View source for Scoliosis

{{Short description|Left-right asymmetry of the spine's curvature}}
{{Distinguish|Sclerosis (medicine){{!}}Sclerosis}}
{{Pp-move}}
{{Use dmy dates|date=October 2019}}
{{Infobox medical condition (new)
| name          = Scoliosis

| image         = Blausen 0785 Scoliosis 01.png
| caption       =
| width         = 180px
| field         = [[Orthopedic surgery]]
| pronounce     = {{IPAc-en|ˌ|s|k|oʊ|l|i|ˈ|oʊ|s|ɪ|s}}<ref>{{cite web|title=Scoliosis|url=http://www.merriam-webster.com/dictionary/scoliosis|website=Merriam Webster|access-date=12 August 2016|url-status=live|archive-url=https://web.archive.org/web/20160811005955/http://www.merriam-webster.com/dictionary/scoliosis|archive-date=11 August 2016}}</ref>
| symptoms      = Sideways curve in the back<ref name=NIH2015/>
| complications =
| onset         = 10–20 years old<ref name=NIH2015/>
| duration      =
| causes        = Usually unknown<ref name=GHR2013/>
| risks         = Family history, [[cerebral palsy]], [[Marfan syndrome]], tumors such as [[neurofibromatosis]]<ref name=NIH2015/>
| diagnosis     = [[X-ray]]<ref name=NIH2015/>
| differential  =
| prevention    =
| treatment     = [[Watchful waiting]], [[Back brace|bracing]], exercises, surgery<ref name=NIH2015/><ref name=Neg2018/>
| medication    =
| prognosis     =
| frequency     = 3%<ref name=Sh2014/><ref>{{cite web|title=Scoliosis - Symptoms, Diagnosis and Treatment|url=https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Scoliosis|website=aans.org|access-date=10 February 2022}}</ref>
| deaths        =
| alt           =
}}

<!-- Definition and symptoms -->
'''Scoliosis''' ({{plural form}}: '''scolioses''') is a medical condition in which the [[Vertebral column|spine]] has an irregular curve<ref name="NIH2015">{{cite web |title=Questions and Answers about Scoliosis in Children and Adolescents |url=https://www.niams.nih.gov/health-topics/scoliosis |website=NIAMS |access-date=12 August 2016 |date=December 2015 |url-status=live |archive-url=https://web.archive.org/web/20160825230043/http://www.niams.nih.gov/health_info/scoliosis/|archive-date=25 August 2016}}</ref> in the [[coronal plane]]. The curve is usually S- or C-shaped over three dimensions.<ref name="NIH2015" /><ref name="Il2019">{{cite journal | vauthors = Illés TS, Lavaste F, Dubousset JF | title = The third dimension of scoliosis: The forgotten axial plane | journal = Orthopaedics & Traumatology, Surgery & Research | volume = 105 | issue = 2 | pages = 351–359 | date = April 2019 | pmid = 30665877 | doi = 10.1016/j.otsr.2018.10.021 | doi-access = free | hdl = 10985/18316 | hdl-access = free }}</ref> In some, the degree of curve is stable, while in others, it increases over time.<ref name="GHR2013" /> Mild scoliosis does not typically cause problems, but more severe cases can affect breathing and movement.<ref name="GHR2013" /><ref>{{cite journal | vauthors = Yang S, Andras LM, Redding GJ, Skaggs DL | title = Early-Onset Scoliosis: A Review of History, Current Treatment, and Future Directions | journal = Pediatrics | volume = 137 | issue = 1 | article-number = e20150709 | date = January 2016 | pmid = 26644484 | doi = 10.1542/peds.2015-0709 | s2cid = 557560 | doi-access = free }}</ref> Pain is usually present in adults, and can worsen with age.<ref>{{cite journal | vauthors = Agabegi SS, Kazemi N, Sturm PF, Mehlman CT | title = Natural History of Adolescent Idiopathic Scoliosis in Skeletally Mature Patients: A Critical Review | journal = The Journal of the American Academy of Orthopaedic Surgeons | volume = 23 | issue = 12 | pages = 714–723 | date = December 2015 | pmid = 26510624 | doi = 10.5435/jaaos-d-14-00037 | s2cid = 6735774 }}</ref> As the condition progresses, it may alter a person's life, and hence can also be considered a [[disability]].<ref>{{Cite web |title=Disability for Scoliosis {{!}} Bross & Frankel |url=https://brossfrankel.com/disability-qualifications/disability-for-scoliosis/ |access-date=2023-06-15 |website=brossfrankel.com |language=en-US}}</ref> It can be compared to [[kyphosis]] and [[lordosis]], other abnormal curvatures of the spine which are in the [[sagittal plane]] (front-back) rather than the coronal (left-right). 

<!-- Cause -->
The cause of most cases is unknown, but it is believed to involve a combination of [[Genetics|genetic]] and [[environmental factor]]s.<ref name=GHR2013/> Scoliosis most often occurs during growth spurts right before puberty.<ref>{{cite web | url=https://www.mayoclinic.org/diseases-conditions/scoliosis/symptoms-causes/syc-20350716 | title=Scoliosis - Symptoms and causes | website=[[Mayo Clinic]] }}</ref> Risk factors include other affected family members.<ref name=NIH2015/> It can also occur due to another condition such as [[muscle spasms]], [[cerebral palsy]], [[Marfan syndrome]], and tumors such as [[neurofibromatosis]].<ref name=NIH2015/> Diagnosis is confirmed with [[X-ray]]s.<ref name=NIH2015/> Scoliosis is typically classified as either structural in which the curve is fixed, or functional in which the underlying spine is normal.<ref name=NIH2015/> Left-right [[asymmetries]], of the vertebrae and their musculature, especially in the thoracic region,<ref name="Kouwenhoven2006">{{cite journal | last1=Kouwenhoven | first1=Jan-Willem | last2=Vincken | first2= Koen L. | last3=Bartels | first3=Lambertus W. | last4=Castelein | first4=Rene M. | year=2006 | title=Analysis of preexistent vertebral rotation in the normal spine. | journal= Spine | volume=31 | issue=13 | pages=1467–1472 | doi=10.1097/01.brs.0000219938.14686.b3 | pmid=16741456 | s2cid=2401041 }}</ref> may cause mechanical instability of the spinal column.

<!-- Treatment -->
Treatment depends on the degree of curve, location, and cause.<ref name=NIH2015/> The age of the patient is also important, since some treatments are ineffective in adults, who are no longer growing. Minor curves may simply be watched periodically.<ref name=NIH2015/> Treatments may include [[Back brace|bracing]], specific exercises, posture checking, and surgery.<ref name=NIH2015/><ref name =Neg2018/> The brace must be fitted to the person and used daily until growth stops.<ref name=NIH2015/> Specific exercises, such as exercises that focus on the core, may be used to try to decrease the risk of worsening.<ref name =Neg2018>{{cite journal | vauthors = Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, Diers H, Grivas TB, Knott P, Kotwicki T, Lebel A, Marti C, Maruyama T, O'Brien J, Price N, Parent E, Rigo M, Romano M, Stikeleather L, Wynne J, Zaina F | display-authors = 6 | title = 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth | journal = Scoliosis and Spinal Disorders | volume = 13 | article-number = 3 | date = 2018 | pmid = 29435499 | pmc = 5795289 | doi = 10.1186/s13013-017-0145-8 | doi-access = free }}</ref> They may be done alone or along with other treatments such as bracing.<ref>{{cite journal | vauthors = Berdishevsky H, Lebel VA, Bettany-Saltikov J, Rigo M, Lebel A, Hennes A, Romano M, Białek M, M'hango A, Betts T, de Mauroy JC, Durmala J | display-authors = 6 | title = Physiotherapy scoliosis-specific exercises - a comprehensive review of seven major schools | journal = Scoliosis and Spinal Disorders | volume = 11 | article-number = 20 | date = 2016 | pmid = 27525315 | pmc = 4973373 | doi = 10.1186/s13013-016-0076-9 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Park JH, Jeon HS, Park HW | title = Effects of the Schroth exercise on idiopathic scoliosis: a meta-analysis | journal = European Journal of Physical and Rehabilitation Medicine | volume = 54 | issue = 3 | pages = 440–449 | date = June 2018 | pmid = 28976171 | doi = 10.23736/S1973-9087.17.04461-6 | s2cid = 39497372 }}</ref> Evidence that [[Spinal adjustment|chiropractic manipulation]], dietary supplements, or exercises can prevent the condition from worsening is weak.<ref name=NIH2015/><ref name=Thom2018>{{cite journal | vauthors = Thompson JY, Williamson EM, Williams MA, Heine PJ, Lamb SE | title = Effectiveness of scoliosis-specific exercises for adolescent idiopathic scoliosis compared with other non-surgical interventions: a systematic review and meta-analysis | journal = Physiotherapy | volume = 105 | issue = 2 | pages = 214–234 | date = June 2019 | pmid = 30824243 | doi = 10.1016/j.physio.2018.10.004 | s2cid = 73471547 | url = https://ora.ox.ac.uk/objects/uuid:71063c94-7706-41a5-94f7-ca31f097d6ce }}</ref> However, exercise is still recommended due to its other health benefits.<ref name=NIH2015/>

<!-- Epidemiology and culture -->
Scoliosis occurs in about 3% of people.<ref name=Sh2014>{{cite journal | vauthors = Shakil H, Iqbal ZA, Al-Ghadir AH | title = Scoliosis: review of types of curves, etiological theories and conservative treatment | journal = Journal of Back and Musculoskeletal Rehabilitation | volume = 27 | issue = 2 | pages = 111–115 | date = 2014 | pmid = 24284269 | doi = 10.3233/bmr-130438 }}</ref> It most commonly develops between the ages of ten and twenty.<ref name=NIH2015/> Females typically are more severely affected than males with a ratio of 4:1.<ref name=NIH2015/><ref name="GHR2013">{{cite web|title=Adolescent idiopathic scoliosis|url=https://medlineplus.gov/genetics/condition/adolescent-idiopathic-scoliosis/|website=Genetics Home Reference|access-date=12 August 2016|date=September 2013|url-status=live|archive-url=https://web.archive.org/web/20160816175557/https://ghr.nlm.nih.gov/condition/adolescent-idiopathic-scoliosis#expand-collapse-start|archive-date=16 August 2016}}</ref> The term is {{ety|grc|''{{linktext|σκολίωσις}}'' ({{grc-transl|σκολίωσις}})|a bending}}.<ref>{{cite Dictionary.com |scoliosis |access-date=12 August 2016}} {{Cite web |url=http://www.dictionary.com/browse/scoliosis |title=Scoliosis Definition & Meaning |access-date=12 August 2016 |archive-date=16 August 2016 |archive-url=https://web.archive.org/web/20160816230939/http://www.dictionary.com/browse/scoliosis |url-status=live}}.</ref>
{{TOC limit}}

