supportive muscles in the back and trunk to become stronger after a period of inactivity. Physical therapy is also recommended, both during bracing and weaning.

Surgical treatment of adolescent idiopathic scoliosis

Patients with curves that continue to progress beyond 50 degrees, either with or without bracing, generally require surgical intervention.

How does scoliosis surgery work?

There are different surgical methods, but the most common type of surgery is a posterior spinal fusion with instrumentation (artificial implants). In this procedure, the orthopedic surgeon makes an incision from the back and essentially "welds" the vertebrae together using bone chips.

These bone chips may be:

  • autografts – taken from elsewhere in the patient's own body
  • allografts – sourced from donors through a bone bank

The spine is then held in alignment by hooks, screws or other instrumentation. Once the fusion is complete, the implants no longer serve a function but are left in place to avoid the need for additional surgery.

X-ray image showing (back to front) posterior spinal fusion with instrumentation. X-ray image showing (side view) posterior spinal fusion with instrumentation.
Postsurgical X-ray images of the corrected spine, with a posterior (rear) view at left and a lateral (outer side) view at right.

Some patients may be candidates for minimally invasive spine fusion surgery.

What is minimally invasive spine surgery?

This refers to muscle-sparing approaches to the spine that use small incisions as access portals. They are often performed using live X-ray or CT scan imaging for guidance, as well as robotic surgery (also called robotic-assisted surgery).

In minimally invasive spine surgery, the surgeon will approach the spine from one of three positions, dependending on the patient's age, symptoms, spine alignment, and the anatomy of the nerves and blood vessels. These positions are:

  • anterior – from the front
  • lateral – from the outer side (flank)
  • posterior – from the back

In most cases, access to the spine is established by using a series of dilators that split the muscle to create a working portal. The size of this portal will vary depending on the surgeon and the specific spine surgery being performed. Using these techniques, however, spine surgery access portals can now be as small as 1.2 centimeters (about a half an inch).

When the spine needs to have screws and rods inserted to hold it in position (called instrumentation), this can also be performed through small incisions with the assistance of intra-operative X-rays, CT scans or robotic guidance.

What is the recovery time for scoliosis surgery?

Most spinal fusion patients stay in the hospital for 3 to 5 days and are standing within two days. Children and teens can usually return to school in 4 to 6 weeks, begin low-impact exercise at three months, and full activity at six months. The complete healing process may take 6 to 12 months.

Patients who undergo combined anterior and posterior spine procedures may have a slightly longer stay in the hospital. Neverthess, recovery times from modern scoliosis spine surgeries are significantly shorter than they were decades ago, when people sometimes spent weeks or months in the hospital in a body cast or in traction.

What are the risks of a spinal fusion surgery?

Rare complications of spinal fusion can include infection and spinal cord abnormalities or injury. However, at HSS, multiple precautions are taken during surgery to protect the patient, including administration of antibiotics during surgery to help guard against infection and continuous monitoring of sensory and motor function of the spinal cord.

What are the results of scoliosis surgery?

Spinal fusion surgery for scoliosis provides significant spine curvature correction, cosmetic and posture benefits, but does cause some inflexibility in the spine.

Curvature correction

Fusion surgery generally yields very good results, with a correction rate of between 60% to 100%, depending on curve flexibility and location. Spinal fusion does result in some loss in range of motion, however. The extent of that loss varies depending on the section of spine corrected and the number of vertebrae that are fused.

Cosmetic results

  • a balanced spine
  • leveled shoulders
  • reduction or elimination of any rib hump

Get more detailed information about scoliosis by reading the articles below, or find the best scoliosis doctor or surgeon for you or your child based on location, insurance and condition.

In-depth scoliosis articles

Get detailed information on the various types of scoliosis and how they affect people of different ages.

Articles on diagnosing scoliosis with radiological imaging

Understand how doctors use X-rays and other imaging technologies to recognize scoliosis.

Scoliosis treatment articles

Read detailed accounts of surgical and nonsurgical treatments for scoliosis.

Scoliosis articles for healthcare professionals

This content is written for an audience of doctors, nurses and physical therapists but may also be of interest to patients.

Articles related to scoliosis

Learn about diseases and conditions that are related to or similar to scoliosis.

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