Scoliosis
What is scoliosis?
Scoliosis is a condition in which the spine has an abnormal curve. Healthy spines have a natural front-to-back curve. A spine with scoliosis curves front to back but also curves sideways. Some spines curve to the left or the right in a “C” shape, while others curve in both directions, forming an “S” shape.
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Scoliosis ranges from mild to severe, based on the degree of the curve. Treatment depends on whether the curve is stable or growing and whether it is mild, moderate, or severe.
- Mild scoliosis - A spinal curve that measures between 10 to 25 degrees often does not require any kind of medical intervention other than regular doctor visits to make sure the curve is not getting worse.
- Moderate scoliosis - A curve of 25 to 45 degrees is considered moderate. Children and young teens with moderate scoliosis can typically be treated with a brace.
- Severe scoliosis - A curve of 45 degrees or more is severe and can interfere with the lungs and other internal organs’ ability to function. Children with severe scoliosis usually need spine surgery.
The degree of the curve may increase over time, especially during growth spurts. If detected early, many children with scoliosis can be treated without surgery, but only if treatment begins before their curve becomes severe.
What are the different types of scoliosis?
Different types of scoliosis include:
- Idiopathic scoliosis, the most common type of scoliosis. Idiopathic scoliosis mainly affects infants, young children, and adolescents, but mainly adolescent girls. In younger children, it is sometimes referred to as “infantile scoliosis” or “early onset scoliosis.” This type of scoliosis has no known cause.
- Neuromuscular scoliosis, a side effect of conditions that impair muscles so that they are too weak to support the spine, such as cerebral palsy, myopathy, or spina bifida.
- Congenital scoliosis, caused by a failure of the vertebrae to form properly while a baby is developing before birth. It is the least common form of scoliosis and often part of a broad set of developmental issues.
What are the symptoms of scoliosis?
Because the spine can curve in many different ways, the symptoms of scoliosis are different in different children. Common signs and symptoms of scoliosis include:
- uneven shoulder heights
- head not centered over the rest of the body
- uneven shoulder blade heights or positions
- one shoulder blade more prominent than the other
- one arm longer than the other when standing up straight
- uneven hip heights or positions
- lopsided appearance of the back when bending forward
Most of the time, scoliosis does not cause back pain or other health problems.
What causes scoliosis?
Different types of scoliosis have different causes.
Idiopathic scoliosis, the most common type, has no known cause but tends to run in families.
Congenital scoliosis develops at an early stage of pregnancy when some of the vertebrae in the spine don’t form completely or don’t separate correctly. In some cases, it’s caused by a combination of both of these problems.
Neuromuscular scoliosis is a common side effect of conditions such as cerebral palsy, spina bifida or muscular dystrophy. Children with these conditions often have underdeveloped muscles. Because of this, their spines can develop side-to-side curvatures, especially during growth spurts. Syndromes that affect muscular development around the spine, such as Marfan syndrome and Down syndrome, can lead to syndromic scoliosis in a similar manner.
Other causes of scoliosis include:
- abnormal bone formation
- connective tissue disorders that cause abnormal tissues and ligaments such as Ehlers-Danlos syndrome
- different leg lengths: mild differences in leg lengths may cause a slight curvature but rarely cause a serious curvature
- spinal cord injury
- infection
- spinal tumors
Scoliosis is not caused by poor posture or carrying a heavy backpack.
How we care for scoliosis
The Spine Division at Boston Children’s Hospital is the largest and busiest pediatric spine center in the United States. Our spine specialists see thousands of spine patients and perform hundreds of spine surgeries each year. We treat all types of scoliosis and other spinal conditions, from the most common to the most complex.
With early intervention, the majority of our patients are treated successfully with bracing and other non-invasive treatments such as physical therapy and Schroth therapy. The most widely used brace for scoliosis, the Boston Brace, was developed at Boston Children’s more than 40 years ago. Today, we continue to work tirelessly to further improve non-surgical treatments for scoliosis and other spine disorders.
For children who need surgery, our surgical team includes surgeons, anesthesiologists, and nurses with specific skills and expertise in spinal fusion surgery. Each member of the team plays a role in ensuring quality and safety before, during and after surgery.
Patient resources
Patient and Family Guide to Scoliosis
This e-book for patients and families shares information about the diagnosis and management of scoliosis, and offers advice about how to live with the condition.
Embrace the Brace Digital Slideshow
Patients and providers offer advice to help others with scoliosis thrive while wearing a brace.
How to support your child who has to wear a brace
Experts at Boston Children’s answer questions about what it’s like to wear a brace and how a parent can support their child when they have to wear one.
