Scoliosis Health Article

Definition

Scoliosis is a side-to-side curvature of the spine.

Description

When viewed from the rear, the spine usually appears perfectly straight. Scoliosis is a lateral (side-to-side) curve in the spine, usually combined with a rotation of the vertebrae. (The lateral curvature of scoliosis should not be confused with the normal set of front-to-back spinal curves visible from the side.) While a small degree of lateral curvature does not cause any medical problems, larger curves can cause postural imbalance and lead to muscle fatigue and pain. More severe scoliosis can interfere with breathing and lead to arthritis of the spine (spondylosis).

Demographics

Approximately 10 percent of all adolescents have some degree of scoliosis, although fewer than 1 percent have curves that require medical attention beyond monitoring. Scoliosis is found in both boys and girls, but a girl's spinal curve is much more likely to progress than a boy's. Girls require scoliosis treatment about five times more often than boys. The reason for these differences as of 2004 was not known.

Causes and symptoms

Four out of five cases of scoliosis are idiopathic, meaning the cause is unknown. While idiopathic scoliosis tends to run in families, no specific genes responsible for the condition have been identified. Children with idiopathic scoliosis appear to be otherwise entirely healthy and have not had any bone or joint disease early in life. Scoliosis is not caused by poor posture, diet, or carrying a heavy book bag on one shoulder.

Idiopathic scoliosis is further classified according to age of onset:

• Infantile: Curvature appears before age three. This type is quite rare in the United States but is more common in Europe.
• Juvenile: Curvature appears between ages three and ten. This type may be equivalent to the adolescent type, except for the age of onset.
• Adolescent: Curvature usually appears between ages of ten and 13, near the beginning of puberty. This is the most common type of idiopathic scoliosis.
• Adult: Curvature begins after physical maturation is completed.

Causes are known for three other types of scoliosis:

• Congenital scoliosis is due to abnormal formation of the bones of the spine and is often associated with other organ defects.
• Neuromuscular scoliosis is due to loss of control of the nerves or muscles that support the spine. The most common causes of this type of scoliosis are cerebral palsy and muscular dystrophy.
• Degenerative scoliosis may be caused by breaking down of the discs that separate the vertebrae or by arthritis in the joints that link them.

Scoliosis causes a noticeable asymmetry in the torso when viewed from the front or back. The first sign of scoliosis is often seen when a child is wearing a bathing suit or underwear. A child may appear to be standing with one shoulder higher than the other or to have a tilt in the waistline. One shoulder blade may appear more prominent than the other due to rotation. In girls, one breast may appear higher than the other or larger if rotation pushes one side forward.

Curve progression is greatest near the adolescent growth spurt. Scoliosis that begins early is more likely to progress significantly than scoliosis that begins later in puberty.

When to call the doctor

If the parent notices that a child's posture is abnormal, if when the child stands one hip appears to be higher than the other, if one shoulder blade appears to be sticking out, or the child appears to lean regularly to one side, the doctor should be notified. If the child is screened at school and the screener reports a suspicion of scoliosis, a doctor should be seen to follow up on this suspicion.