Scoliosis is a lateral (toward the side) curvature in the normally straight vertical line of the spine. The normal spine curves gently backward (kyphosis) in the upper back and gently inward in the lower back (lordosis). Normally, a person's spine, when viewed from the side, shows a mild roundness in the upper back and shows a degree of swayback (inward curvature) in the lower back. When a person with a normal spine is viewed from the front or back, the spine appears to be straight. When a person with scoliosis is viewed from the front or back, the spine appears to be curved.

Scoliosis is a deformity of the spine in which the spine curves abnormally from side to side (S-shaped or C-shaped) rather than being straight. The spine may also be twisted (rotated). Scoliosis usually starts during childhood, most commonly in girls between the ages of 10 and 14. In most cases, the cause of scoliosis is unknown.

In children and teens, scoliosis generally has no symptoms and is not obvious until the curve becomes large. Most cases of scoliosis are mild and require only observation (examination every 4 to 6 months) so that a doctor can see whether the curve is getting worse. Severe cases of scoliosis may require bracing or surgery. Bracing is usually successful in stopping the curve from getting worse, but it does not correct or straighten the spine. Surgery can provide some permanent correction.

There are many types of scoliosis and many causes for curvature. Congenital scoliosis is a result of a bone abnormality present at birth. Neuromuscular scoliosis is a result of abnormal muscles or nerves, and is frequently seen in patients with spinal bifida, cerebral palsy or those with various conditions that are accompanied by, or result in, paralysis. Degenerative scoliosis may result from traumatic (from an injury or illness) bone collapse, previous major back surgery or osteoporosis.

Certain types of spinal cord abnormalities can cause scoliosis. The most common type of scoliosis, called idiopathic scoliosis, has no specific identifiable cause. There are many theories on the cause, but none have been found to be all-encompassing. There is, however, definitely a strong genetic link in idiopathic scoliosis.

The prevalence of scoliosis in the American population at age 16 is 2 percent to 3 percent. Less than 0.1 percent has curves measuring greater than 40 degrees, which is the magnitude of curvature when surgery becomes a consideration.

Overall, girls are affected 3.6 times more than boys. Girls with curves greater than 30 degrees outnumber boys, 10 to one. Idiopathic scoliosis is most commonly a condition of adolescence affecting those ages 10 through 16. Idiopathic scoliosis may progress during the "growth spurt" years, but usually will not progress to adulthood.

Scoliosis can be observed by family members. Signs may be uneven hemlines in clothes, a noticeable curve when the child is in a bathing suit, clothes not fitting properly or an elevated shoulder. Some children may report back pain.

Scoliosis may also be noted by your own physician during a regular office visit or check up.

No, but early detection and treatment are important in preventing long term effects of scoliosis in other body systems. In 80-95% of scoliosis patients, surgery may be avoided if treatment is started when the abnormal spinal curve is small and while the child is still growing.

There are two types of scoliosis which occur in adults. Scoliosis can develop as result of osteoporosis or arthritis, or it can begin after bone growth has stopped. More commonly, scoliosis begins in childhood but the curves continue to progress in adulthood despite various treatments. Potential problems for adults with scoliosis include back pain, increased stress to the heart and disabling lung disease. Many adults undergo surgery to prevent further complications and deterioration of these body systems. Research studies are being conducted to determine the cause of scoliosis and to find the best treatment approach.

Treatment depends on the severity of the curve and the child's age. The earlier scoliosis is detected, the more treatment options are available. All changes from the normal spinal curves should be checked by a physician. Physical examination should include assessing the child's back and possibly x-rays. There are currently three types of treatment for scoliosis:

• Observation - The physician observes the child's back over a period of time to determine if the curve increases with growth. X-rays are routinely done in addition to the physical examination.
• Braces - Braces prevent additional curving of the spine, but will not restore the spine to straight alignment. Braces are used while the child is still growing and for small spine curves. When wearing the brace, children are able to participate in many activities. The Milwaukee brace and low profile braces are examples of two types of braces.
• Surgery - Surgery straightens the curved portion of the spine as much as possible and holds it in place. Spinal fusion is a type of surgery frequently done to correct scoliosis. Spine fusion welds the spine together and decreases the amount of the curve. Small metal rods are inserted along the spine, which helps the bone grow together by holding the spine in place. Surgery is done on severe curves or curves which continue to progress despite bracing.