==Signs and symptoms==
[[File:Braus 1921 84.png|thumb|upright|A 20th-century illustration of a severe case of an S-shaped scoliosis]]
Symptoms associated with scoliosis can include:
* Pain in the back at the site of the curve, which may radiate to the legs.<ref>{{cite journal |last= Aebi |first= Max |date= 2005 |title= The Adult Scoliosis |url= https://doc.rero.ch/record/321519/files/586_2005_Article_1053.pdf |journal= European Spine Journal |volume= 14 |issue= 10 |pages= 925–948 |doi= 10.1007/s00586-005-1053-9 |pmid= 16328223 |s2cid= 22119278 |access-date= 2022-12-21}}</ref> Chest pain at the ribs and sternum location can sometimes be linked to scoliosis of the spine because the ribs wrap around to the chest area which can be misaligned. This can lead to injury, pain and swelling which can turn up on medical imaging (CT scans etc.).{{medical citation needed|date=March 2025}}
* Respiratory or cardiac problems in severe cases<ref name= Alf>{{cite journal |last= Nachemson |first= Alf |date= 1968 |title= A Long Term Follow-up Study of Non-treated Scoliosis |url= https://www.tandfonline.com/doi/pdf/10.3109/17453676808989664 |journal= Acta Orthopaedica Scandinavica |volume= 39 |issue= 4 |pages= 466–476 |doi= 10.3109/17453676808989664 |pmid= 5726117 |access-date= 2022-12-21|url-access= subscription }}</ref>
* Constipation due to curvature causing "tightening" of the stomach, intestines, etc.<ref>{{cite web |url= https://spineina.com/blog/how-scoliosis-affects-the-body/#:~:text=Digestive%20systems%3A%20By%20compressing%20the,cause%20nausea%20for%20some%20patients |title= How Scoliosis Affects the Body |last= Yanner |first= Baher S. |date= 2021-12-17 |website= spineina.com |publisher= Spine Institute of North America |access-date= 2023-01-08}}</ref>

The signs of scoliosis can include:
* Uneven musculature on one side of the spine<ref>{{cite web |url= https://www.scoliosissos.com/blog/scoliosis-weak-side#:~:text=The%20condition%20known%20as%20scoliosis,those%20on%20the%20other%20side. |title= Muscular Imbalance: Why Does Scoliosis Create One Weak Side? |date= 2017-08-28 |website= www.scoliosissos.com |publisher= Scoliosis SOS Clinic |access-date= 2023-01-10}}</ref>
* Rib prominence or a prominent [[shoulder blade]], caused by rotation of the rib cage in [[human thorax|thoracic]] scoliosis<ref name= Zabjek/>
* Uneven posture<ref name= Zabjek>{{cite journal |last1= Coillard |first1= Christine |last2= Leroux |first2= Michel A. |last3= Prince |first3= François |last4= Rivard |first4= Charles H. |last5= Zabjek |first5= Karl Franc |date= 2008 |title= Postural Characteristics of Adolescents With Idiopathic Scoliosis |url= https://www.researchgate.net/publication/5463283 |journal= Journal of Pediatric Orthopaedics |volume= 28 |issue= 2 |pages= 218–224 |doi= 10.1097/BPO.0b013e3181651bdc |pmid= 18388718 |s2cid= 34046217 |access-date= 2023-01-08}}</ref>
* Heart and lung problems in severe cases<ref name= Alf />
* Calcium deposits in the cartilage endplate and sometimes in the disc itself<ref>{{cite journal | vauthors = Giachelli CM | title = Ectopic calcification: gathering hard facts about soft tissue mineralization | journal = The American Journal of Pathology | volume = 154 | issue = 3 | pages = 671–675 | date = March 1999 | pmid = 10079244 | pmc = 1866412 | doi = 10.1016/S0002-9440(10)65313-8 }}</ref>

===Course===
People who have reached skeletal maturity are less likely to have a worsening case.<ref>{{cite journal | vauthors = Thometz JG, Simon SR | title = Progression of scoliosis after skeletal maturity in institutionalized adults who have cerebral palsy | journal = The Journal of Bone and Joint Surgery. American Volume | volume = 70 | issue = 9 | pages = 1290–1296 | date = October 1988 | pmid = 3182881 | doi = 10.2106/00004623-198870090-00002 }}</ref> Some severe cases of scoliosis can lead to diminishing lung capacity, pressure exerted on the heart, and restricted physical activities.<ref>{{cite journal | vauthors = Koumbourlis AC | title = Scoliosis and the respiratory system | journal = Paediatric Respiratory Reviews | volume = 7 | issue = 2 | pages = 152–160 | date = June 2006 | pmid = 16765303 | doi = 10.1016/j.prrv.2006.04.009 }}</ref>

[[Longitudinal studies]] have revealed that the most common form of the condition, late-onset idiopathic scoliosis, causes little physical impairment other than back pain and cosmetic concerns, even when untreated, with mortality rates similar to the general population.<ref name="jama.ama-assn.org"/><ref name="jbjs.org"/> Older beliefs that untreated idiopathic scoliosis necessarily progressed into severe (cardiopulmonary) disability by old age have been refuted.<ref>{{cite journal | vauthors = Trobisch P, Suess O, Schwab F | title = Idiopathic scoliosis | journal = Deutsches Ärzteblatt International | volume = 107 | issue = 49 | pages = 875–83; quiz 884 | date = December 2010 | pmid = 21191550 | pmc = 3011182 | doi = 10.3238/arztebl.2010.0875 | quote = It was once assumed, on the basis of studies in heterogeneous patient populations, that patients with untreated adolescent scoliosis would necessarily become wheelchair-dependent in old age and were likely to die of cardiopulmonary arrest for reasons related to scoliosis. This is no longer held to be the case. }}</ref>

==Causes==

An estimated 65% of scoliosis cases are [[idiopathic]] (cause unknown), about 15% are [[congenital]], and about 10% are secondary to a [[neuromuscular disease]].<ref name="agabegi2nd90">{{cite book | vauthors = Agabegi ED, Agabegi SS | name-list-style = vanc | title = Step-Up to Medicine | series = Step-Up Series | publisher = Lippincott Williams & Wilkins | location = Hagerstwon, MD | year = 2008 |page=[https://archive.org/details/stepuptomedicine0000agab/page/90 90]| isbn = 978-0-7817-7153-5 | url-access = registration | url = https://archive.org/details/stepuptomedicine0000agab }}</ref>

About 38% of variance in scoliosis risk is due to genetic factors, and 62% is due to the environment.<ref name="Gorman 1905–1919">{{cite journal | vauthors = Gorman KF, Julien C, Moreau A | title = The genetic epidemiology of idiopathic scoliosis | journal = European Spine Journal | volume = 21 | issue = 10 | pages = 1905–1919 | date = October 2012 | pmid = 22695700 | pmc = 3463687 | doi = 10.1007/s00586-012-2389-6 }}</ref> The genetics are likely complex, however, given the inconsistent inheritance and discordance among monozygotic twins.<ref name="Gorman 1905–1919"/> The specific genes that contribute to the development of scoliosis have not been conclusively identified. Several candidate gene studies have found associations between idiopathic scoliosis and genes mediating bone formation, bone metabolism, and connective tissue structure.<ref name="Gorman 1905–1919"/> Several genome-wide studies have identified several loci as significantly linked to idiopathic scoliosis.<ref name="Gorman 1905–1919"/> In 2006, idiopathic scoliosis was linked with three [[microsatellite]] [[Polymorphism (biology)|polymorphisms]] in the [[MATN1|''MATN1'' gene]] (encoding for matrilin 1, cartilage matrix protein).<ref name="pmid17176459">{{cite journal | vauthors = Montanaro L, Parisini P, Greggi T, Di Silvestre M, Campoccia D, Rizzi S, Arciola CR | title = Evidence of a linkage between matrilin-1 gene (MATN1) and idiopathic scoliosis | journal = Scoliosis | volume = 1 | article-number = 21 | date = December 2006 | pmid = 17176459 | pmc = 1769398 | doi = 10.1186/1748-7161-1-21 | doi-access = free }}</ref> Fifty-three single nucleotide polymorphism markers in the DNA that are significantly associated with adolescent idiopathic scoliosis were identified through a genome-wide association study.<ref name=Ogilvie/>

{{Main|Adolescent idiopathic scoliosis}}

Adolescent idiopathic scoliosis has no clear causal agent and is generally believed to be multifactorial, leading to "progressive functional limitations" for individuals.<ref name="Cheng_2015">{{cite journal | vauthors = Cheng JC, Castelein RM, Chu WC, Danielsson AJ, Dobbs MB, Grivas TB, Gurnett CA, Luk KD, Moreau A, Newton PO, Stokes IA, Weinstein SL, Burwell RG | display-authors = 6 | title = Adolescent idiopathic scoliosis | journal = Nature Reviews. Disease Primers | volume = 1 | issue = | article-number = 15030 | date = September 2015 | pmid = 27188385 | doi = 10.1038/nrdp.2015.30 | s2cid = 21284193 }}</ref><ref>{{cite journal | vauthors = Burwell RG | title = Aetiology of idiopathic scoliosis: current concepts | journal = Pediatric Rehabilitation | volume = 6 | issue = 3–4 | pages = 137–170 | year = 2003 | pmid = 14713582 | doi = 10.1080/13638490310001642757 | s2cid = 12154979 }}</ref><ref>{{cite journal | vauthors = Shahidi B, Yoo A, Farnsworth C, Newton PO, Ward SR | title = Paraspinal muscle morphology and composition in adolescent idiopathic scoliosis: A histological analysis | journal = JOR Spine | volume = 4 | issue = 3 | article-number = e1169 | date = September 2021 | pmid = 34611591 | pmc = 8479518 | doi = 10.1002/jsp2.1169 | doi-access = free }}</ref><ref name="j1">{{cite journal | vauthors = Ogilvie JW, Braun J, Argyle V, Nelson L, Meade M, Ward K | title = The search for idiopathic scoliosis genes | journal = Spine | volume = 31 | issue = 6 | pages = 679–681 | date = March 2006 | pmid = 16540873 | doi = 10.1097/01.brs.0000202527.25356.90 | s2cid = 24280322 }}</ref><ref>{{cite journal | vauthors = Kouwenhoven JW, Castelein RM | title = The pathogenesis of adolescent idiopathic scoliosis: review of the literature | journal = Spine | volume = 33 | issue = 26 | pages = 2898–2908 | date = December 2008 | pmid = 19092622 | doi = 10.1097/BRS.0b013e3181891751 | s2cid = 19749217 }}</ref> Research suggests that Posterior Spinal Fusion (PSF) can be used to correct the more severe deformities caused by adolescent idiopathic scoliosis.<ref>{{cite journal | vauthors = Weiss HR, Goodall D | title = Rate of complications in scoliosis surgery - a systematic review of the Pub Med literature | journal = Scoliosis | volume = 3 | article-number = 9 | date = August 2008 | pmid = 18681956 | pmc = 2525632 | doi = 10.1186/1748-7161-3-9 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Fischer CR, Kim Y | title = Selective fusion for adolescent idiopathic scoliosis: a review of current operative strategy | journal = European Spine Journal | volume = 20 | issue = 7 | pages = 1048–1057 | date = July 2011 | pmid = 21387194 | pmc = 3176697 | doi = 10.1007/s00586-011-1730-9 }}</ref><ref>{{cite journal | vauthors = Merola AA, Haher TR, Brkaric M, Panagopoulos G, Mathur S, Kohani O, Lowe TG, Lenke LG, Wenger DR, Newton PO, Clements DH, Betz RR | display-authors = 6 | title = A multicenter study of the outcomes of the surgical treatment of adolescent idiopathic scoliosis using the Scoliosis Research Society (SRS) outcome instrument | journal = Spine | volume = 27 | issue = 18 | pages = 2046–2051 | date = September 2002 | pmid = 12634567 | doi = 10.1097/00007632-200209150-00015 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Chen Z, Rong L | title = Comparison of combined anterior-posterior approach versus posterior-only approach in treating adolescent idiopathic scoliosis: a meta-analysis | journal = European Spine Journal | volume = 25 | issue = 2 | pages = 363–371 | date = February 2016 | pmid = 25900299 | doi = 10.1007/s00586-015-3968-0 | s2cid = 4434949 }}</ref><ref name="ReferenceA">{{cite journal | vauthors = Rapp van Roden EA, Richardson RT, Russo SA, Rose WC, Nicholson KF, Chafetz RS, Gabos PG, Shah SA, Samdani AF, Richards JG | display-authors = 6 | title = Analysis of Shoulder Complex Function After Posterior Spinal Fusion in Adolescents With Idiopathic Scoliosis | journal = Journal of Pediatric Orthopedics | volume = 39 | issue = 1 | pages = e32–e38 | date = January 2019 | pmid = 30312252 | doi = 10.1097/BPO.0000000000001267 | s2cid = 52975845 }}</ref> Such procedures can result in a return to physical activity in about 6 months, which is very promising, although minimal back pain is still to be expected in the most severe cases.<ref>{{cite journal | vauthors = Bastrom TP, Marks MC, Yaszay B, Newton PO | title = Prevalence of postoperative pain in adolescent idiopathic scoliosis and the association with preoperative pain | journal = Spine | volume = 38 | issue = 21 | pages = 1848–1852 | date = October 2013 | pmid = 23883827 | doi = 10.1097/brs.0b013e3182a4aa97 | collaboration = Harms Study Group | doi-access = free }}</ref><ref>{{cite journal | vauthors = Landman Z, Oswald T, Sanders J, Diab M | title = Prevalence and predictors of pain in surgical treatment of adolescent idiopathic scoliosis | journal = Spine | volume = 36 | issue = 10 | pages = 825–829 | date = May 2011 | pmid = 21192302 | doi = 10.1097/brs.0b013e3181de8c2b | s2cid = 205514923 | collaboration = Spinal Deformity Study Group }}</ref><ref>{{cite journal | vauthors = Rubery PT, Bradford DS | title = Athletic activity after spine surgery in children and adolescents: results of a survey | journal = Spine | volume = 27 | issue = 4 | pages = 423–427 | date = February 2002 | pmid = 11840110 | doi = 10.1097/00007632-200202150-00019 | s2cid = 19524978 }}</ref><ref>{{cite journal | vauthors = Tarrant RC, O'Loughlin PF, Lynch S, Queally JM, Sheeran P, Moore DP, Kiely PJ | title = Timing and predictors of return to short-term functional activity in adolescent idiopathic scoliosis after posterior spinal fusion: a prospective study | journal = Spine | volume = 39 | issue = 18 | pages = 1471–1478 | date = August 2014 | pmid = 24875955 | doi = 10.1097/brs.0000000000000452 | s2cid = 35816768 }}</ref><ref name="ReferenceA" /> The prevalence of scoliosis is 1–2% among adolescents, but the likelihood of progression among adolescents with a [[Cobb angle]] less than 20° is about 10–20%.<ref name=trobisch-2010/>

