Scoliosis

Also known as: Spinal curvature, Curved spine, Lateral spinal curvature, Abnormal curvature of the spine, Idiopathic scoliosis, Adolescent idiopathic scoliosis (AIS), Thoracic scoliosis, Lumbar scoliosis

Last updated: December 18, 2024

Scoliosis is an abnormal sideways curvature of the spine that usually includes twisting of the vertebrae, creating a three‑dimensional change rather than a simple bend. It can affect the upper, middle, or lower back and may be described by a Cobb angle on standing X‑rays. Common signs include uneven shoulders, a rib or back prominence on forward bending, and an uneven waist or hip position. Smaller curves may be observed over time. Many mild curves stay stable or progress slowly, especially after growth ends.

Key Facts

•Scoliosis be described as an abnormal lateral curvature of the spine that includes vertebral rotation, creating a three-dimensional deformity rather than a simple side-to-side bend
•Uneven shoulders or scapular prominence that become more noticeable with forward bending
•Diagnosed through history, physical exam, and imaging
•First-line treatment includes exercise, weight management, and activity modification

What It Is

Scoliosis may be described as an abnormal lateral curvature of the spine that typically includes vertebral rotation, creating a three-dimensional deformity rather than a simple side-to-side bend. The curvature can involve thoracic, thoracolumbar, or lumbar regions and may be characterized by a Cobb angle measurement on standing spinal radiographs. Adolescent idiopathic scoliosis often presents during periods of rapid growth and may be detected through visible asymmetry of the shoulders, ribs, or waist. Some forms may be associated with underlying neuromuscular, congenital, or connective tissue conditions, which can influence curve pattern and progression risk.

Affected Anatomy

This condition affects several structures in and around the joint:

•Thoracic vertebral bodies and posterior elements (including pedicles and laminae)
•Lumbar vertebral bodies and posterior elements (including facet joints)
•Intervertebral discs (annulus fibrosus and nucleus pulposus) across the curved segments
•Rib cage and costovertebral joints (contributing to rib prominence in thoracic curves)
•Paraspinal muscles (erector spinae and multifidus) with potential imbalance across the curve
•Spinal ligaments (anterior longitudinal ligament, posterior longitudinal ligament, and ligamentum flavum)
•Spinal canal and neural foramina (with potential narrowing in some curve patterns or degenerative cases)
•Pelvis and sacroiliac region (pelvic obliquity and compensatory alignment changes)

Common Symptoms

Symptoms can vary in intensity and may change over time. Common experiences include:

•Uneven shoulders or scapular prominence that may become more noticeable with forward bending
•Rib hump or thoracic prominence that can reflect vertebral rotation, often more apparent on the Adams forward bend test
•Uneven waistline, trunk shift, or hip asymmetry that may affect clothing fit and posture
•Back discomfort or pain that may worsen with prolonged standing or activity and can occur at rest, particularly in adults or with degenerative changes
•Reduced spinal flexibility or stiffness that can be more prominent in larger curves or long-standing deformity
•Fatigue of the back muscles that may relate to altered biomechanics and muscle imbalance
•Breathing limitation or reduced exercise tolerance that can occur with severe thoracic curves affecting chest wall mechanics
•Neurologic symptoms such as radiating leg pain, numbness, or weakness that may occur more often in adult scoliosis with spinal stenosis or foraminal narrowing

Causes and Risk Factors

Multiple factors can contribute to the development of this condition:

Causes

•Idiopathic scoliosis, which may have multifactorial contributors and often presents in adolescence without an identifiable single cause
•Congenital scoliosis due to vertebral formation or segmentation anomalies (such as hemivertebrae or unsegmented bars) that can create asymmetric growth
•Neuromuscular scoliosis associated with conditions that affect muscle control or tone (such as cerebral palsy, muscular dystrophy, or spinal muscular atrophy), which can alter spinal stability
•Degenerative (adult) scoliosis related to asymmetric disc degeneration, facet arthropathy, and spinal alignment changes that can develop over time
•Syndromic or connective tissue–associated scoliosis (such as in Marfan syndrome or Ehlers-Danlos syndromes) that may relate to ligamentous laxity and altered structural support
•Leg length discrepancy or pelvic obliquity that can contribute to compensatory spinal curvature in some individuals

Risk Factors

•Age during rapid growth, particularly late childhood through adolescence, when curve progression can be more likely
•Sex assigned at birth, with females often having a higher likelihood of curve progression in adolescent idiopathic scoliosis
•Family history of scoliosis, which may reflect genetic susceptibility in idiopathic forms
•Skeletal immaturity (such as lower Risser grade or earlier pubertal stage), which can be associated with greater progression potential
•Presence of congenital vertebral anomalies, which can increase the likelihood of early onset and progression
•Neuromuscular disorders that can reduce trunk control and spinal stability
•Connective tissue disorders with hypermobility or ligamentous laxity that can influence spinal alignment
•Older age with degenerative disc and facet joint disease, which can increase risk for adult degenerative scoliosis

How It's Diagnosed

Diagnosis typically involves a combination of clinical assessment and imaging studies:

