Learn About Scoliosis Treatment Options

Understanding What Scoliosis Is and How It Develops

Scoliosis is a condition where the spine curves sideways in an abnormal way. Instead of running straight down the middle of the back, the spine develops a curve that looks like an "S" or "C" when viewed from behind. This curvature can range from mild to severe, and it affects people of all ages.

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The spine is made up of small bones called vertebrae stacked on top of each other. Normally, these bones line up in a straight column. When scoliosis develops, the vertebrae rotate and curve to the side. A curve of 10 degrees or less is considered normal variation in the spine. Curves greater than 10 degrees are typically diagnosed as scoliosis. Doctors measure the degree of curvature using X-rays to determine how severe the condition is.

There are several types of scoliosis based on what causes the curve. Idiopathic scoliosis is the most common type, accounting for about 80% of all scoliosis cases. The word "idiopathic" means the cause is unknown. This type most often appears during the teenage years, particularly in girls. Congenital scoliosis occurs when a baby is born with malformed vertebrae that cause the spine to curve. Neuromuscular scoliosis develops as a result of nervous system or muscle disorders such as cerebral palsy or muscular dystrophy. Degenerative scoliosis appears later in life when the discs and joints of the spine wear down due to aging.

Risk factors for developing scoliosis include family history, being female (girls are five times more likely than boys to have curves that worsen), and age. Teenagers between 10 and 16 years old are at highest risk for developing idiopathic scoliosis. The condition is not caused by poor posture, sports, or carrying heavy backpacks, despite common misconceptions. Studies have not found links between these activities and scoliosis development.

Practical takeaway: Scoliosis is a sideways curvature of the spine that varies in cause and severity. Understanding which type of scoliosis someone has is important because different types may progress differently and may require different approaches to monitoring and treatment.

How Doctors Diagnose Scoliosis

Diagnosis of scoliosis typically begins with a physical examination. A doctor will ask about family history and any symptoms the person is experiencing. The doctor will then perform the "forward bend test" or Adam's test, where the person bends forward at the waist with arms hanging down. From this position, the doctor can see if the spine curves abnormally or if one side of the rib cage is higher than the other. This simple test can reveal signs of scoliosis that might not be visible when standing upright.

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If scoliosis is suspected after the physical exam, imaging tests are used to confirm the diagnosis and measure the severity of the curve. X-rays are the standard imaging tool for scoliosis diagnosis. A full-length spinal X-ray shows the entire spine and allows doctors to measure the angle of the curve using the Cobb angle method. The Cobb angle is measured by drawing lines along the top of the highest vertebra involved in the curve and the bottom of the lowest vertebra involved, then measuring the angle between these lines. This measurement is crucial because it helps determine what treatment options may be necessary.

Other imaging tests may be used in certain situations. MRI scans provide detailed images of the spine and can be helpful in cases of congenital scoliosis or when there are concerns about the spinal cord. CT scans offer another way to visualize the spine in detail. These tests are typically ordered when there are specific concerns beyond standard scoliosis, such as pain, neurological symptoms, or unusual curve patterns. For most cases of idiopathic scoliosis in teenagers, X-rays are sufficient for diagnosis and monitoring.

Doctors also classify scoliosis by severity using the Cobb angle measurement. Mild scoliosis is generally considered a curve of 10 to 25 degrees. Moderate scoliosis ranges from 25 to 40 degrees. Severe scoliosis is 40 degrees or greater. These classifications help guide treatment decisions. A person with mild scoliosis may only need monitoring, while moderate or severe curves may require bracing or surgery.

The location of the curve also matters. Thoracic curves occur in the upper back, lumbar curves in the lower back, and thoracolumbar curves span both regions. The location affects how the curve may progress and what treatment approaches might be recommended.

Practical takeaway: Diagnosis involves physical examination and X-rays to measure the curve angle. The Cobb angle measurement is the key number that determines severity and guides treatment decisions. Regular monitoring with repeat X-rays helps doctors track whether the curve is stable or getting worse.

Non-Surgical Treatment Options for Scoliosis

Many people with scoliosis never need surgery. Treatment decisions depend on several factors including age, curve severity, curve location, and whether the curve is stable or progressing. For mild curves and curves that are not progressing, observation with regular monitoring is often the recommended approach. This means seeing a doctor periodically and having X-rays taken at scheduled intervals to watch for changes. This approach works well for many people and avoids unnecessary treatment.

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Bracing is a treatment option used primarily for children and teenagers who have moderate curves and whose bones are still growing. The goal of bracing is to prevent the curve from getting worse while the child grows. According to research published in the New England Journal of Medicine, bracing is effective at reducing the progression of curves in growing children. A brace does not straighten an existing curve, but it can stop or slow progression in about 70-80% of cases when used as prescribed.

There are several types of braces used for scoliosis treatment. The Milwaukee brace is a full-torso brace that extends from the neck to the hips and includes a neck ring. The Boston brace and Charleston brace are underarm braces that fit under the arms and are less visible under clothing. The effectiveness of bracing depends on consistent wear. Most braces need to be worn 16-23 hours per day to be effective. Newer designs and custom-molded options have improved comfort and compliance in recent years. Children and teenagers wearing braces gradually increase their activities and participation in sports under medical guidance.

Physical therapy and exercise are often recommended as part of scoliosis treatment at any stage. While exercise cannot cure scoliosis or reduce an existing curve, it can help maintain flexibility, improve posture, strengthen core muscles, and manage pain if present. Physical therapists can teach specific exercises that target the muscles supporting the spine. Swimming and water-based exercises are particularly popular because they provide resistance while being gentle on the joints. Yoga and Pilates may also be beneficial for flexibility and core strength.

Pain management becomes more relevant as people with scoliosis get older. While many children and teenagers with scoliosis experience no pain, adults may develop back discomfort related to the curve or to degeneration of the spine. Treatment options for pain include over-the-counter pain relievers, heat and cold therapy, and prescription medications in some cases. Physical therapy continues to be important for maintaining strength and mobility.

Practical takeaway: Non-surgical options include observation (monitoring without treatment), bracing for growing children with moderate curves, and physical therapy to maintain function. These approaches work well for many people and can prevent progression without surgery.

Surgical Treatment Options and When They Are Considered

Surgery becomes an option when scoliosis is severe or when curves are progressing rapidly despite bracing or other treatment. The primary goal of scoliosis surgery is to prevent further progression and to correct some of the curve. Surgery is typically considered when curves exceed 40-50 degrees in children and teenagers, or when curves are progressing despite appropriate bracing.

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The most common surgical procedure for scoliosis is spinal fusion. During this operation, the surgeon places metal rods, screws, and hooks along the curved section of the spine to straighten it and hold it in place. Bone graft material is added to help fuse the vertebrae together permanently. The procedure typically takes several hours, and the fusion creates a permanent bond between the vertebrae, preventing movement at that section of the spine. Most spinal fusion surgeries can correct 40-60% of the curve, though the goal is prevention of further progression