Congenital scoliosis can be attributed to a malformation of the spine during weeks three to six ''[[Uterus|in utero]]'' due to a failure of formation, a failure of segmentation, or a combination of stimuli.<ref>{{cite web|url=http://www.medicalbug.com/what-is-scoliosis-what-causes-scoliosis/|title=What is Scoliosis: What Causes Scoliosis?|date=17 February 2012|publisher=MedicalBug|access-date=18 March 2012|url-status=live|archive-url=https://web.archive.org/web/20120409062122/http://www.medicalbug.com/what-is-scoliosis-what-causes-scoliosis/|archive-date=9 April 2012}}</ref> Incomplete and abnormal segmentation results in an abnormally shaped vertebra, at times fused to a normal vertebra or unilaterally fused vertebrae, leading to the abnormal lateral curvature of the spine.<ref>{{cite web |title=Congenital Scoliosis |publisher=Scoliosis Research Society (SRS) |url=http://www.srs.org/professionals/conditions_and_treatment/congenital_scoliosis/ |access-date=21 May 2014 |archive-url=https://web.archive.org/web/20140701144614/http://www.srs.org/professionals/conditions_and_treatment/congenital_scoliosis/ |archive-date=1 July 2014 }}</ref>

[[File:Yakovlev and thoracal spine asymmetries.pdf|thumb|upright=1.5|Opposite rotational asymmetries as viewed from below. Left: the Yakovlevian torque in the healthy cerebrum (exaggerated). Redrawn from Toga & Thompson.<ref name="Toga2003">{{cite journal | last1=Toga | first1=Arthur W. | last2=Thompson | first2=Paul M. | doi=10.1038/nrn1009 | journal=Nat. Rev. Neurosci. | pages=37–48 | title=Mapping brain asymmetry | volume=4 | issue=1 | year=2003| pmid=12511860 | s2cid=15867592 }}</ref> Right: the opposite, rightward asymmetry of the thoracal spine in healthy subjects.<ref name="Kouwenhoven2006"/> Source: figure 4 of reference<ref name="lussanet2019"/>]]
Vertebrae of the spine, especially in the thoracic region, are, on average, asymmetric.<ref name="Kouwenhoven2006"/> The mid-axis of these vertebral bodies tends to point systematically to the right of the [[Median plane|median body plane]]. A strong asymmetry of the vertebrae and their musculature, may lead to mechanical instability of the column, especially during phases of rapid growth. The asymmetry is thought to be caused by an [[Axial Twist theory|embryological twist of the body]].<ref name="lussanet2019">{{cite journal
| last=de Lussanet|first=M.H.E.
| doi=10.7717/peerj.7096
| journal=PeerJ
| article-number=e7096
| title=Opposite asymmetries of face and trunk and of kissing and hugging, as predicted by the axial twist hypothesis
| volume=7
| year=2019
| pmid=31211022
| pmc=6557252
| doi-access=free}}</ref>

===Resulting from other conditions===
Secondary scoliosis due to [[neuropathic]] and [[myopathic]] conditions can lead to a loss of muscular support for the spinal column so that the spinal column is pulled in abnormal directions.{{citation needed |date=February 2021}} Some conditions which may cause secondary scoliosis include [[muscular dystrophy]], [[spinal muscular atrophy]], [[poliomyelitis]], [[cerebral palsy]], spinal cord trauma, and [[myotonia]].<ref>{{cite journal | vauthors = Trontelj JV, Pecak F, Dimitrijević MR | title = Segmental neurophysiological mechanisms in scoliosis | journal = The Journal of Bone and Joint Surgery. British Volume | volume = 61-B | issue = 3 | pages = 310–313 | date = August 1979 | pmid = 479254 | doi = 10.1302/0301-620x.61b3.479254 | doi-access = free }}</ref><ref>POSNA. (2014). Neuromuscular Scoliosis. The Pediatric Orthopaedic Society of North America. {{cite web |url=http://www.posna.org/education/StudyGuide/neuromuscularScoliosis.asp |title=Neuromuscular Scoliosis - POSNA |access-date=21 May 2014 |archive-url=https://web.archive.org/web/20140521234840/http://www.posna.org/education/StudyGuide/neuromuscularScoliosis.asp |archive-date=21 May 2014}}</ref> Scoliosis often presents itself, or worsens, during an adolescent's growth spurt and is more often diagnosed in females than males.<ref name=trobisch-2010/>

