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Questions and Answers About Scoliosis

This fact sheet defines scoliosis and provides information about how it is diagnosed and treated in children and adolescents. You may be interested in contacting one or more of the organizations referenced at the end of the fact sheet for more information.

What Is Scoliosis?

Scoliosis is a sideways curvature of the spine, or backbone. The bones that make up the spine are called vertebrae. Some people who have scoliosis require treatment. Other people, who have milder curves, may only need to visit their doctor for periodic observation. The section "Does Scoliosis Have To Be Treated?" describes how doctors decide whether or not to treat scoliosis.

Who Gets Scoliosis?

People of all ages can have scoliosis, but this fact sheet focuses on children and adolescents. Of every 1,000 children, 3 to 5 develop spinal curves that are considered large enough to need treatment. Adolescent idiopathic scoliosis (scoliosis of unknown cause) is the most common type and occurs after the age of 10. Girls are more likely than boys to have this type of scoliosis.

Since scoliosis can run in families, a child who has a parent, brother, or sister with idiopathic scoliosis should be checked regularly for scoliosis by the family physician.

Idiopathic scoliosis can also occur in children younger than 10 years of age, but is very rare. Early onset or infantile idiopathic scoliosis occurs in children less than 3 years old. It is more common in Europe than in the United States. Juvenile idiopathic scoliosis occurs in children between the ages of 3 and 10.

What Causes Scoliosis?

In 80 to 85 percent of people, the cause of scoliosis is unknown; this is called idiopathic scoliosis. Before concluding that a person has idiopathic scoliosis, the doctor looks for other possible causes, such as injury or infection. Causes of curves are classified as either nonstructural or structural.

How Does the Doctor Diagnose Scoliosis?

The doctor takes the following steps to evaluate a patient for scoliosis:

Doctors group curves of the spine by their location, shape, pattern, and cause. They use this information to decide how best to treat the scoliosis.

Does Scoliosis Have To Be Treated? What Are the Treatments?

Many children who are sent to the doctor by a school scoliosis screening program have very mild spinal curves that do not need treatment. When a child does need treatment, the doctor may send him or her to an orthopedic spine specialist.

The doctor will suggest the best treatment for each patient based on the patient's age, how much more he or she is likely to grow, the degree and pattern of the curve, and the type of scoliosis. The doctor may recommend observation, bracing, or surgery.

Are There Other Ways To Treat Scoliosis?

Some people have tried other ways to treat scoliosis, including manipulation by a chiropractor, electrical stimulation, dietary supplements, and corrective exercises. So far, studies of the following treatments have not been shown to prevent curve progression, or worsening:

Which Brace Is Best?

The decision about which brace to wear depends on the type of curve and whether the patient will follow the doctor's directions about how many hours a day to wear the brace.

There are two main types of braces. Braces can be custom made or can be made from a pre-fabricated mold. All must be selected for the specific curve problem and fitted to each patient. To have their intended effect (to keep a curve from getting worse), braces must be worn every day for the full number of hours prescribed by the doctor until the child stops growing.

If the Doctor Recommends Surgery, Which Procedure Is Best?

Many surgical techniques can be used to correct the curves of scoliosis. The main surgical procedure is correction, stabilization, and fusion of the curve. Fusion is the joining of two or more vertebrae. Surgeons can choose different ways to straighten the spine and also different implants to keep the spine stable after surgery. (Implants are devices that remain in the patient after surgery to keep the spine aligned.) The decision about the type of implant will depend on the cost; the size of the implant, which depends on the size of the patient; the shape of the implant; its safety; and the experience of the surgeon. Each patient should discuss their options with at least two experienced surgeons.

Patients and parents who are thinking about surgery may want to ask the following questions:

Can People with Scoliosis Exercise?

Exercise does not make scoliosis worse. In fact, it is very important for all people, including those with scoliosis, to exercise and remain physically fit. Girls have a higher risk than boys of developing osteoporosis (a disorder that results in weak bones that can break easily) later in life. The risk of osteoporosis is reduced in women who exercise regularly all their lives; and weight-bearing exercise, such as walking, running, soccer, and gymnastics, increases bone density and helps prevent osteoporosis. For both boys and girls, exercising and participating in sports also improves their general sense of well being.

What Are Researchers Trying To Find Out About Scoliosis?

Researchers are looking for the cause of idiopathic scoliosis. They have studied genetics, growth, structural and biochemical alterations in the discs and muscles, and central nervous system changes. The changes in the discs and muscles seem to be a result of scoliosis and not the cause. Scientists are still hopeful that studying changes in the central nervous system in people with idiopathic scoliosis may reveal a cause of this disorder.

Researchers continue to examine how a variety of braces, surgical procedures, and surgical instruments can be used to straighten the spine or to prevent further curvature. They are also studying the long-term effects of a scoliosis fusion and the long-term effects of untreated scoliosis.

Where Can People Get More Information About Scoliosis?

Acknowledgments

The NIAMS gratefully acknowledges the assistance of Dr. Stuart Weinstein, Professor of Orthopedic Surgery, University of Iowa, in the preparation and review of this fact sheet, and Dr. John Lonstein, Department of Orthopaedic Surgery, University of Minnesota, and Dr. James Panagis, NIAMS, in the review of this fact sheet.

The National Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse (NAMSIC) is a public service sponsored by the NIAMS that provides health information and information sources. The NIAMS, a part of the National Institutes of Health (NIH), leads the Federal medical research effort in arthritis and musculoskeletal and skin diseases. The NIAMS sponsors research and research training throughout the United States as well as on the NIH campus in Bethesda, MD, and disseminates health and research information.

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