Scoliosis : Causes, Symptoms and Treatment Options

Scoliosis is categorized into different types, based on its cause and the age when it begins:

Adolescent idiopathic scoliosis is the most common form. It accounts for about 80% of cases. It mainly affects teens ages 10 to 18. The exact cause is still not known, but genetics may play a role.

“When you think about scoliosis, the most common thing that pops into your head is kids. It's usually teenagers who get it,” says Dr. Mundis.

Congenital scoliosis is present at birth. It occurs due to abnormal spinal development in the womb. It is less common and might require early surgery.

Neuromuscular scoliosis happens because of conditions like cerebral palsy, muscular dystrophy or spinal cord injury. It is caused by muscle imbalance and weak support from the spine.

Degenerative scoliosis (De Novo) is common in adults over 50. It occurs because of wear and tear on the spine. This can be caused by arthritis or disc degeneration. It may lead to back pain and limit movement.

Traumatic scoliosis occurs after an injury to the spine. This injury can come from a fall, accident or surgery. It may be structural, meaning it causes permanent changes to the spine. It can also be functional, which means it is temporary due to muscle spasms or inflammation.

While idiopathic scoliosis has no known cause, other types do have clear reasons:

• Genetics: A family history raises the risk.
• Birth defects: Malformed vertebrae or ribs can cause issues.
• Neurological disorders: Nerve-related problems can cause muscle imbalances.
• Aging: Arthritis and disc wear can lead to scoliosis.
• Trauma: Injuries can misalign the spine.
• Infection or tumors: These can damage or weaken the spine, leading to changes in its shape.

Symptoms of scoliosis vary by severity and age. They may include:

• Uneven shoulders or waist
• One shoulder blade more prominent
• Rib cage protrusion or rib hump when bending forward
• Leaning to one side
• Back pain, especially in adults
• Clothes that fit unevenly
• Fatigue in back or legs

In severe cases, scoliosis can affect lung and heart function.

Scoliosis is diagnosed when the spine curves more than 10 degrees. During a physical exam, your doctor may ask you to bend forward. They will use a tool called a scoliometer to check for spinal rotation. If the reading is 7 degrees or more, they may order an X-ray to confirm scoliosis.

Treatment, like bracing, is usually considered when the curve is over 20 to 25 degrees. This is especially true for children and teens who are still growing.

Most children diagnosed with adolescent idiopathic scoliosis have mild cases requiring only monitoring. If the curve progresses, treatment may include bracing.

Bracing helps slow progression during growth. “Think of a tree that’s growing crooked. You tie a straight stick to it, and the tree grows straight. That’s how the brace works,” Dr. Mundis says.

Today’s braces are smaller and can be worn under clothes. Most children wear their braces for 12 hours each day. Physical therapy can help strengthen core muscles and improve posture.

Adults can get scoliosis in two ways. It can start in childhood and get worse over time. It can also happen due to age-related changes, which is called degenerative scoliosis.

“The spine wears out from arthritis, degeneration, disc herniations or just aging. Sometimes the little bones and discs in the back don’t collapse symmetrically, so the spine twists,” Dr. Mundis says.

In older adults, symptoms often include:

• Chronic lower back pain
• Nerve compression leading to sciatica or numbness
• Postural imbalance and reduced height

Bracing usually does not help adults. “Adults have finished growing, so wearing a brace doesn’t help much,” says Dr. Mundis.

Instead of using braces, treatment focuses on managing pain and maintaining mobility.

“For pain from scoliosis, we first try nonsurgical treatments. These include chiropractic care, acupuncture or physical therapy. If symptoms spread to the legs, like nerve pain or sciatica, we often use nerve blocks or epidural injections,” Dr. Mundis says.

If nonsurgical treatments do not work, surgery might be the next option. The type of surgery depends on the severity of the scoliosis.

Some patients may only need minor surgery. This can be done using minimally invasive methods and takes a few weeks to recover. In more severe cases, however, more extensive procedures may be necessary.

Spinal fusion is the most common surgery for moderate to severe scoliosis. In this procedure, two or more vertebrae are joined to help straighten and stabilize the spine, preventing further curvature.

Surgeons use metal rods, screws and bone grafts to hold the spine in place while the bones gradually fuse together over time.

New technology has made scoliosis surgery less invasive and easier to recover from. Some of these advancements include:

• Vertebral body tethering (VBT): Preserves spinal flexibility in growing children and teens
• 3D custom spinal implants: Designed specifically for the patient's anatomy, improving alignment
• Robotic-assisted surgery: Enhances precision and safety

Scoliosis is a condition that cannot be prevented, but it can be managed. To keep your spine healthy, maintain a good weight. Do low-impact exercises regularly. Make sure you get enough vitamin D and calcium.

Good posture is very important, too. If you have back pain or notice changes in your posture, seek medical help.

Not all spinal curvature requires treatment, says Dr. Mundis. However, if you have ongoing or worsening pain, get it checked quickly. “Some curvature is normal as we age, but treating pain early is important. It helps prevent worsening and helps maintain your quality of life,” he says.

If you feel pain for more than four days a week, seek medical help. This is especially important if you have symptoms like shooting pain down the legs, sciatica or nerve pain.

Early evaluation can lead to better outcomes and may reduce the need for more invasive treatments later on.

Watch the San Diego Health video featuring Susan Taylor and Dr. Mundis discussing scoliosis.