Scoliosis associated with known syndromes is often subclassified as "syndromic scoliosis".<ref>{{cite journal | vauthors = Chung AS, Renfree S, Lockwood DB, Karlen J, Belthur M | title = Syndromic Scoliosis: National Trends in Surgical Management and Inpatient Hospital Outcomes: A 12-Year Analysis | journal = Spine | volume = 44 | issue = 22 | pages = 1564–1570 | date = November 2019 | pmid = 31689252 | doi = 10.1097/BRS.0000000000003134 | s2cid = 201175687 }}</ref> Scoliosis can be associated with <!-- add in alphanumeric order -->[[amniotic band syndrome]],<ref>{{cite journal |last1= Komazec |first1= Jovan |last2= Matic |first2= Aleksandra |date= 2009 |title= Amniotic Band Syndrome |url= https://publisher.medfak.ni.ac.rs/AMM_1/amm-stari/2009-html/2-broj/AMNIOTIC%20BAND%20SYNDROME.pdf |journal= Acta Medica Medianae |volume= 48 |issue= 2 |pages= 44–48 |access-date= 2023-01-29}}</ref> [[Arnold–Chiari malformation]],<ref>{{cite web |url= https://www.mayoclinic.org/diseases-conditions/chiari-malformation/symptoms-causes/syc-20354010 |title= Chiari malformation |website= mayoclinic.org |publisher= [[Mayo Clinic]] |access-date= 2023-01-29}}</ref> [[Charcot–Marie–Tooth disease]],<ref>{{cite journal |last1= Marchesi |first1= Chiara |last2= Pareyson |first2= Davide |date= 2009 |title= Diagnosis, natural history, and management of Charcot-Marie-Tooth disease |url= http://new.c-m-t.cz/wp-content/uploads/2016/01/Diagnosis-natural-history-and-management-of-Charcot%E2%80%93Marie%E2%80%93Tooth-disease.pdf |journal= [[The Lancet Neurology]] |volume= 8 |issue= 7 |pages= 654–667 |doi= 10.1016/S1474-4422(09)70110-3 |pmid= 19539237 |s2cid= 665324 |access-date= 2023-01-29 |archive-date= 4 February 2023 |archive-url= https://web.archive.org/web/20230204185833/http://new.c-m-t.cz/wp-content/uploads/2016/01/Diagnosis-natural-history-and-management-of-Charcot%E2%80%93Marie%E2%80%93Tooth-disease.pdf }}</ref> [[cerebral palsy]],<ref>{{cite journal |last1= Krigger |first1= Karen W. |date= 2006 |title= Cerebral Palsy: An Overview |url= https://www.aafp.org/pubs/afp/issues/2006/0101/p91.html |journal= [[American Family Physician]] |volume= 73 |issue= 1 |pages= 91–100 |pmid= 16417071 |access-date= 2023-01-29}}</ref> [[congenital diaphragmatic hernia]],<ref>{{cite journal |last1= Chandraekharan |first1= Praveen Kumar |last2= Lakshminrusimha |first2= Satyan |last3= Madappa |first3= Rajeshwari |last4= Rawat |first4= Munmun |last5= Rothstein |first5= David H. |date= 2017 |title= Congenital Diaphragmatic hernia - a review |journal= Maternal Health, Neonatology and Perinatology |volume= 3|article-number= 6 |doi= 10.1186/s40748-017-0045-1 |pmid= 28331629 |pmc= 5356475 |doi-access= free }}</ref> [[connective tissue disorder]]s,<ref name= Hresko>{{cite journal |last1= Hresko |first1= M. Timothy |date= 2013 |title= Idiopathic Scoliosis in Adolescents |url= https://pedclerk.uchicago.edu/sites/pedclerk.uchicago.edu/files/uploads/scoliosis_0.pdf |journal= [[The New England Journal of Medicine]] |volume= 368 |issue= 9 |pages= 834–841 |doi= 10.1056/NEJMcp1209063 |pmid= 23445094 |access-date= 2023-01-29 |archive-date= 29 January 2023 |archive-url= https://web.archive.org/web/20230129193408/https://pedclerk.uchicago.edu/sites/pedclerk.uchicago.edu/files/uploads/scoliosis_0.pdf }}</ref> [[muscular dystrophy]],<ref>{{cite journal |last1= Aartsma-Ra |first1= Annemieke |last2= Duan |first2= Dongsheng |last3= Goemans |first3= Nathalie |last4= Mercuri |first4= Eugenio |last5= Takeda |first5= Shin'ichi |date= 2021 |title= Duchenne muscular dystrophy |url= https://www.nature.com/articles/s41572-021-00248-3 |journal= [[Nature Reviews Disease Primers]] |volume= 7}}</ref> [[familial dysautonomia]],<ref>{{cite journal |last1= Fuente-Mora |first1= Cristina |last2= Kauffman |first2= Horacio |last3= Mendoza-Santiesteban |first3= Carlos |last4= Norcliffe-Kauffman |first4= Lucy |last5= Palma |first5= Jose-Alberto |last6= Percival |first6= Leila |date= 2014 |url= https://www.researchgate.net/publication/267043910|title= Current treatments in familial dysautonomia |journal= [[Expert Opinion on Pharmacotherapy]] |volume= 15 |issue= 18 |pages= 2653–2671 |doi= 10.1517/14656566.2014.970530 |pmid= 25323828 |pmc= 4236240 |access-date= 2023-01-29}}</ref> [[CHARGE syndrome]],<ref>{{cite journal |last1= Blake |first1= Kim D |last2= Prasad |first2= Chitra |date= 2006 |title= CHARGE syndrome |journal= [[Orphanet Journal of Rare Diseases]] |volume= 1 |article-number= 34 |doi= 10.1186/1750-1172-1-34 |pmid= 16959034 |pmc= 1586184 |doi-access= free }}</ref> [[Ehlers–Danlos syndrome]]<ref name= Hresko /> (hyperflexibility, "floppy baby" syndrome, and other variants of the condition), [[fragile X syndrome]],<ref>{{cite web|title=Fragile X syndrome|url=http://www.dwp.gov.uk/publications/specialist-guides/medical-conditions/a-z-of-medical-conditions/learning-disability/fragile-x-syndrome-ld.shtml|publisher=Department for Work and Pensions, UK|access-date=29 August 2011|url-status=live|archive-url=https://web.archive.org/web/20120319202707/http://www.dwp.gov.uk/publications/specialist-guides/medical-conditions/a-z-of-medical-conditions/learning-disability/fragile-x-syndrome-ld.shtml|archive-date=19 March 2012}}</ref><ref>{{cite journal | vauthors = Davids JR, Hagerman RJ, Eilert RE | title = Orthopaedic aspects of fragile-X syndrome | journal = The Journal of Bone and Joint Surgery. American Volume | volume = 72 | issue = 6 | pages = 889–896 | date = July 1990 | pmid = 2195034 | doi = 10.2106/00004623-199072060-00015 }}</ref> [[Friedreich's ataxia]],<ref>{{cite journal |last1= Delatycki |first1= Martin B |last2= Forrest |first2= Susan M |last3= Williamson |first3= Robert |date= 2000 |title= Freidreich ataxia: an overview |url= https://jmg.bmj.com/content/jmedgenet/37/1/1.full.pdf |journal= [[Journal of Medical Genetics]] |volume= 37 |issue= 1 |pages= 1–8 |doi= 10.1136/jmg.37.1.1 |pmid= 10633128 |pmc= 1734457 |access-date= 2023-01-30}}</ref> [[hemihypertrophy]],<ref>{{cite web |url= https://www.orthobullets.com/pediatrics/4044/hemihypertrophy |title= Hemihypertrophy |last= Sheth |first= Ujash |date= 2021 |website= www.orthobullets.com |publisher= OrthoBullets |access-date= 2023-01-31}}</ref> [[Loeys–Dietz syndrome]],<ref>{{cite journal |last1= Black |first1= James H. |last2= Bowdin |first2= Sarah |last3= Dietz |first3= Harry C. |last4= El-Hamamsy |first4= Ismail |last5= Frischmeyer-Guerrerio |first5= Pamela A. |last6= Guerrerio |first6= Anthony L. |last7= Loeys |first7= Bart |last8= MacCarrick |first8= Gretchen |last9= Sponseller |first9= Paul D |date= 2014 |title= Loeys-Dietz syndrome: a primer for diagnosis and management |journal= [[Genetics in Medicine]] |volume= 16 |issue= 8 |pages= 576–587 |doi= 10.1038/gim.2014.11 |pmid= 24577266 |pmc= 4131122 }}</ref> [[Marfan syndrome]],<ref name= Hresko /> [[nail–patella syndrome]],<ref>{{cite journal |last1= Fryer |first1= G |last2= Green |first2= A |last3= McIntosh |first3= I |last4= Mountford |first4= R |last5= Sweeney |first5= E |date= 2003 |title= Nail patella syndrome: a review of the phenotype aided by developmental biology |url= https://jmg.bmj.com/content/jmedgenet/40/3/153.full.pdf |journal= [[Journal of Medical Genetics]] |volume= 40 |issue= 3 |pages= 153–162 |doi= 10.1136/jmg.40.3.153 |pmid= 12624132 |pmc= 1735400 |access-date= 2023-01-30}}</ref> [[neurofibromatosis]],<ref>{{cite journal |last1= Boyd |first1= Kevin P. |last2= Korf |first2= Bruce R. |last3= Theos |first3= Amy |date= 2009 |title= Neurofibromatosis type 1 |journal= [[Journal of the American Academy of Dermatology]] |volume= 61 |issue= 1 |pages= 1–16 |doi= 10.1016/j.jaad.2008.12.051 |pmid= 19539839 |pmc= 2716546 }}</ref> [[osteogenesis imperfecta]],<ref>{{cite journal |last1= Glorieux |first1= Francis H |last2= Rauch |first2= Frank |date= 2004 |title= Osteogenesis imperfecta |url= http://publicationslist.org.s3.amazonaws.com/data/frauch/ref-67/Rauch%20OI%20review%20Lancet%202004.pdf |journal= [[The Lancet]] |volume= 363 |issue= 9418 |pages= 1377–1385 |doi= 10.1016/S0140-6736(04)16051-0 |pmid= 15110498 |s2cid= 24081895 |access-date= 2023-01-30}}</ref> [[Prader–Willi syndrome]],<ref>{{cite journal |last1= Cassidy |first1= Suzanne B. |last2= Driscoll |first2= Daniel J. |last3= Miller |first3= Jennifer L. |last4= Schwartz |first4= Stuart |date= 2012 |title= Prader-Willi syndrome |journal= [[Genetics in Medicine]] |volume= 14 |issue= 1 |pages= 10–26 |doi= 10.1038/gim.0b013e31822bead0 |pmid= 22237428 |s2cid= 19992 |doi-access= free }}</ref> [[proteus syndrome]],<ref>{{cite journal |last1= Biesecker |first1= Leslie G. |last2= Choyke |first2= Peter L. |last3= Jamis-Dow |first3= Carlos A. |last4= Turner |first4= Joyce |date= 2004 |title= Radiologic Manifestations of Proteus Syndrome |url= https://www.proteus-syndrome.org/uploads/1/1/4/6/114696341/compressed_jamis-dow_et_al.pdf |journal= RadioGraphics |volume= 24 |issue= 4 |pages= 1051–1068 |doi= 10.1148/rg.244035726 |pmid= 15256628 |access-date= 2023-01-31}}</ref> [[spina bifida]],<ref>{{cite journal |last1= Adzick |first1= N Scott |last2= Melchionne |first2= Jeanne |last3= Mitchell |first3= Laura E |last4= Pasquariello |first4= Patrick S |last5= Sutton |first5= Leslie N |last6= Whitehead |first6= Alexander S |date= 2004 |title= Spina bifida |url= https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=186b07a3d4651e28f9ffd0b9bc7ec1c2af33e56b |journal= [[The Lancet]] |volume= 364 |issue= 9448 |pages= 1885–1895 |doi= 10.1016/S0140-6736(04)17445-X |pmid= 15555669 |s2cid= 37770338 |access-date= 2023-01-31|url-access= subscription }}</ref> [[Spinal muscular atrophies|spinal muscular atrophy]],<ref>{{cite journal |last1= Lunn |first1= Mitchell R |last2= Wang |first2= Ching H |date= 2008 |title= Spinal muscular atrophy |url= https://www.academia.edu/18213331 |journal= [[The Lancet]] |volume= 371 |issue= 9630 |pages= 2120–2133 |doi= 10.1016/S0140-6736(08)60921-6 |pmid= 18572081 |s2cid= 11023418 |access-date= 2023-01-31}}</ref> [[syringomyelia]],<ref>{{cite journal |last1= Vandertop |first1= W. Peter |date= 2014 |title= Syringomyelia |journal= Neuropediatrics |volume= 45 |issue= 1 |pages= 003–009 |doi= 10.1055/s-0033-1361921 |pmid= 24272770 |s2cid= 256730957 |doi-access= free }}</ref> and [[pectus carinatum]].<ref>{{cite journal |last1= Desmarais |first1= Thomas J. |last2= Keller |first2= Martin S. |date= 2013 |title= Pectus carinatum |url= https://www.braceworks.ca/wp-content/uploads/2016/08/Desmarais-Keller-2013-Pectus-carinatum.pdf |journal= Current Opinion in Pediatrics |volume= 25 |issue= 3 |pages= 375–381 |doi= 10.1097/MOP.0b013e3283604088 |pmid= 23657247 |s2cid= 46604820 |access-date= 2023-01-31}}</ref>

Another form of secondary scoliosis is degenerative scoliosis, also known as de novo scoliosis, which develops later in life secondary to degenerative (may or may not be associated with aging) changes. This is a type of deformity that starts and progresses because of the collapse of the vertebral column in an asymmetrical manner. As bones start to become weaker and the ligaments and discs located in the spine become worn as a result of age-related changes, the spine begins to curve.<ref name= ds>{{cite journal |last1= Giradi |first1= Federico |last2= Hughes |first2= Alex |last3= Kotwal |first3= Suhel |last4= Pumberger |first4= Matthias |date= 2011 |title= Degenerative Scoliosis: A Review |journal= [[HSS Journal]] |volume= 7 |issue= 3 |pages= 257–264|doi= 10.1007/s11420-011-9204-5 |pmid= 23024623 |pmc= 3192887 }}</ref>

==Diagnosis==
[[File:Scoliosis cobb.svg|thumb|upright|[[Cobb angle]] measurement of a scoliosis]]

People who initially present with scoliosis undergo a physical examination to determine whether the deformity has an underlying cause and to exclude the possibility of the more serious underlying condition than simple scoliosis.{{citation needed|date=October 2020}}

The person's [[gait analysis|gait is assessed]], with an exam for [[sign (medicine)|sign]]s of other abnormalities (e.g., [[spina bifida]] as evidenced by a [[dimple]], hairy patch, [[lipoma]], or [[hemangioma]]). A thorough [[neurological examination]] is also performed, the [[skin]] for [[café au lait spot|''café au lait'' spots]], indicative of [[neurofibromatosis]], the feet for [[Pes cavus|cavovarus deformity]], abdominal reflexes and muscle tone for [[spasticity]].{{citation needed|date=October 2020}}

When a person can cooperate, he or she is asked to bend forward as far as possible. This is known as the [[Adams Forward Bend Test|Adams forward bend test]]<ref>{{cite web |url=http://www.iscoliosis.com/symptoms-screening.html |title=Scoliosis symptoms – pain, flat back, screening, self-assessment |work=iscoliosis.com}}</ref> and is often performed on school students. If a prominence is noted, then scoliosis is a possibility, and an X-ray may be done to confirm the diagnosis.

