Scoliosis is a condition in which the spine shows an abnormal sideways "S" or "C" curvature. It is seen in 2-3% of adolescents; it is 4 times more common in females. Most cases are mild and do not require treatment; however, progressive cases require intervention.
It is most commonly noticed during rapid growth between ages 10-14.
Types
1. Idiopathic scoliosis (most common):
- Cause unknown
- Starts in adolescence
2. Congenital scoliosis:
- Birth defect of the spine
3. Neuromuscular scoliosis:
- Cerebral palsy, muscular dystrophy
4. Degenerative scoliosis:
- Spine wear in the elderly
5. Syndromic scoliosis:
- Associated with genetic syndromes (Marfan, Down)
Symptoms
There are usually no symptoms in early stages. In prominent cases:
- Shoulders at different heights
- Asymmetry of the waistline
- One hip higher than the other
- A hump in the back when bending forward ("rib hump")
- Back pain (in adults)
- Difficulty breathing (in advanced cases)
- Fatigue
- Visible asymmetry (especially noticed in swimming, swimsuit photos)
Causes
- Genetics (family history)
- Congenital spinal developmental disorders
- Neuromuscular diseases
- Trauma
- After spine surgery at a young age
- Tumor (rare)
Risk Factors
- Family history
- Age (10-14, pre-adolescent growth period)
- Being female (4 times)
- Some genetic syndromes
Complications
- Back and low back pain (in adulthood)
- Respiratory problems (in severe curves, >70°)
- Cardiac complications (in very severe)
- Cosmetic, psychological effects
- Lung infections (in advanced cases)
- Progressive curvature in adulthood
When to See a Doctor
- If your child has back or shoulder asymmetry
- Suspected scoliosis at school screenings
- Back or low back pain (in adults)
- If you notice curvature (especially at ages 10-14)
- If family history exists
- Shortness of breath, chest problems
Screening recommendation: 10-year-old girls and 13-year-old boys should definitely be evaluated at school examinations.
Diagnosis and Treatment
Diagnosis:
- Physical examination
- Adam's forward bend test
- Spinal X-ray: Cobb angle measurement
- <10°: Normal variant
- 10-25°: Mild (observation)
- 25-45°: Moderate (brace)
- >45-50°: Severe (surgery)
- MRI (nerve involvement, unclear cases)
- CT
- Pulmonary function test
Treatment (according to curve angle and age):
1. Observation (mild cases):
- Curves below 25°
- Check-up every 4-6 months
- Until growth is complete
2. Bracing:
- Curves of 25-45°
- Children still growing
- Worn 16-23 hours a day
- To stop the progression of the curve
- Boston, Milwaukee, TLSO models
3. Physical therapy and exercise:
- Schroth method
- Muscle strengthening
- Stretching
- Applied alongside bracing
4. Surgery:
*Indications:*
- Curve >45-50°
- Progressive curve
- Pain or respiratory problem
- Aesthetic concern (advanced cases)
*Method:*
- Spinal fusion: Correction and fusion of the spine with screws and rods
- Vertebral body tethering (VBT) — new technique (growth is preserved)
- Some methods are still debated
Prevention and Lifestyle
Idiopathic scoliosis cannot be prevented; however:
- Regular spine examinations (especially ages 10-14)
- Pay attention to school screenings for early diagnosis
- Regular follow-up if family history exists
- Refer your child to a pediatric orthopedist
- Exercises that strengthen back muscles
- Maintain proper posture
- Carry backpack on both shoulders
- Healthy weight, regular exercise
In bracing treatment:
- Provide moral support to your child
- Monitor regular use
- Skin care
- Psychological support (if needed)
In adults:
- Regular exercise (swimming very beneficial)
- Strengthen core muscles
- Ergonomic work environment
- Proper lifting techniques
- Pain management