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Scoliosis - Types, Diagnosis, and Treatment

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Scoliosis - Types, Diagnosis, and Treatment

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Scoliosis is a bony deformity characterized by a sideways curvature of the spine. Read the following article to understand scoliosis in detail.

Written by

Dr. Anuj Gupta

Medically reviewed by

Dr. Sneha Kannan

Published At February 5, 2020
Reviewed AtMay 11, 2023


The spine is the backbone of the human body. It consists of around 33 small bones called vertebrae stacked one over the other. The spinal cord (a group of nerves and nerve cells from the brain) runs through the vertebral column. The spine has the curvature in the forward-backward direction at various places to stabilize the back. But they remain almost straight and vertical in the lateral direction.

What Is Scoliosis?

Scoliosis refers to the abnormal sideways curvature of the spine. The spine looks like the letter S or C. It is a spinal deformity classified under idiopathic congenital musculoskeletal disorders (birth defect of muscles and bone with unknown cause). The angulation of lateral deformity should equal or more than 10 degrees to be termed scoliosis. Sometimes there is vertebral bone rotation and few structural abnormalities associated with scoliosis.

What Are the Types of Scoliosis?

Generally, scoliosis is classified as,

Structural Scoliosis:

They are the most common form of scoliosis involving both structural rotation and lateral curvature. The structural damage is permanent and needs definitive treatment.

Non-Structural Scoliosis:

The deformity is temporary with lateral curvature and without rotation. There is no structural abnormality. They are caused due to underlying conditions and are also known as functional scoliosis.

Based on the origin, structural scoliosis can be classified as;

Congenital Scoliosis:

This rare condition affects the fetus inside the womb and is present at the time of birth. However, most cases will need surgical correction.

Idiopathic Scoliosis:

More than 50 % of patients with scoliosis will have unknown causative factors. Therefore, they are called idiopathic scoliosis, and they appear in the childhood or adolescence stage. Recently, research suggests genetic involvement in idiopathic scoliosis.

Neuromuscular Scoliosis:

Scoliosis can accompany neurological and muscular abnormalities and often present with various other signs and symptoms. Some of the neuromuscular conditions associated with scoliosis are poliomyelitis (poliovirus infection), cerebral palsy (abnormal brain development), achondroplasia (growth disorder with short limbs), paralysis, etc. This condition is also known as myopathic scoliosis.

Degenerative Scoliosis:

Age-related scoliosis often occurs later in life due to wear and tear and degenerative changes.

Based on the location,

Thoracic Scoliosis:

The curvature is present in the middle back region involving the thoracic spine.

Lumbar Scoliosis:

They involve the lumbar spine in the lower back region.

Thoracolumbar Scoliosis:

The curvature is quite long, entailing both the thoracic and lumbar spine.

Combined (Double Curve) Scoliosis:

In this case, there are two curves along the length of the spine, combining the thoracic and lumbar spines.

What Are the Causes of Scoliosis?

Although many causes of scoliosis have been identified, most are due to unidentifiable reasons, called idiopathic scoliosis. Congenital scoliosis caused due to a developmental defect in the vertebral column is usually diagnosed early and progresses rapidly. There may be innumerable combinations of developmental anomalies, and the progression of the curve is greatly influenced by it. Diseases of the muscles or nerves may also induce scoliosis, as in the case of neuromuscular scoliosis, which usually progresses relentlessly and requires early diagnosis and surgical intervention. Rarely scoliosis may be associated with some genetic conditions resulting in syndromic scoliosis, diagnosis of which is also paramount for global management of the patient.

Most of the time, the cause is unknown, which results in structural scoliosis. Some of the common causes of non-structural scoliosis are,

  • Infection.

  • Inflammation.

  • Muscle injury.

  • Tumors.

How to Diagnose Scoliosis?

The sooner the diagnosis (younger kids), the more the chance to halt the progression of the curve. A thorough history regarding the duration of the deformity, progression, achievement of milestones, school performance, spinal deformity in the family, and other medical histories helps to narrow down the diagnosis. This is followed by a detailed clinical examination of the spine and neurological examination.

1. Physical Examination: Physicians may begin by inspecting the appearance, skin, height, gait, physical development, neuromuscular evaluation (balance, sensation, reflex, stimulation, muscle contractions), symmetry measurement, and bending movements.