As an alternative, a [[scoliometer]] may be used to diagnose the condition.<ref>{{cite web |url=http://www.scoliosis.org/store/scoliometer.php |title=Scoliometer (Inclinometer) |publisher=National Scoliosis Foundation |url-status=live |archive-url=https://web.archive.org/web/20141121085301/http://www.scoliosis.org/store/scoliometer.php |archive-date=21 November 2014}}</ref>

When scoliosis is suspected, weight-bearing, full-spine AP/[[Coronal plane|coronal]] (front-back view) and [[Sagittal|lateral]]/[[sagittal]] (side view) X-rays are usually taken to assess the scoliosis curves and the [[kyphosis]] and [[lordosis]], as these can also be affected in individuals with scoliosis. Full-length standing spine [[radiography|X-ray]]s are the standard method for evaluating the severity and progression of scoliosis, and whether it is congenital or idiopathic in nature. In growing individuals, serial radiographs are obtained at 3- to 12-month intervals to follow curve progression, and, in some instances, [[MRI]] investigation is warranted to look at the spinal cord.<ref name="ScoliosisMRI">{{cite journal | vauthors = Kim H, Kim HS, Moon ES, Yoon CS, Chung TS, Song HT, Suh JS, Lee YH, Kim S | display-authors = 6 | title = Scoliosis imaging: what radiologists should know | journal = Radiographics | volume = 30 | issue = 7 | pages = 1823–1842 | date = November 2010 | pmid = 21057122 | doi = 10.1148/rg.307105061 | url = https://ir.ymlib.yonsei.ac.kr/handle/22282913/103044 | quote = The main purpose of performing CT or MR imaging in a patient with scoliosis is to identify the underlying cause. MR imaging is used with increasing frequency to evaluate patients with an unusual curve pattern or alarming clinical manifestations. Nevertheless, two reasons for performing such screening are plausible: First, the treatment of an underlying neurologic lesion could help alleviate progressive neurologic deterioration and lead to improvement or stabilization of scoliosis; second, surgery performed to correct scoliosis in the presence of an underlying neurologic disorder that has not been identified and treated could result in new or additional neurologic deficits. }}</ref> An average scoliosis patient has been in contact with around 50–300&nbsp;mGy of radiation due to these radiographs during this period.<ref>{{cite journal | vauthors = Oakley PA, Ehsani NN, Harrison DE | title = The Scoliosis Quandary: Are Radiation Exposures From Repeated X-Rays Harmful? | journal = Dose-Response | volume = 17 | issue = 2 | article-number = 1559325819852810 | date = 2019-04-01 | pmid = 31217755 | pmc = 6560808 | doi = 10.1177/1559325819852810 }}</ref>

The standard method for assessing the curvature quantitatively is measuring the [[Cobb angle]], which is the angle between two lines, drawn perpendicular to the upper endplate of the uppermost vertebra involved and the lower endplate of the lowest vertebra involved. For people with two curves, Cobb angles are followed for both curves. In some people, lateral-bending X-rays are obtained to assess the flexibility of the curves or the primary and compensatory curves.{{Citation needed|date=October 2014}}<ref>{{Cite journal |last=Junhua Zhang , Edmond Lou, Douglas L Hill, James V Raso, Yuanyuan Wang, Lawrence H Le, Xinling Shi |date=2010 |title=Computer-aided assessment of scoliosis on posteroanterior radiographs |journal=National Library of Medicine |volume=48 |issue=2 |pages=185–95 |doi=10.1007/s11517-009-0556-7 |pmid=20012376 }}</ref><ref>{{Cite journal |last=Weifei Wu, Jie Liang, Yuanli Du, Xiaoyi Tan, Xuanping Xiang, Wanhong Wang, Neng Ru & Jinbo Le BMC Musculoskeletal Disorders |date=2014 |title=Reliability and reproducibility analysis of the Cobb angle and assessing sagittal plane by computer-assisted and manual measurement tools |journal=BMC Musculoskeletal Disorder |volume=33 |issue=2014 |article-number=33 |doi=10.1186/1471-2474-15-33 |pmid=24502397 |pmc=3922010 |doi-access=free }}</ref>

Congenital and idiopathic scoliosis that develops before the age of 10 is referred to as early-onset scoliosis.<ref>{{cite web|url=http://www.srs.org/patients-and-families/conditions-and-treatments/parents/scoliosis/early-onset-scoliosis|title=Early Onset Scoliosis {{!}} Scoliosis Research Society|website=www.srs.org|access-date=10 July 2016|url-status=live|archive-url=https://web.archive.org/web/20160621014135/http://www.srs.org/patients-and-families/conditions-and-treatments/parents/scoliosis/early-onset-scoliosis|archive-date=21 June 2016}}</ref> Progressive idiopathic early-onset scoliosis can be a life-threatening condition with negative effects on pulmonary function.<ref>Sponseller PD, Yazici M, Demetracopoulos C, et al. Evidence basis for management of spine and chest wall deformities in children.Spine(Phila Pa 1976). 2007;32(suppl):S81–S90</ref><ref>Celebioglu E., Yataganbaba A., Bekmez S., et al Growing-rod Graduates with Idiopathic Early-onset Scoliosis Have Comparable Exercise Tolerance to Patients with Surgically Treated Adolescent Idiopathic Scoliosis. ''J. Pediatr. Orthop..'' 2020;40(8):e734-e739. doi:10.1097/BPO.0000000000001567</ref> Scoliosis that develops after 10 is referred to as [[adolescent idiopathic scoliosis]].<ref name=GHR2013/> Screening adolescents without symptoms for scoliosis is of unclear benefit.<ref>{{cite journal | vauthors = Grossman DC, Curry SJ, Owens DK, Barry MJ, Davidson KW, Doubeni CA, Epling JW, Kemper AR, Krist AH, Kurth AE, Landefeld CS, Mangione CM, Phipps MG, Silverstein M, Simon MA, Tseng CW | display-authors = 6 | title = Screening for Adolescent Idiopathic Scoliosis: US Preventive Services Task Force Recommendation Statement | journal = JAMA | volume = 319 | issue = 2 | pages = 165–172 | date = January 2018 | pmid = 29318284 | doi = 10.1001/jama.2017.19342 | s2cid = 38852032 | doi-access = free }}</ref>

===Definition===
Scoliosis is defined as a three-dimensional deviation in the axis of a person's [[vertebral column|spine]].<ref name="trobisch-2010">{{cite journal | vauthors = Trobisch P, Suess O, Schwab F | title = Idiopathic scoliosis | journal = Deutsches Ärzteblatt International | volume = 107 | issue = 49 | pages = 875–83; quiz 884 | date = December 2010 | pmid = 21191550 | pmc = 3011182 | doi = 10.3238/arztebl.2010.0875 }}</ref><ref name=Il2019/> Most instances, including the Scoliosis Research Society, define scoliosis as a [[Cobb angle]] of more than 10° to the right or left as the examiner faces the person, i.e. in the [[coronal plane]].<ref>{{cite book|url=https://books.google.com/books?id=fLIkBQAAQBAJ&pg=PA89 |title=The Complete Scoliosis Surgery Handbook for Patients: An In-Depth and Unbiased Look Into What to Expect Before and During Scoliosis Surgery| vauthors=Lau K |date=2014 |page=89|publisher=Health In Your Hands|isbn=978-981-07-8592-5}}</ref>

Scoliosis has been described as a biomechanical deformity, the progression of which depends on asymmetric forces otherwise known as the [[Carl Hueter|Hueter–Volkmann Law]].<ref name="Ogilvie">{{cite journal | vauthors = Ogilvie J | title = Adolescent idiopathic scoliosis and genetic testing | journal = Current Opinion in Pediatrics | volume = 22 | issue = 1 | pages = 67–70 | date = February 2010 | pmid = 19949338 | doi = 10.1097/MOP.0b013e32833419ac | s2cid = 1044562 }}</ref>

==Management==
{{Main|Management of scoliosis}}
Our lack of understanding of the etiology and pathogenesis of scoliosis makes it difficult to manage.<ref>{{Cite journal |last1=Schreiber |first1=Sanja |last2=Whibley |first2=Daniel |last3=Somers |first3=Emily C |date=2023-05-27 |title=Schroth Physiotherapeutic Scoliosis-Specific Exercise (PSSE) Trials—Systematic Review of Methods and Recommendations for Future Research |journal=Children |language=en |volume=10 |issue=6 |page=954 |doi=10.3390/children10060954 |doi-access=free |issn=2227-9067 |pmc=10297476 |pmid=37371186}}</ref> Scoliosis curves do not straighten out on their own. Many children have slight curves that do not need treatment. In these cases, the children grow up to lead a normal body posture by itself, even though their small curves never go away. If the patient is still growing and has a larger curve, it is important to monitor the curve for change by periodic examination and standing x-rays as needed. The rise in spinal abnormalities requires examination by a neurosurgeon to determine if active treatment is needed.<ref>{{Cite web|title=Treatment Options {{!}} Scoliosis Research Society|url=https://www.srs.org/patients-and-families/common-questions-and-glossary/frequently-asked-questions/treatment-and-coping|access-date=2022-02-11|website=www.srs.org}}</ref> Although AIS normally does not cause health problems throughout development, the observable changes in appearance can have a substantial impact on teenagers, leading to quality-of-life concerns and, in extreme cases, emotional stress.<ref>{{Cite journal |last1=Romano |first1=Michele |last2=Minozzi |first2=Silvia |last3=Bettany-Saltikov |first3=Josette |last4=Zaina |first4=Fabio |last5=Chockalingam |first5=Nachiappan |last6=Kotwicki |first6=Tomasz |last7=Maier-Hennes |first7=Axel |last8=Arienti |first8=Chiara |last9=Negrini |first9=Stefano |date=2024-02-28 |title=Therapeutic exercises for idiopathic scoliosis in adolescents |journal=The Cochrane Database of Systematic Reviews |volume=2 |issue=2 |article-number=CD007837 |doi=10.1002/14651858.CD007837.pub3 |issn=1469-493X |pmc=10900302 |pmid=38415871}}</ref>

The traditional medical management of scoliosis is complex and is determined by the severity of the curvature and [[Bone age|skeletal maturity]], which together help predict the likelihood of progression.
The conventional options for children and adolescents are:<ref name="NHS-child">{{cite web |url=http://www.nhs.uk/Conditions/Scoliosis/Pages/Treatment.aspx |title=Treating scoliosis in children |publisher=NHS Choices |date=19 February 2013 |access-date=14 May 2014 |url-status=live |archive-url=https://web.archive.org/web/20140514182026/http://www.nhs.uk/Conditions/Scoliosis/Pages/Treatment.aspx |archive-date=14 May 2014}}</ref>

