Scoliosis is often, but not always, a hereditary condition, and more girls than boys suffer from it.  It is most commonly diagnosed in childhood, but adults can suffer from it, too.  When it is experienced by adults, it is usually for one of two reasons: either they had it as a child and it was left untreated to grow worse into adulthood, or it is a new condition caused by a degenerative disease of the joints in the spine, which causes the appearance of a curve.

The most common type of scoliosis is called idiopathic scoliosis, which simply means that doctors cannot determine the cause.  Most of the time it is simply not known why a child’s spine begins to curve the way it does.  Sometimes, though doctors can determine that the scoliosis is caused by a neuromuscular disorder, or when a child’s legs are different lengths.  Birth defects can also be responsible for scoliosis, in cases where the fetus’s spine doesn’t develop properly and the child is born with a malformation.  One of these birth defects is called congenital scoliosis, which can be accompanied by other congenital disorders.

Most of the symptoms of scoliosis have to do with a slightly distorted appearance that comes with having an abnormally curved spine: one shoulder higher than the other, the waist being uneven, the hipbones being at different heights, or the child leaning to one side when standing or walking.  The child herself may feel backaches or unusual fatigue from the added stress of the curvature. Doctors routinely check for scoliosis during children’s yearly medical exams, but parents and teachers should also be aware of these symptoms and be prepared to bring them to medical attention.

At first, the health care provider simply visually examines the child’s spine and body.  The spine should be a straight line from the base of the neck to the tailbone.  They will also do an Adams test, in which the patient bends forward and the doctor traces the spine with the finger. This allows the doctor manually to detect a curve that may not be visible. Lateral curves—that is, curves that go side to side—are not normal.  In addition to the line of the spine, the health care provider will look for differences in the height of each shoulder, in the prominence of the shoulder blades, in the set of the waist and in the height of the hips.

If an abnormality in any of these areas is detected or suspected, the health care provider will then order x-rays to be taken of each of these areas.  If the x-rays confirm the presence of a spinal curvature, they will then be used to determine just how curved the spine is.  In most cases of scoliosis, the curve is very slight and will not need treatment at all.  However, x-rays will be a part of the patient’s future, as the condition is monitored throughout childhood, until the patient is fully grown.

When diagnosing the severity of the scoliosis and the possibilities for treatment, the age of the patient is one major consideration.  The younger the patient, the more options there are for non-invasive treatments, or for simply observing.  The older and taller an adolescent gets, the more serious their scoliosis can become, and if it is not diagnosed until later is adolescence, it may be more difficult to treat.

Another important point for diagnosis is the severity of the curve, which is determined by the visual, manual, and x-ray exams.  Spinal curves are usually divided into three categories: under 25 degrees of curvature, 25 to 40 degrees of curvature, and over 40 degrees of curvature.  These divisions will help the doctors decide what course of treatment will be best for the patient, but the guideline is that under 25 degrees will require no treatment but will require observation, 25 to 40 degrees will usually be treated by wearing a brace and doing the accompanying exercises, and over 40 degrees will usually result in surgery.

Further diagnostic work will depend on what is seen in the x-rays.  Several different factors will contribute to a diagnosis, including shape of the curve, location—or where in the spine it occurs, direction, angle—or how sharp the curve is, and cause—whether it is an unknown cause or a symptom of another disease.

There are three main categories or degrees of seriousness of scoliosis: less than 25 degrees curvature, 25 to 40 degrees, and over 40 degrees.  Treatments can vary with each of these degrees of curvature.

Less than 25 degrees

Most children and adolescents who are diagnosed with scoliosis are found to have quite mild curves, in most cases less than 20 degrees of curvature.  These children will seldom require any treatment at all, though their doctor will order regular x-rays for them—every 4 to 6 months—in order to monitor whether the curve grows worse, or progresses.  They will require these regular check-ups until they stop growing

25 to 40 degrees

A moderate curvature is usually treated by wearing a brace.  A brace does not actually cure scoliosis or reverse the curvature, but it can help to prevent the curvature from progressing.  Scoliosis braces have a very high degree of success; by preventing the progression of the scoliosis, they can make it possible for the patient to avoid surgery over 90 percent of the time.

Braces often seem like an ideal compromise between doing nothing and doing something invasive like surgery.  Of course, braces need to be worn as instructed, which usually means day and night, and the patient needs to be sure to do the exercises that are often prescribed for brace-wearers.  Braces do not keep children from participating in most things; they can still do sports and other activities with very few restrictions.  They may even be allowed to remove the brace temporarily for the duration of the activity, if they are diligent about putting it back on again afterward.

Of course, braces do have their drawbacks.  For one thing, they can only help patients who are still growing.  If a teen has reached his or her full height, a brace can no longer help them.  In addition, some older types of braces can make an adolescent feel self-conscious because they protrude from the clothes to brace the head as well as the upper back.  Fortunately, this type is not frequently used anymore.  More modern braces are much more comfortable and are concealed under the clothes.  These braces are custom-made to fit the child’s body contours and put corrective pressure on the spine through the use of pads in areas where they will be most effective.

Over 40 degrees

Scoliosis with this degree of curvature tends to get progressively worse throughout the child’s life, so doctors usually recommend corrective surgery for this type.  The most common type of surgery fuses two or more of the vertebrae together along the curve.  Metal pins are inserted into the vertebrae help to make sure that the spine cannot curve anymore and the curvature doesn’t progress any further.  This is a very difficult surgery that includes months of recovery time, but it can be worth it if the progression of the scoliosis is stopped.