2. Imaging Evaluation:

  • X-Ray: Images obtained in the posterior-anterior view (passing radiation from back to front) determine the angulation of spine curvature. A lateral view radiograph may help to rule out associated spondylosis (degeneration of disc and joints). X-rays also measure the magnitude of the curve (Cobb angle), which may have few degrees of interobserver variability and are used serially to monitor progression along with clinical evaluation.

  • MRI (Magnetic Resonance Imaging): This may be necessary to check for neurological complications in scoliosis and is suggested during the treatment phase.

  • Bone Scan: This uses radiotracers that highlight the presence of infection or tumors in non-structural scoliosis.

How to Treat Scoliosis?

The treatment of scoliosis depends on age, angulation of the curvature, type of the condition, and the patient’s choice in asymptomatic cases. Common treatment plans include,

1. Wait and Watch Strategy:

Patients are kept under observation to watch for the progression of the curvature. Most of the cases remain mild and do not progress.

2. Supporting Device:

Usually, when the curvature is greater than 50 degrees, the condition tends to progress at a rate of one degree per year. In such a situation, a brace is used to prevent disease progression.

3. Surgery:

Surgery is done to correct the deformity and restrict the disease’s progression. Some congenital scoliosis with the potential for rapid progression is treated early or even with prophylactic surgery, where delay leading to severe deformity may represent more surgical risk and poorer outcomes.

Non-fusion Spinal Surgery:

Definitive scoliosis surgery is a fusion surgery where the individual vertebrae are fused with screws and rods, and bone grafts are placed after safe allowable deformity correction, preventing further progression. Since the growth of the spine on the back of the chest (thoracic spine) allows space for the growth of the lung, premature fusion of the thoracic spine before eight to nine years of age prevents full maturation of the lungs due to lack of space and has a significant deleterious effect on the lung function. But unabated deformity of the thoracic spine also compresses on one or rarely both sides of the lung preventing its full development.

In this difficult scenario, a non-fusion spinal surgery is undertaken where spine growth is allowed periodically either with a short duration of spinal surgery with growing rods or from outside with a magnetically controlled growing rod to lengthen the construct, thereby allowing thoracic growth (including lung growth) and correction or maintenance of deformity till patients’ lungs are fully developed and are ready for definitive scoliosis surgery if needed.


Scoliosis is mostly idiopathic. Since it may involve many systems in the body, a multidisciplinary treatment approach can give better results. Bracing gives much discomfort resulting in poor patient compliance. Surgical corrections are associated with numerous complications. Therefore, the overall treatment outcome of scoliosis is not favorable.

Frequently Asked Questions


How Is Scoliosis Diagnosed?

Scoliosis is a condition described as an abnormal lateral curvature of the spine. Scoliosis is usually diagnosed by physical examination by a doctor, and the following tests are done to confirm the diagnosis
- Cobb Method- A positive scoliosis diagnosis is based on a coronal curvature measured on a posterior-anterior radiograph of greater than 10 degrees. Generally, a curve is considered significant if it is more than 25 to 30 degrees and curves that are exceeding 45 to 50 degrees are considered severe and require more aggressive treatment.
- X-ray- The application of radiation for producing a film or picture of a part of the body can show the structure of the vertebrae as well as the outline of the joints. X-rays of the spine are usually obtained to search for other potential causes of pain, infections, fractures, deformities, etc.
- Computed Tomography (CT scan)- CT scans show the shape and size of the spinal canal, its contents, and the structures around it. 
- Magnetic Resonance Imaging (MRI scan)- MRI can show the spinal cord, nerve roots, surrounding areas, and enlargement, degeneration, and deformities.


What Are the Treatment Options for Scoliosis?

The treatment options for scoliosis are explained below -
- Observation- Scoliosis in children is usually done through physical examination, and if the physician feels the curvature is increasing, further treatment options will be decided.
- Bracing- Braces can only be effective in patients who have not reached their skeletal maturity. If a child is still growing and his or her curve is between 25 degrees and 40 degrees, braces can be recommended to prevent the curve from progressing.
- Surgery- Surgery should be done only when the spinal curve is greater than 40 degrees and there are signs of progression. The surgery can be done through the front using an anterior approach or through the back using a posterior approach, depending on the particular case.


Who Is More at Risk of Developing Scoliosis?