# Observation
# [[Back brace|Bracing]]
# Surgery
# Physical therapy. Evidence suggests use of scoliosis specific exercises might prevent the progression of the curve along with possible bracing and surgery avoidance.<ref name="Effects of corrective, therapeutic">{{cite journal | vauthors = Ceballos Laita L, Tejedor Cubillo C, Mingo Gómez T, Jiménez Del Barrio S | title = Effects of corrective, therapeutic exercise techniques on adolescent idiopathic scoliosis. A systematic review | journal = Archivos Argentinos de Pediatria | volume = 116 | issue = 4 | pages = e582–e589 | date = August 2018 | pmid = 30016036 | doi = 10.5546/aap.2018.eng.e582 | doi-access = free }}</ref>

For adults, treatment usually focuses on relieving any pain:<ref name="NHS-adult">{{cite web |url=http://www.nhs.uk/Conditions/Scoliosis/Pages/treatment-adults.aspx |title=Scoliosis – Treatment in adults |publisher=NHS Choices |date=19 February 2013 |access-date=14 May 2014 |url-status=live |archive-url=https://web.archive.org/web/20140514180521/http://www.nhs.uk/Conditions/Scoliosis/Pages/treatment-adults.aspx |archive-date=14 May 2014}}</ref><ref name="srs-adult-nonoperative">{{cite web |url=http://www.srs.org/patient_and_family/scoliosis/idiopathic/adults/nonoperative_management.htm |title=Idiopathic Scoliosis – Adult Nonoperative Management |publisher=Scoliosis Research Society |access-date=14 May 2014 |archive-url=https://web.archive.org/web/20140701132729/http://www.srs.org/patient_and_family/scoliosis/idiopathic/adults/nonoperative_management.htm |archive-date=1 July 2014}}</ref>

# Pain medication
# Posture checking
# Bracing
# Surgery<ref name=srs-adult-surgical>{{cite web |url=http://www.srs.org/patient_and_family/scoliosis/idiopathic/adults/surgical_treatment.htm |title=Idiopathic Scoliosis – Adult Surgical Treatment |publisher=Scoliosis Research Society |access-date=14 May 2014 |archive-url=https://web.archive.org/web/20140701121525/http://www.srs.org/patient_and_family/scoliosis/idiopathic/adults/surgical_treatment.htm |archive-date=1 July 2014}}</ref>

Treatment for idiopathic scoliosis also depends upon the severity of the curvature, the spine's potential for further growth, and the risk that the curvature will progress. Mild scoliosis (less than 30° deviation) and moderate scoliosis (30–45°) can typically be treated conservatively with bracing in conjunction with scoliosis-specific exercises.<ref name = Neg2018 /> Severe curvatures that rapidly progress may require surgery with spinal rod placement and spinal fusion. In all cases, early intervention offers the best results.{{citation needed|date=October 2020}}

A specific type of [[physical therapy]] may be useful.<ref>{{cite journal | vauthors = Negrini S, Fusco C, Minozzi S, Atanasio S, Zaina F, Romano M | title = Exercises reduce the progression rate of adolescent idiopathic scoliosis: results of a comprehensive systematic review of the literature | journal = Disability and Rehabilitation | volume = 30 | issue = 10 | pages = 772–785 | year = 2008 | pmid = 18432435 | doi = 10.1080/09638280801889568 | s2cid = 13188152 }}</ref><ref name = Neg2018 /> Evidence to support its use, however, is weak.<ref name=NIH2015/><ref name=Thom2018/> Low quality evidence suggests scoliosis-specific exercises (SSE) may be more effective than electrostimulation.<ref>{{cite journal | vauthors = Romano M, Minozzi S, Bettany-Saltikov J, Zaina F, Chockalingam N, Kotwicki T, Maier-Hennes A, Negrini S | display-authors = 6 | title = Exercises for adolescent idiopathic scoliosis | journal = The Cochrane Database of Systematic Reviews | issue = 8 | article-number = CD007837 | date = August 2012 | volume = 2012 | pmid = 22895967 | pmc = 7386883 | doi = 10.1002/14651858.cd007837.pub2 }}</ref>{{Update inline|reason=Updated version https://www.ncbi.nlm.nih.gov/pubmed/38415871|date = May 2024}} Evidence for the Schroth method is insufficient to support its use.<ref>{{cite journal | vauthors = Day JM, Fletcher J, Coghlan M, Ravine T | title = Review of scoliosis-specific exercise methods used to correct adolescent idiopathic scoliosis | journal = Archives of Physiotherapy | volume = 9 | article-number = 8 | date = 2019 | pmid = 31463082 | pmc = 6708126 | doi = 10.1186/s40945-019-0060-9 | doi-access = free }}</ref> Significant improvement in function, vertebral angles and trunk asymmetries have been recorded following the implementation of Schroth method in terms of conservative management of scoliosis. Some other forms of exercise interventions have been lately{{When|date=July 2023}} used in clinical practice for the therapeutic management of scoliosis, such as global postural reeducation and the Klapp method.<ref name="Effects of corrective, therapeutic"/>

===Bracing===
[[File:Scoliosis patient in cheneau brace correcting from 56 to 27 deg.png|thumb|upright=1.5|A Chêneau brace achieving correction from 56° to 27° Cobb angle]]
Bracing is normally done when the person has bone growth remaining and is, in general, implemented to hold the curve and prevent it from progressing to the point where surgery is recommended. In some cases with juveniles, bracing has reduced curves significantly, going from a 40° (of the curve, mentioned in length above) out of the brace to 18°. Braces are sometimes prescribed for adults to relieve pain related to scoliosis. Bracing involves fitting the person with a device that covers the torso; in some cases, it extends to the neck (example being the Milwaukee Brace).<ref name="Brace2">{{citation|title= The influence of elastic orthotic belt on sagittal profile in adolescent idiopathic thoracic scoliosis: A comparative radiographic study with Milwaukee brace. |date=September 2010 |url= https://www.researchgate.net/figure/The-same-patient-wearing-Milwaukee-brace-The-neck-ring-cause-a-stimulant-effect-on-the_fig2_46412715 |publisher=Research Gate}}</ref>

[[File:Milwaukee brace - with neck ring and mandible pad.jpg|thumb|Female adolescent (14 years old) patient wearing a Milwaukee brace – with neck ring and mandible (chin) pad showing]]

The most commonly used brace is a [[TLSO]], such as a [[Boston brace]], a [[corset]]-like appliance that fits from armpits to hips and is custom-made from fiberglass or plastic. It is typically recommended to be worn 22–23 hours a day, and it applies pressure on the curves in the spine. The effectiveness of the brace depends not only on brace design and [[orthotist]] skill, but also on people's compliance and the amount of wear per day. An alternative form of brace is a nighttime-only brace, which is worn only at night whilst the child sleeps, and which overcorrects the deformity.<ref>{{cite journal | vauthors = Antoine L, Nathan D, Laure M, Briac C, Jean-François M, Corinne B | title = Compliance with night-time overcorrection bracing in adolescent idiopathic scoliosis: Result from a cohort follow-up | journal = Medical Engineering & Physics | volume = 77 | pages = 137–141 | date = March 2020 | pmid = 31992499 | doi = 10.1016/j.medengphy.2020.01.003 | s2cid = 210945485 | doi-access = free }}</ref> Whilst nighttime braces are more convenient for children and families, it is unknown if the effectiveness of the brace is as good as conventional braces. The UK government has funded a large clinical trial (called the BASIS study) to resolve this uncertainty.<ref>{{cite web | url = https://basisstudy.org | title = BASIS study }}</ref> The BASIS study is ongoing throughout the UK in all of the leading UK children's hospitals that treat scoliosis, with families encouraged to take part.

Indications for bracing: People who are still growing and who present with Cobb angles less than 20° should be closely monitored. People who are still growing and present with Cobb angles of 20 to 29° should be braced according to the risk of progression by considering age, Cobb angle increase over a six-month period, Risser sign, and clinical presentation. People who are still growing and present with Cobb angles greater than 30° should be braced. However, these are guidelines, and not every person will fit into this table.

For example, a person who is still growing with a 17° Cobb angle and significant thoracic rotation or [[Harrington rod#Flatback syndrome|flatback]] could be considered for nighttime bracing. On the opposite end of the growth spectrum, a 29° Cobb angle and a Risser sign three or four might not need to be braced because the potential for progression is reduced.<ref>{{cite book | vauthors = Wood G | date = 2013 | title = Academy Today (The Edge) | publisher = American Academy of Orthosits and Prosthetist. | chapter = To Brace or Not to Brace: The Three-Dimensional Nature and Growth Considerations for Adolescent Idiopathic Scoliosis | pages = 5–8 }}</ref> The Scoliosis Research Society's recommendations for bracing include curves progressing to larger than 25°, curves presenting between 30 and 45°, [[Risser sign]] 0, 1, or 2 (an X-ray measurement of a pelvic growth area), and less than six months from the onset of menses in girls.<ref name="Herring JA 2002"/>

Evidence supports that bracing prevents worsening of disease, but whether it changes quality of life, appearance, or back pain is unclear.<ref>{{cite journal | vauthors = Negrini S, Minozzi S, Bettany-Saltikov J, Chockalingam N, Grivas TB, Kotwicki T, Maruyama T, Romano M, Zaina F | display-authors = 6 | title = Braces for idiopathic scoliosis in adolescents | journal = The Cochrane Database of Systematic Reviews | issue = 6 | article-number = CD006850 | date = June 2015 | volume = 2015 | pmid = 26086959 | doi = 10.1002/14651858.CD006850.pub3 | pmc = 10616811 | hdl-access = free | hdl = 2434/721317 }}</ref>

===Surgery===
{{multiple image
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| footer = Preoperative (left) and postoperative (right) [[X-ray]] of a person with [[thoracic vertebrae|thoracic]] dextroscoliosis and [[lumbar vertebrae|lumbar]] levoscoliosis: The X-ray is usually projected anteroposterior, such that the right side of the subject is on the right side of the image; i.e., the subject is viewed from the rear (see left image; the right image is seen from the front). This projection is typically used by spine surgeons, as it is how [[orthopedic surgeon|surgeon]]s see their patients when they are on the operating table (in the prone position). This is the opposite of many [[Chest radiograph]]s, where the image is posteroanterior, i.e., projected as if looking at the patient from the front. The surgery was a fusion with instrumentation.{{citation needed|date=October 2020}}
}}
Surgery is usually recommended by orthopedists for curves with a high likelihood of progression (i.e., greater than 45–50° of magnitude), curves that would be cosmetically unacceptable as an adult, curves in people with [[spina bifida]] and [[cerebral palsy]] that interfere with sitting and care, and curves that affect physiological functions such as breathing.<ref>{{cite web | vauthors = Alli RA | date = 19 December 2020 |title=Scoliosis Treatment |url=https://www.webmd.com/back-pain/treatment-for-scoliosis#1 |website=WebMD |access-date=11 February 2020}}</ref><ref name=":0">{{Cite journal |last1=Guay |first1=Joanne |last2=Suresh |first2=Santhanam |last3=Kopp |first3=Sandra |last4=Johnson |first4=Rebecca L. |date=2019-01-16 |title=Postoperative epidural analgesia versus systemic analgesia for thoraco-lumbar spine surgery in children |url= |journal=The Cochrane Database of Systematic Reviews |volume=1 |issue=1 |article-number=CD012819 |doi=10.1002/14651858.CD012819.pub2 |issn=1469-493X |pmc=6360928 |pmid=30650189}}</ref>

