Scoliosis is a condition characterized by an abnormal sideways curvature of the spine, often forming an “S” or “C” shape when viewed from the back. While a healthy spine runs straight down the back, a person with scoliosis experiences a shift to the side, sometimes accompanied by spinal rotation. This condition affects about 2% to 3% of the population and is typically diagnosed in childhood or adolescence when bone development is still underway.

Although many cases are mild and go unnoticed, more severe forms can cause visible deformities, chronic pain, and even breathing difficulties. Understanding scoliosis, its causes, symptoms, and treatment options is vital for managing the condition and maintaining quality of life.

Types of scoliosis

Scoliosis is categorized into several types, based on the cause, the age of onset, and the specific location of the curve. Identifying the type helps guide treatment and management decisions.

Idiopathic scoliosis
This is the most common form, accounting for about 80% of all scoliosis cases. “Idiopathic” means the cause is unknown, though genetics are believed to play a role. It is most commonly found in adolescents, but it may be present from infancy or early childhood.

Subtypes include:

  • Infantile (0–3 years)

  • Juvenile (4–10 years)

  • Adolescent (11–18 years)

Congenital scoliosis
This occurs when the spine fails to develop properly in the womb. Vertebrae may be incompletely formed or fused together. Congenital scoliosis is usually diagnosed early in life and is often associated with other health issues like heart or kidney defects.

Neuromuscular scoliosis
Neuromuscular conditions, such as muscular dystrophy or cerebral palsy, can affect the nerves and muscles that stabilize the spine. This type of scoliosis usually has a longer, more progressive curvature and requires more intensive intervention.

Degenerative scoliosis
Typically seen in older adults, degenerative scoliosis results from age-related changes in the spine, including disc degeneration, arthritis, and bone weakening. It commonly affects the lumbar spine and may cause pain and mobility limitations.

Common symptoms

Scoliosis presents differently depending on the type and severity. Many children and teens with mild scoliosis have no symptoms at all. When symptoms do occur, they may include:

  • Uneven shoulders or hips

  • One shoulder blade sticking out more prominently

  • Ribs protruding on one side

  • Visible spinal curve

  • Leaning or tilting posture

  • Back pain or stiffness

  • Fatigue after standing or sitting for long periods

  • In severe cases: breathing difficulties due to restricted lung capacity

Symptoms often become more apparent during growth spurts, making early detection important in children and teens.

What causes scoliosis?

The cause of scoliosis varies depending on the type.

  • Idiopathic scoliosis has no known single cause, but researchers believe genetics may play a role. A family history increases the risk.

  • Congenital scoliosis occurs due to abnormal spinal development during fetal growth.

  • Neuromuscular scoliosis is caused by conditions that affect muscle control, such as spinal cord injury, muscular dystrophy, or cerebral palsy.

  • Degenerative scoliosis develops from wear-and-tear changes in the spine, such as arthritis or disc degeneration.

  • Less commonly, scoliosis can result from trauma, tumors, or infections affecting the spine.

Risk factors

While scoliosis can affect anyone, several factors increase the likelihood of developing it:

  • Family history: Genetic predisposition is common, especially in idiopathic scoliosis.

  • Age: Most cases are detected during adolescence.

  • Gender: Females are more likely to develop scoliosis and are at greater risk of severe curves.

  • Medical conditions: Disorders such as Marfan syndrome, Ehlers-Danlos syndrome, and neuromuscular disorders are linked to scoliosis.

  • Growth spurts: Rapid skeletal growth can cause curvature to progress.

Recognizing these risk factors can lead to earlier detection and management.

How scoliosis is diagnosed

Diagnosis typically begins with a physical exam, followed by imaging tests if needed.

Physical examination
The healthcare provider assesses posture, shoulder height, rib symmetry, and spinal alignment. A test called the “Adam’s forward bend test” is commonly used. A scoliometer may also be used to estimate the degree of curvature.

Medical history
A comprehensive history helps identify hereditary patterns or underlying health issues contributing to spinal abnormalities.

Imaging tests

  • X-rays: The most common diagnostic tool, used to measure the Cobb angle—a curve greater than 10° is considered scoliosis.

  • MRI scans: Provide detailed images to assess spinal cord or nerve involvement.

  • CT scans: Helpful in evaluating structural issues, especially before surgery.

  • Ultrasounds: May be used for congenital scoliosis to evaluate other organ systems like the heart and kidneys.

Early detection through school screenings or regular pediatric checkups is crucial for effective management.

Treatment options

Scoliosis treatment depends on the patient’s age, the curve’s severity, its location, and the likelihood of progression.

Observation
For mild curves (under 20°), especially in children who are still growing, periodic monitoring is often sufficient.

Bracing
Braces do not correct existing curves but can prevent further progression in growing children and adolescents. The brace must be worn as prescribed (usually 16–23 hours per day) to be effective.

Surgery
Surgical intervention is recommended for curves greater than 45–50°, especially if symptoms are present. Common procedures include:

  • Spinal fusion: The most common surgery, fusing vertebrae with metal rods and screws to stabilize the spine.

  • Osteotomy: A more complex realignment surgery involving bone cuts and repositioning.

  • VEPTR (Vertical Expandable Prosthetic Titanium Rib): Used in children, allowing spinal growth while correcting curvature.

Physical therapy
Though not a cure, physical therapy can help with posture, mobility, and pain relief. Scoliosis-specific exercises (SSEs) focus on spinal stabilization, muscle balance, and body awareness.

Can scoliosis be prevented?

Unfortunately, scoliosis—especially idiopathic—cannot be prevented since the cause is often unknown. However, early intervention can help minimize progression and reduce long-term complications.

Ways to manage progression:

  • Early screenings in children

  • Scoliosis-specific exercises

  • Bracing during growth phases

  • Maintaining strong core and back muscles

In adults, maintaining spinal health through regular exercise, avoiding sedentary habits, and managing osteoporosis can help limit curvature from worsening with age.

Related conditions

Scoliosis may increase the risk of developing or coexisting with other health issues:

  • Osteoporosis: Lower bone density is commonly seen in people with scoliosis.

  • GERD (Gastroesophageal Reflux Disease): Abnormal curvature may affect the diaphragm and stomach position.

  • Headaches: Spinal misalignment can cause neck strain and reduced cerebrospinal fluid flow, triggering tension or spinal headaches.

  • Mental health conditions: Adolescents with scoliosis may face increased rates of anxiety, depression, and body image concerns.

Understanding these associations allows for a more holistic approach to care.

Living with scoliosis

Most people with scoliosis can lead active, fulfilling lives. The key lies in consistent monitoring and following through with treatment recommendations.

Tips for daily life:

  • Maintain a strong core through appropriate exercises

  • Follow brace or therapy instructions if prescribed

  • Use ergonomic furniture to support posture

  • Avoid activities that cause strain or discomfort

  • Connect with others through scoliosis support groups

For children and teens, emotional support from family and peers can be just as important as medical care.

Frequently asked questions

Is scoliosis painful?
Mild scoliosis may not cause pain. Severe cases, especially in adults, can cause discomfort due to muscle fatigue, disc pressure, or joint strain.

Can scoliosis go away on its own?
No. Once developed, scoliosis does not resolve naturally. Mild cases may remain stable, but others can worsen without treatment.

Will I need surgery?
Only a small percentage of cases require surgery. Most are managed with observation, bracing, or physical therapy.

Can I exercise with scoliosis?
Yes! In fact, regular physical activity—especially swimming, yoga, or Pilates—can improve flexibility, strength, and posture.

Can adults develop scoliosis?
Yes, particularly degenerative scoliosis, which results from aging and spinal wear.