Anyone can develop scoliosis, although it is more common in girls than boys. Scoliosis also runs in families; hence a person can inherit the condition. Other risk factors include neuromuscular conditions, such as cerebral palsy or muscular dystrophy, birth defects that affect the development of the spine's bones, previous surgery on the chest wall as a baby, spinal cord abnormalities, injuries to or infections of the spine.


What Exercises Can Be Done for Scoliosis?

Some of the exercises for scoliosis are explained below -
- Pelvic Tilts- The patient can lie on their back with their knees bent and feet flat on the floor. Flatten the back by tightening the stomach muscles and buttocks. Hold for five seconds, breathing normally. Repeat ten times per set.
- Cat-Camel- On the hands and knees, maintain tight abdominals with the head straight. Now take a deep breath in and lift the lower rib cage, round the back, and relax the neck. As one breathes out, lower the chest towards the floor, looking slightly upward. Return to the beginning position with tight abdominals. Repeat ten times per set. 
- Double-Leg Abdominal Press- Lie on the back with knees bent and feet flat on the floor, keeping the back in a neutral position. Raise legs off the floor one at a time so that knees and hips are bent at 90 degrees angles. Push hands against knees while pulling knees toward hands, which will engage abdominal muscles. Keep arms straight and hold for three deep breaths. Repeat ten times per set. 
- Single-Leg Balance- With eyes open, bend one knee up and balance on one foot. At first, one may use their hands, like holding the back of a chair, table, or wall. As balancing gets easier, take the hands away and place them to the side. Challenge by bringing the arms across the chest. One can try closing their eyes for an even greater challenge. Repeat five times per set. 
- Plank Exercise- A plank is a basic stabilizing exercise that activates muscles that support the spine. Start by laying on the stomach with arms bent by the sides. Place elbows directly under the shoulders and place the palms flat on the floor in front of the elbows. The body should be straight from the feet to the head. To ensure that the spine stays in a neutral position, keep abs tight and bring the hips level to the shoulders. Hold this position for a few seconds.


Is Scoliosis a Serious Condition?

Scoliosis usually does not cause any significant pain or any other health problems. It tends to stay the same after a person stops growing, but in a few severe cases of scoliosis, the ribcage can be pushed against the heart and lungs, and cause breathing problems and making it difficult for the heart to pump blood around the body. This can also increase the chances of lung infections, such as pneumonia, and lead to problems like heart failure.


What Is the Fastest Way of Treating Scoliosis?

Scoliosis is not a disease but rather a condition that most definitely takes time to resolve, but amongst all the treatment options available for scoliosis, active bracing can help cure the condition in much faster ways compared to exercises.


Can Scoliosis Be Straightened Without Surgery?

The treatment of scoliosis solely depends upon the degree or magnitude of the spine’s curvature. If the condition is minute, then it might resolve on its own or may require training, but in severe cases, only surgery can help cure the condition.


Is Walking Good and Safe for Scoliosis?

Walking is a safe and healthy exercise for people with scoliosis because it does not play into the condition's asymmetrical effects by overusing one side of the body, nor does it involve repeated jarring motions that might increase compression.


Which Age Is Best for Scoliosis Surgery?

Generally, children with scoliosis do not require surgery if their condition is resolvable and can improve with increasing age but for children with the severe form of scoliosis, undergoing surgery by the age of 10 years can provide the best results.


What Degree of Scoliosis Requires Surgery?

Only 10 % of people require surgery and most people undergo braces and training. Most experts recommend surgery only when the spinal curve is greater than 40 degrees and there are chances of progression.


What Will Happen if Scoliosis Is Left Untreated?

Untreated early-onset scoliosis will eventually progress to more than 90 degrees after growth and cause severe health problems with an increased chance of mortality. Therefore, surgical intervention is often indicated before developing a life-threatening deformity.


How to Sleep With Scoliosis?

People with scoliosis are advised to sleep sidewise because it keeps their spine in a straight and neutral position, making sleeping more comfortable as there will be less strain on their spinal nerves.


Can Scoliosis Be Fixed naturally?

Mild scoliosis can be managed simply with a medical observation, exercise, scoliosis-specific physical therapy, and chiropractic treatment from a chiropractic scoliosis specialist. Yoga or pilates is also recommended for some people with scoliosis to decrease their pain level and increase the flexibility.
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Dr. Anuj Gupta
Dr. Anuj Gupta

Spine Surgery


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