Surgery is indicated by the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) at 45–50°<ref name = Neg2018 /> and by the Scoliosis Research Society (SRS) at a Cobb angle of 45°.<ref name=":1">{{cite web |title=Adolescent Idiopathic Scoliosis |publisher=Scoliosis Research Society (SRS) |url=http://www.srs.org/patient_and_family/scoliosis/idiopathic/ |access-date=2 January 2014 |archive-url=https://web.archive.org/web/20140116090156/http://www.srs.org/patient_and_family/scoliosis/idiopathic/ |archive-date=16 January 2014}} adolescents/surgical_treatment.htm. Accessed 27 January 2013</ref> SOSORT uses the 45–50° threshold as a result of the well-documented, plus or minus 5° measurement error that can occur while measuring Cobb angles.<ref name=":1" />

[[Surgeon]]s who specialize in spine surgery perform surgery for scoliosis. To completely straighten a scoliotic spine is usually impossible, but for the most part, significant corrections are achieved.<ref>{{cite book | vauthors = Gibson I, Jagdish BN, Zhan G, Hajizedah K, Tho HK, Mengjie H, Dissanayake C | chapter = Development of a human spine simulation system. |chapter-url=https://books.google.com/books?id=ylLNBQAAQBAJ&pg=PA27 |title=Advances in Therapeutic Engineering| veditors = Yu W, Chattopadhyay S, Lim TC, Acharya UR |date = January 2012 |publisher=CRC Press|isbn=978-1-4398-7174-4 |language=en | page = 27 }}</ref>

The two main types of surgery are:<ref>{{Cite journal |last1=Lin |first1=Yang |last2=Chen |first2=Wenjian |last3=Chen |first3=Anmin |last4=Li |first4=Feng |last5=Xiong |first5=Wei |date=March 2018 |title=Anterior versus Posterior Selective Fusion in Treating Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis of Radiologic Parameters |journal=World Neurosurgery |volume=111 |pages=e830–e844 |doi=10.1016/j.wneu.2017.12.161 |issn=1878-8769 |pmid=29309975}}</ref>
* Anterior fusion: This surgical approach is through an incision at the side of the chest wall.
* Posterior fusion: This surgical approach is through an incision on the back and uses metal instrumentation to correct the curve.

One or both of these surgical procedures may be needed. The surgery may be done in one or two stages and, on average, takes four to eight hours.

A new tethering procedure ([[anterior vertebral body tethering]]) may be appropriate for some patients.<ref>{{cite journal |last1= Andreacchio |first1= Antonio |last2= Caretti |first2= Valentina |last3= Colombo |first3= Luca |date= 2022 |title= Anterior vertebral body tethering as a treatment for scoliosis in skeletally immature patients |journal= La Pediatria Medica e Chirurgica |volume= 44 |issue= 1 |page= 291|doi= 10.4081/pmc.2022.291 |pmid= 37184319 |s2cid= 253212051 |doi-access= free }}</ref>

Spine surgery can be painful and may also be associated with post-surgical pain.<ref name=":0" /> Different approaches for pain management are used in surgery, including epidural administration and systemic [[analgesia]] (also known as general analgesia).<ref name=":0" /> Epidural analgesia medication are often used surgically including combinations of local anesthetics and pain medications injected via an epidural injection.<ref name=":0" /> Evidence comparing different approaches for analgesia, side effects or benefits, and which approach results in greater pain relief and for how long after this type of surgery is of low to moderate quality.<ref name=":0" />

== Prognosis ==
A 50-year follow-up study published in the ''[[Journal of the American Medical Association]]'' (2003) asserted that the lifelong physical health, including cardiopulmonary and neurological functions, and mental health of people with idiopathic scoliosis are comparable to those of the general population. Scoliosis that interferes with normal systemic functions is "exceptional"<ref>{{cite journal | vauthors = Hawes MC | title = Health and Function of Patients With Untreated Idiopathic Scoliosis—Reply. | journal = JAMA | date = May 2003 | volume = 289 | issue = 20 | pages = 2644; author reply 2644–5 | doi = 10.1001/jama.289.20.2644-a | pmid = 12771105 }}</ref> and "rare", and "untreated [scoliosis] people had similar death rates and were just as functional and likely to lead productive lives 50 years after diagnosis as people with normal spines."<ref name="jama.ama-assn.org">{{cite journal | vauthors = Weinstein SL, Dolan LA, Spratt KF, Peterson KK, Spoonamore MJ, Ponseti IV | title = Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study | journal = JAMA | volume = 289 | issue = 5 | pages = 559–567 | date = February 2003 | pmid = 12578488 | doi = 10.1001/jama.289.5.559 | doi-access = free }}</ref><ref>{{cite web | url = http://www.stopgettingsick.com/templates/news_template.cfm/6427 | title = Many With Scoliosis Can Skip Treatments | archive-url = https://web.archive.org/web/20080820025107/http://www.stopgettingsick.com/templates/news_template.cfm/6427 | archive-date = 20 August 2008 | work = stopgettingsick.com }}</ref> In an earlier University of Iowa follow-up study, 91% of people with idiopathic scoliosis displayed normal pulmonary function, and their life expectancy was found to be 2% more than that of the general population.<ref name="jbjs.org">{{cite journal | vauthors = Weinstein SL, Zavala DC, Ponseti IV | title = Idiopathic scoliosis: long-term follow-up and prognosis in untreated patients | journal = The Journal of Bone and Joint Surgery. American Volume | volume = 63 | issue = 5 | pages = 702–712 | date = June 1981 | pmid = 6453874 | doi = 10.2106/00004623-198163050-00003 | s2cid = 22429772 }}</ref> Later (2006–) studies corroborate these findings, adding that they are "reassuring for the adult patient who has adolescent onset idiopathic scoliosis in approximately the 50–70° range."<ref>{{cite journal | vauthors = Asher MA, Burton DC | title = Adolescent idiopathic scoliosis: natural history and long term treatment effects | journal = Scoliosis | volume = 1 | issue = 1 | article-number = 2 | date = March 2006 | pmid = 16759428 | pmc = 1475645 | doi = 10.1186/1748-7161-1-2 | s2cid = 14194273 | doi-access = free }}</ref> These modern landmark studies supersede earlier studies (e.g. Mankin-Graham-Schauk 1964) that did implicate moderate idiopathic scoliosis in impaired pulmonary function.{{citation needed|date=July 2022}}

Generally, the prognosis of scoliosis depends on the likelihood of progression. The general rules of progression are larger curves carry a higher risk of progression than smaller curves, and thoracic and double primary curves carry a higher risk of progression than single lumbar or thoracolumbar curves. In addition, people not having yet reached skeletal maturity have a higher likelihood of progression (i.e., if the person has not yet completed the adolescent growth spurt).<ref>{{cite web|url=http://www.srs.org/patients-and-families/conditions-and-treatments/parents/scoliosis/adolescent-idiopathic-scoliosis|title=Adolescent Idiopathic Scoliosis {{!}} Scoliosis Research Society|website=www.srs.org|access-date=28 February 2018}}</ref>

==Epidemiology==
Scoliosis affects 2–3% of the United States population, or about five to nine million cases.<ref name = Neg2018 /> A scoliosis (spinal column curve) of 10° or less affects 1.5–3% of individuals.<ref name="Herring JA 2002">{{cite book| vauthors = Herring JA |title=Tachdjian's Pediatric Orthopaedics | url = https://archive.org/details/tachdjianspediat0002unse | url-access = registration |publisher=W.B. Saunders |location=Philadelphia, PA |isbn=978-0-7216-5684-7|year=2002}}{{Page needed|date=September 2010}}</ref> The [[age of onset]] is usually between 10 years and 15 years (but can occur younger) in children and adolescents, making up to 85% of those diagnosed. This is due to rapid growth spurts during [[puberty]] when spinal development is most susceptible to genetic and environmental influences.<ref>{{cite journal | vauthors = Edery P, Margaritte-Jeannin P, Biot B, Labalme A, Bernard JC, Chastang J, Kassai B, Plais MH, Moldovan F, Clerget-Darpoux F | display-authors = 6 | title = New disease gene location and high genetic heterogeneity in idiopathic scoliosis | journal = European Journal of Human Genetics | volume = 19 | issue = 8 | pages = 865–869 | date = August 2011 | pmid = 21407261 | pmc = 3172921 | doi = 10.1038/ejhg.2011.31 }}</ref> Because female adolescents undergo growth spurts before postural [[musculoskeletal]] maturity, scoliosis is more prevalent among females.<ref name="Burwell_2003">{{cite journal | vauthors = Burwell RG | title = Aetiology of idiopathic scoliosis: current concepts | journal = Pediatric Rehabilitation | volume = 6 | issue = 3–4 | pages = 137–70 | date = 2003 | pmid = 14713582 | doi = 10.1080/13638490310001642757 | s2cid = 12154979 }}</ref>

Although fewer cases are present since using [[Cobb angle]] analysis for diagnosis, scoliosis remains significant, appearing in otherwise healthy children. Even though scoliosis is a disfigurement of the spine, it has been shown to influence the pulmonary function, [[Balance (ability)|balance]] while standing and stride execution in children. The impact of carrying backpacks on these three side effects has been broadly researched.<ref>{{cite book | veditors = Bessette A, Rousseau CM |title=Scoliosis: Causes, Symptoms and Treatment |date= October 2012 |publisher=Nova Science Publishers |url=https://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3020988 |isbn=978-1-62081-007-1 }}</ref> Incidence of idiopathic scoliosis (IS) stops after puberty when skeletal maturity is attained, however further curvature may occur during late adulthood due to vertebral [[osteoporosis]] and weakened musculature.<ref name=Neg2018/>

==History==
[[File:Diseases of infancy and childhood (1914) (14772101745).jpg|thumb|Female patient with lateral curvature of the spine; photo from 1914]]
[[File:The King In The Car Park - Page 15 - Figure 12.png|thumb|The [[Exhumation and reburial of Richard III of England|remains of King Richard III]] of England discovered in 2012 revealed that [[King Richard III of England|the king]] had severe scoliosis, which appears to have been idiopathic (rather than congenital or neuromuscular) and of adolescent onset.<ref>{{cite journal |vauthors=Appleby J, Mitchell PD, Robinson C, et al. |title=The scoliosis of Richard III, last Plantagenet King of England: diagnosis and clinical significance |journal=Lancet |volume=383 |issue=9932 |page=1944 |date=2014 |pmid=24881996 |doi=10.1016/S0140-6736(14)60762-5 |url=http://www.richardiii.ca/wp-content/uploads/2017/10/The-Lancet-Richard-III-Scoliosis-053114.pdf}}</ref>]]

Ever since the condition was discovered by the [[Greeks|Greek]] [[physician]] [[Hippocrates]], a cure has been sought. Treatments such as [[Back brace|bracing]] and the insertion of rods into the spine were employed during the 1900s. In the mid-20th century, new treatments and improved screening methods were developed to reduce the progression of scoliosis in patients and alleviate their associated pain. School children were during this period believed to develop poor posture as a result of working at their desks, and many were diagnosed with scoliosis. It was also considered to be caused by [[tuberculosis]] or [[poliomyelitis]], diseases that were successfully managed using vaccines and antibiotics.{{Citation needed|date=March 2020}}

