Most often there are not any symptoms as the disease has a mild presentation in the majority of individuals. It is only when the curvature in the spine progresses that it may start to cause disfigurement and subsequent symptoms. The upper body starts to bend to one side along with the curving spine. This causes the shoulders to become uneven and protrusion of the shoulder blade. The rib cage on the same side will appear to bulge out giving the waist an irregular appearance. Similarly, the hips will not appear to be in line with each other and cause the legs to have unequal lengths. Patients in whom scoliosis progresses may also experience difficulty breathing as the lungs become compressed within an abnormally shaped rib cage. Patients also complain of chronic back pain.

The spine is a column of small bones or vertebrae, that is grouped into three sections:

• Cervical (C) – 5 bones that support the neck
• Thoracic (T) – 12 spinal bones that connect the rib cage
• Lumbar (L) –5 lower and largest bones of the spinal column

Below the lumbar region of the spine, you will find the sacrum, a bony structure that connects the pelvis to the spine. At the end of the sacrum is the coccyx or tailbone. The spinal column protects the spinal cord or the central trunk of nerves that connect the brain from the rest of the body. The upper trunk of the spine has a slight outward curve (kyphosis) and the lower section of the back has a reverse inward curve (lordosis). Scoliosis is a deformity of the spine and rib cage that is characterized by either a single primary curve that resembles a C or two curves that form an S shape. These curves may develop in the upper back, middle, or lower back. The most common location of the deformity is in the area between the thoracic and lumbar sections of the spine. This deformity can cause the trunk to rotate.

The most common type of scoliosis is idiopathic, meaning the exact cause of the disease is unknown. A family history of scoliosis has been suggested as a strong contributor to the inheritance of this condition. Children may be born with an abnormally curved spine, in which case the condition is called congenital. Individuals with diseases affecting the neuromuscular system have been associated with developing scoliosis as well.

• Female sex
• History of congenital heart disease (CHD)
• Genetic syndrome (i.e., Down’s syndrome)
• Developmental delay
• Age (before puberty)
• Family history of scoliosis
• History of childhood cardiothoracic surgery

The screening test used for scoliosis requires the patient to bend forward, keeping the knees straight and arms dangling on the side of the body. This will allow the healthcare professional to visualize the type and degree of spinal curvature. The spine may curve at one location only to the right or only to the left and it may also curve at two locations. A part of the physical examination can include neurological and muscular testing. This can involve reflexes and checking for muscle weakness. Imaging studies including an x-ray are done to confirm the diagnosis. They also helpassess whether there is an underlying pathology causing scoliosis. For example, the presence of a tumor mass may be pushing the spine to one side. If a secondary cause is suspected, further imaging tests may be required.

Most patients presenting with only mild scoliosis don’t require any kind of treatment. Instead, they are monitored every few months to make sure the condition is not progressing. The patients who require treatment are managed based on their particular severity, age, and other factors. Children who are still growing are often asked to wear a brace. The most common type is a contoured plastic brace that can be worn under clothes and is not seen. The efficacy of the brace is based on the duration of time it is worn. They can also be worn to sleep and do not prevent the child from participating in physical activities.

If the curvature of the spine is progressing and the brace has proven ineffective then the patient may require surgery. Usually, surgery is avoided in children who are still growing and doctors try to wait until the bones have stopped growing. If surgery cannot be delayed then an adjustable rod is put in place. This will allow the bones to continue growing and not leave the child with stunted growth. If the child has reached an age where the bones are no longer growing then the surgical procedure is different and can include fusing the bones of the spinal column.

Scoliosis is a spinal condition that must be treated by a physician and/or surgeon who will recommend bracing or surgery in extreme cases. Alternative treatments will not “cure” the condition. However, there are alternative treatments that can be used to complement treatment. Discuss any treatment you are planning to use with your physician before you begin. Alternative options to treat scoliosis include yoga, chiropractic treatment, and physical therapy exercises. If you plan to practice yoga, find an instructor who has specific experience in teaching people with scoliosis to safely practice yoga maneuvers. There is a resource for those who want to take yoga with scoliosis found here.

Breathing problems. The increased curvature of the spine can cause the ribs to become malformed and restrict the capacity of the lungs and cause shortness of breath, especially on exertion.

Cardiovascular problems. The restricted rib cage caused by severe curvature of the spine can cause heart problems including heart failure in extreme cases.

Chronic back pain. Adults are more likely to have chronic back pain if they had scoliosis as children as compared to those without the condition.

Leg pain. Untreated scoliosis can also cause a leg to appear shorter than the other. This is due to the hips being misaligned which will change a person’s gait and posture.

Lumbar stenosis. With age, advanced cases of scoliosis can cause the narrowing of the spinal canal in the lumbar region or lumbar stenosis. This narrowing may lead to weakness or leg pain due to nerve complications.

Physical appearance. Untreated scoliosis can cause changes in the overall structure of the skeleton such as uneven shoulders and hips, a prominent rib cage, and the waist and trunk to shift to one side. These changes can cause those with scoliosis to feel self-conscious and develop low self-esteem.

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Mayo Clinic Staff. (2019, June 22). Scoliosis. Retrieved from Mayo Clinic:https://www.mayoclinic.org/diseases-conditions/scoliosis/symptoms-causes/syc-20350716

Scoliosis SOS Clinic Writing Staff. (2017, July 19).Scoliosis complications later in life. Retrieved from:https://www.scoliosissos.com/news/post/scoliosis-complications-later-in-life

Shah, S. S. (2021). Scoliosis. Retrieved from Nemours: https://www.nemours.org/content/dam/nemours/www/filebox/service/medical/orthopedics/scoliosis.pdf

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