•Clinical history and physical examination that can include posture assessment, shoulder/waist symmetry evaluation, leg length screening, and neurologic examination (strength, sensation, reflexes) when indicated
•Adams forward bend test, which can help identify rotational prominence and asymmetry suggestive of structural scoliosis
•Scoliometer measurement during forward bending, which can quantify trunk rotation and support decisions about imaging or monitoring
•Standing full-length spine radiographs (PA and lateral) that can measure Cobb angle, evaluate curve pattern, and assess sagittal alignment; serial imaging can help evaluate progression
•Assessment of skeletal maturity (such as Risser sign on pelvic radiograph and/or hand/wrist bone age in selected cases) that can help estimate growth remaining and progression risk
•MRI of the spine in selected presentations (such as atypical curve patterns, rapid progression, significant pain, or neurologic findings) to evaluate for intraspinal abnormalities
•Pulmonary function testing in some individuals with larger thoracic curves or respiratory symptoms to evaluate potential restrictive physiology

Treatment Options

Treatment approaches range from conservative measures to surgical interventions, often starting with the least invasive options:

Self-Care and Activity Modification

•Observation with periodic clinical and radiographic monitoring for smaller curves or curves with low progression risk, with intervals that can vary by age, curve magnitude, and growth status
•Activity modification and ergonomic strategies that can help manage discomfort associated with muscle fatigue or degenerative changes
•Bracing for skeletally immature individuals with curves in a progression-risk range, which can aim to reduce the likelihood of curve progression during growth
•Psychosocial support and body image counseling resources, which can be relevant for adolescents and adults experiencing distress related to appearance or chronic symptoms

Physical Therapy and Exercise

•Physical therapy–based exercise approaches (including scoliosis-specific exercise programs in some settings) that may support posture, core endurance, and function
•Post-treatment rehabilitation and long-term follow-up, which can support conditioning, function, and monitoring for progression or complications

Medications

•Pain management options that may include non-opioid analgesics and anti-inflammatory medications, used in a manner consistent with clinician guidance and individual risk factors

Injections and Office-Based Procedures

•Injections (such as epidural steroid injections or facet-related interventions) that can be considered in some adult degenerative cases with radicular pain or facet-mediated pain patterns

Surgery

•Surgical correction and spinal fusion for selected individuals with larger or progressive curves, significant deformity, or functional compromise, with goals that can include curve stabilization and alignment improvement
•Growth-friendly surgical techniques in some early-onset cases (such as growing rods or other expandable systems), which can aim to control curvature while allowing spinal and thoracic growth

Prognosis and Recovery

The course of this condition varies between individuals:

•Many mild curves may remain stable or progress slowly, particularly after skeletal maturity, although progression can still occur in some individuals depending on curve size and pattern
•In adolescent idiopathic scoliosis, risk of progression can be higher with larger initial Cobb angles and greater remaining growth, and lower with skeletal maturity
•Adults with degenerative scoliosis may experience symptom patterns influenced by disc degeneration, facet arthropathy, and spinal stenosis, and pain or functional limitation can vary widely
•Severe thoracic curves may be associated with reduced pulmonary reserve, and respiratory impact can depend on curve magnitude, location, and overall health
•Treatment outcomes can vary by curve type, magnitude, age, and comorbidities; bracing may reduce progression risk in appropriate candidates, and surgery may improve alignment and some symptoms while carrying procedural risks

Lumbar Spinal Fusion(Procedure)
Physical Therapy (Physiotherapy)(Procedure)

Frequently Asked Questions

Common symptoms include: Uneven shoulders or scapular prominence that may become more noticeable with forward bending; Rib hump or thoracic prominence that can reflect vertebral rotation, often more apparent on the Adams forward bend test; Uneven waistline, trunk shift, or hip asymmetry that may affect clothing fit and posture; Back discomfort or pain that may worsen with prolonged standing or activity and can occur at rest, particularly in adults or with degenerative changes; Reduced spinal flexibility or stiffness that can be more prominent in larger curves or long-standing deformity.

Diagnosis typically involves: Clinical history and physical examination that can include posture assessment, shoulder/waist symmetry evaluation, leg length screening, and neurologic examination (strength, sensation, reflexes) when indicated; Adams forward bend test, which can help identify rotational prominence and asymmetry suggestive of structural scoliosis; Scoliometer measurement during forward bending, which can quantify trunk rotation and support decisions about imaging or monitoring; Standing full-length spine radiographs (PA and lateral) that can measure Cobb angle, evaluate curve pattern, and assess sagittal alignment; serial imaging can help evaluate progression.

Treatment options range from conservative measures to surgical interventions, including: Observation with periodic clinical and radiographic monitoring for smaller curves or curves with low progression risk, with intervals that can vary by age, curve magnitude, and growth status; Physical therapy–based exercise approaches (including scoliosis-specific exercise programs in some settings) that may support posture, core endurance, and function; Activity modification and ergonomic strategies that can help manage discomfort associated with muscle fatigue or degenerative changes; Pain management options that may include non-opioid analgesics and anti-inflammatory medications, used in a manner consistent with clinician guidance and individual risk factors; Bracing for skeletally immature individuals with curves in a progression-risk range, which can aim to reduce the likelihood of curve progression during growth.