The American [[Orthopedic surgery|orthopaedic surgeon]] Alfred Shands Jr. discovered that two percent of patients had non-disease related scoliosis, later termed ''idiopathic scoliosis'', or the "cancer of orthopaedic surgery". These patients were treated with questionable remedies.<ref>{{cite journal | vauthors = Linker B | title = A dangerous curve: the role of history in America's scoliosis screening programs | journal = American Journal of Public Health | volume = 102 | issue = 4 | pages = 606–616 | date = April 2012 | pmid = 22397340 | pmc = 3489358 | doi = 10.2105/AJPH.2011.300531 }}</ref> A theory at the time—now discredited—was that the condition needed to be detected early to halt its progression, and so some schools made screening for scoliosis mandatory. Measurements of shoulder height, leg length, and spinal curvature were made, and the ability to bend forwards, along with body posture, was tested, but students were sometimes misdiagnosed because of their poor posture.{{Citation needed|date=March 2020}}

An early treatment was the [[Milwaukee brace]], a rigid contraption of metal rods attached to a plastic or leather girdle, designed to straighten the spine. Because of the constant pressure applied to the spine, the brace was uncomfortable. It caused jaw and muscle pain, skin irritation, as well as low self-esteem.{{Citation needed|date=March 2020}}

===Surgery===
In 1962, the American orthopaedic surgeon [[Paul Randall Harrington|Paul Harrington]] introduced a metal spinal system of instrumentation that assisted with straightening the spine, as well as holding it rigid while [[Spinal fusion|fusion]] took place. The now obsolete [[Harrington rod]] operated on a [[Ratchet (device)|ratchet system]], attached by hooks to the spine at the top and bottom of the curvature that, when cranked, would distract—or straighten—the curve. The Harrington rod obviates the need for prolonged casting, allowing patients greater mobility in the postoperative period and significantly reducing the quality of life burden of fusion surgery. The Harrington rod was the precursor to most modern spinal instrumentation systems. A major shortcoming was that it failed to produce a posture wherein the skull would be in proper alignment with the pelvis, and it did not address rotational deformity. As the person aged, there would be increased wear and tear, early onset [[arthritis]], disc degeneration, muscular stiffness, and acute pain. "Flatback" became the medical name for a related complication, especially for those who had [[lumbar]] scoliosis.<ref name="news-medical1">{{cite web | url = http://www.news-medical.net/health/Scoliosis-Surgery.aspx | title = Scoliosis Surgery | work = News-medical.net | date = 22 November 2009 | access-date = 16 January 2011 }}</ref>

In the 1960s, the gold standard for idiopathic scoliosis was a posterior approach using a single Harrington rod. Post-operative recovery involved bed rest, casts, and braces. Poor results became apparent over time.<ref name="Bridwell_2014">{{cite web |url=http://www.spineuniverse.com/conditions/scoliosis/idiopathic-scoliosis-options-fixation-fusion-thoracic-curves |title=Idiopathic Scoliosis: Options of Fixation and Fusion of Thoracic Curves | vauthors = Bridwell K |publisher=SpineUniverse |date=8 February 2013 |access-date=21 May 2014}}</ref>{{cn|date=November 2025|reason=obsolete ref}}

In the 1970s, an improved technique was developed using two rods and wires attached at each level of the spine. This segmented instrumentation system allowed patients to become mobile soon after surgery.<ref name="Bridwell_2014"/>{{cn|date=November 2025|reason=obsolete ref}}

In the 1980s, [[Cotrel–Dubousset instrumentation]] improved fixation and addressed [[sagittal]] imbalance and rotational defects unresolved by the Harrington rod system. This technique uses multiple hooks with rods to give stronger fixation in three dimensions, usually eliminating the need for postoperative bracing.<ref name="Bridwell_2014"/>{{cn|date=November 2025|reason=obsolete ref}}

===Evolution===
[[File:Abnormal bone growth.jpg|thumb|upright|A 14–15th-century woman who had severe scoliosis, and died at about 35 years, Limburgs Museum, [[Venlo]]]]

There are links between human spinal morphology, bipedality, and scoliosis, which suggest an evolutionary basis for the condition. Scoliosis has not been found in [[chimpanzee]]s or [[gorilla]]s.<ref name="Lovejoy OC 2005">{{cite journal | vauthors = Lovejoy CO | title = The natural history of human gait and posture. Part 1. Spine and pelvis | journal = Gait & Posture | volume = 21 | issue = 1 | pages = 95–112 | date = January 2005 | pmid = 15536039 | doi = 10.1016/s0966-6362(04)00014-1 }}</ref> Thus, it has been hypothesized that scoliosis may actually be related to humans' morphological differences from these apes.<ref name="Lovejoy OC 2005"/> Other apes have a shorter and less mobile lower spine than humans. Some of the [[lumbar vertebrae]] in ''[[Pan (genus)|Pan]]'' are "captured", meaning that they are held fast between the [[Ilium (bone)|ilium]] bones of the pelvis. Compared to humans, [[Old World monkey]]s have far larger [[erector spinae muscles]], which are the muscles that hold the spine steady.<ref name="Lovejoy OC 2005"/> These factors make the lumbar spine of most primates less flexible and far less likely to deviate than those of humans. While this may explicitly relate only to lumbar scolioses, small imbalances in the lumbar spine could precipitate thoracic problems as well.<ref name="Lovejoy OC 2005"/>

Scoliosis may be a byproduct of strong selection for [[bipedalism]]. For a bipedal stance, a highly mobile, elongated lower spine is very beneficial.<ref name="Lovejoy OC 2005"/> For instance, the human spine takes on an S-shaped curve with [[lumbar lordosis]], which allows for better balance and support of an upright trunk.<ref>{{cite book| vauthors = Harcourt-Smith WE |title=Handbook of Paleoanthropology|year=2007|publisher=Springer Berlin Heidelberg|chapter=Chapter 5|pages=1483–1518}}</ref> Selection for bipedality was likely strong enough to justify the maintenance of such a disorder. Bipedality is hypothesized to have emerged for a variety of different reasons, many of which would have certainly conferred fitness advantages. It may increase viewing distance, which can be beneficial in hunting and foraging as well as protection from predators or other humans; it makes long-distance travel more efficient for foraging or hunting; and it facilitates terrestrial feeding from grasses, trees, and bushes.<ref>{{cite journal| vauthors = Hunt KD |title=The evolution of human bipedality: ecology and functional morphology|journal=Journal of Human Evolution|date=March 1994|volume=26|issue=3|pages=182–202|doi=10.1006/jhev.1994.1011|bibcode=1994JHumE..26..183H }}</ref> Given the many benefits of bipedality which depends on a particularly formed spine, it is likely that selection for bipedalism played a large role in the development of the spine as we see it today, in spite of the potential for "scoliotic deviations".<ref name="Lovejoy OC 2005"/> According to the fossil record, scoliosis may have been more prevalent among earlier hominids such as ''[[Australopithecus]]'' and ''[[Homo erectus]]'', when bipedality was first emerging. Their fossils indicate that there may have been selected over time for a slight reduction in lumbar length to what we see today, favoring a spine that could efficiently support bipedality with a lower risk of scoliosis.<ref name="Lovejoy OC 2005"/>

==Society and culture==
The cost of scoliosis involves both monetary loss and lifestyle limitations that increase with severity. Respiratory deficiencies may arise from thoracic deformities and cause abnormal breathing.<ref>{{cite journal | vauthors = Larson N | title = Early onset scoliosis: what the primary care provider needs to know and implications for practice | journal = Journal of the American Academy of Nurse Practitioners | volume = 23 | issue = 8 | pages = 392–403 | date = August 2011 | pmid = 21790832 | doi = 10.1111/j.1745-7599.2011.00634.x | s2cid = 25902637 | doi-access = free }}</ref> This directly affects capacity for exercise and work, decreasing the overall quality of life.<ref name=Neg2018/>

In the [[Health care in the United States|United States]], the average hospital cost for cases involving surgical procedures was $30,000 to $60,000 per person in 2010.<ref name="Kamerlink_2010">{{cite journal | vauthors = Kamerlink JR, Quirno M, Auerbach JD, Milby AH, Windsor L, Dean L, Dryer JW, Errico TJ, Lonner BS | display-authors = 6 | title = Hospital cost analysis of adolescent idiopathic scoliosis correction surgery in 125 consecutive cases | journal = The Journal of Bone and Joint Surgery. American Volume | volume = 92 | issue = 5 | pages = 1097–1104 | date = May 2010 | pmid = 20439654 | doi = 10.2106/JBJS.I.00879 }}</ref> As of 2006, the cost of bracing was up to $5,000 during rapid growth periods, when [[Orthotics#Spinal orthoses|braces]] must be consistently replaced across multiple follow-ups.<ref name=Neg2018/>

The month of June is recognized as [[Scoliosis Awareness Month]] to highlight and spread awareness of scoliosis. It emphasizes its wide impact and the need for early detection.<ref>{{Cite web |title=Scoliosis Awareness Month {{!}} Scoliosis Research Society |url=https://www.srs.org/patients-and-families/additional-scoliosis-resources/scoliosis-awareness-month |access-date=2023-06-15 |website=www.srs.org}}</ref>

==Research==
[[Genetic testing]] for adolescent [[idiopathic]] scoliosis, which became available in 2009 and is still under investigation, attempts to gauge the likelihood of curve progression.<ref name="stenning-nelson-2011">{{cite web |url=http://www.boneandjoint.org.uk/content/recent-advances-treatment-scoliosis-children |title=Recent advances in the treatment of scoliosis in children | vauthors = Stenning M, Nelson I |publisher=British Editorial Society of Bone and Joint Surgery |year=2011 |access-date=1 January 2014 |archive-url=https://web.archive.org/web/20140102191538/http://www.boneandjoint.org.uk/content/recent-advances-treatment-scoliosis-children |archive-date=2 January 2014 |url-status=live}}</ref>{{update inline|date=December 2022}}

== See also ==
{{col div|colwidth=30em}}
* [[Back brace]]
* [[Kyphosis]]
* [[Lordosis]]
* [[Neuromechanics of idiopathic scoliosis]]
* [[Pott disease]]
* [[Scheuermann's disease]]
* [[Schooliosis]]
* [[Scoliosis Research Society]]
{{colend}}

== References ==
{{Reflist}}

== External links ==
{{Commons category}}
* [https://www.cincinnatichildrens.org/health/e/early-onset-scoliosis Early Onset Scoliosis] is the abnormal, side-to-side curve of the spine in children under five years old, often including children with congenital scoliosis (present at birth, with spine abnormalities) and infantile scoliosis (birth to three years).
* [https://www.niams.nih.gov/health-topics/scoliosis Questions and Answers about Scoliosis in Children and Adolescents] – US National Institute of Arthritis and Musculoskeletal and Skin Diseases

{{Medical condition classification and resources
|  ICD9           = {{ICD9|737}}
|  ICD10          = {{ICD10|M|41||m|41}}
|  OMIM           =
|  DiseasesDB     = 26545
|  MedlinePlus    = 001241
|  eMedicineSubj  =
|  eMedicineTopic =
|  MeshID         =
}}
{{Dorsopathies}}
{{Congenital malformations and deformations of musculoskeletal system}}
{{Authority control}}

[[Category:Bones of the vertebral column]]
[[Category:Congenital disorders of musculoskeletal system]]
[[Category:Deforming dorsopathies]]
[[Category:Wikipedia medicine articles ready to translate]]