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.
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.
View an animation on adult and juvenile scoliosis.
There are three basic types of scoliosis: idiopathic, congenital and neuromuscular.
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:
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.
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.
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.
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.
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.
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.
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:
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.
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
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.
Patients with curves that continue to progress beyond 50 degrees, either with or without bracing, generally require surgical intervention.
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:
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.
Some patients may be candidates for minimally invasive spine fusion 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:
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.
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.
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.
Spinal fusion surgery for scoliosis provides significant spine curvature correction, cosmetic and posture benefits, but does cause some inflexibility in the spine.
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.
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 by selecting Treating Physicians.
Get detailed information on the various types of scoliosis and how they affect people of different ages.
Understand how doctors use X-rays and other imaging technologies to recognize scoliosis.
Read detailed accounts of surgical and nonsurgical treatments for scoliosis.
Learn about diseases and conditions that are related to or similar to scoliosis.