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The spine is a marvel of engineering, a delicate mechanism of 33 disk-like bones, the vertebrae, as well as ribs, muscles, tendons, and connective tissue, joined together like the parts of suspension bridge keeping us upright and balanced. Sometimes, however, the overall structure of the spine starts to alter and curve, usually right at the onset of puberty, a condition called scoliosis. We don’t understand what precisely causes the condition, but nearly all cases of scoliosis can be successfully managed with an arsenal of medical treatments including braces, exercise, and surgery.
What is scoliosis?
Scoliosis is a side-to-side curve in the spine. If you look at the spine from the back, it forms a straight vertical line. A scoliotic spine forms a “C” or “S” curve vertically and also rotates left or right.
The American Association of Neurological Surgeons (AANS) estimates that scoliosis affects about six to nine million Americans, about 1% to 3% of the population. The condition usually starts in adolescence, but most cases are minor and don’t require medical intervention. Severe scoliosis is very rare, affecting about 0.1% of the American population.
The types of scoliosis are categorized according to the underlying cause:
- Adolescent idiopathic scoliosis, the most common type, has no cause. It begins around a child’s initial growth spurt at puberty and may or may not get more pronounced in the years following.
- Neuromuscular scoliosis is caused by neuromuscular conditions such as cerebral palsy, Duchenne muscular dystrophy, polio, and paralysis. In some neuromuscular conditions, such as paralysis, scoliosis is present 100% of the time.
- Congenital scoliosis is a curve in the spine due to a birth defect, such as spina bifida.
- Syndrome-related scoliosis is due to particular syndromes such as Marfan syndrome (a condition that affects connective tissue such as cartilage) or neurofibromatosis (noncancerous tumors of the nerves or spinal cord).
- Other causes may also produce scoliosis curvature. Degenerative scoliosis, a common adult-onset scoliosis, is caused by degeneration of the cartilage discs that separate and cushion the vertebrae. However, many cases of adult scoliosis are thought to be due to undiagnosed adolescent idiopathic scoliosis.
Treatment will depend on the amount of spine curvature and any underlying conditions. For idiopathic scoliosis, the fundamental pillars of scoliosis treatment are observation, bracing, physical therapy, and surgery, depending on the severity of the curve.
The danger with scoliosis, particularly idiopathic scoliosis, is that it may progress. The goal of treatment will be to halt that progress. If scoliosis becomes severe, the curve in the spine will progressively worsen by about 1 degree per year. Complications from severe scoliosis include back pain, sciatica, nerve damage, spondylosis (arthritis of the spine), osteoporosis, and breathing problems. The most extreme cases of scoliosis can reduce life expectancy.
For this reason, children are regularly screened for scoliosis to spot the condition at the earliest possible stage. Screening typically starts at the age of 10. Follow-up screening takes place every year or every two years until the age of 14 or 16.
How is scoliosis diagnosed?
Scoliosis is typically not diagnosed on a patient’s or parent’s initiative. Instead, children are screened by their pediatrician for scoliosis near the beginning of puberty, starting at the age of 10. Neuromuscular scoliosis, adult scoliosis, and syndrome scoliosis are typically diagnosed by the specialist treating the underlying condition.
Nonetheless, some patients are more likely to get scoliosis than others. Risk factors for adolescent idiopathic scoliosis include being female, athletic, or having another family member with the condition. Degenerative disc disease and osteoporosis are risk factors for adult scoliosis. Other types of scoliosis are caused by neuromuscular conditions or well-known syndromes.
Screening for scoliosis starts with a visual examination of the back to see if the shoulders, shoulder blades, and hips are symmetrical. The most common screen is the forward bend test (or the Adam’s test). The shirt is removed so that the spine can be easily seen. The patient puts the feet together and bends forward until the spine is parallel to the floor and the arms are hanging straight down. Curves in the spine, such as lordosis (excessive inward curve), kyphosis (hunching), or scoliosis can be observed by looking across the horizontal plane of the back.
If scoliosis or any other spinal abnormality is observed, an orthopedist will order an X-ray. Scoliosis is largely diagnosed by imaging, which not only confirms the doctor’s physical observations but also gives an accurate picture of the shape of the spinal curvature.
The curvature of the spine is measured from the X-ray using the Cobb angle. It is important to understand that the Cobb angle is not any single angle of the spinal curvature. Instead, the Cobb angle is a geometrical calculation that quantifies all the angles involved in the geometry of the “S” or “C” spinal curve in a scoliosis patient. The smaller the angle, the smaller the spinal curvature. More severe curves will calculate to larger Cobb angles.
A Cobb angle of 10˚ is the only requirement for a diagnosis of scoliosis. The cause, however, is a different matter.
To answer this question, the physician will take a detailed history and perform a physical examination to rule out other causes for the spine curvature. A neurologic assessment will be performed and the physician will evaluate the curve’s shape and the flexibility of the spine.
The curvature of the spine will determine the next steps. If the Cobb angle is greater than 10˚ for young children or greater than 20˚ for adolescents, which is rare, the patient will be referred to a specialist.
Scoliosis treatment options
Scoliosis treatment options are monitoring, bracing, physical therapy, and surgery. The scoliosis treatment used depends on the type of scoliosis, the extent of the spinal curve, and the risk of curve progression. For adolescent idiopathic scoliosis, the risk factors for progression are early onset, the Cobb angle, and the number of growth years left. The goal of all treatment options is to keep spinal curvature below 50˚—after that point, the only way to stop curve progression is surgery.
Observation
Mild scoliosis, defined by a Cobb angle of 10˚ to 25˚, does not progress in over 80% of cases. So patients with mild scoliosis will be observed in follow-up visits and given serial X-rays to monitor the progress of the curve.
Scoliosis braces
Adolescents with a curve between 25˚ and 45˚and pre-adolescents with a curve greater than 10˚ are candidates for a bracing (orthotics). A back brace does not correct scoliosis, but instead helps slow or halt the progression. Scoliosis braces are specialty TLSO (thoracolumbosacral orthosis) spine braces; TLSO braces are familiar to people with lower back pain. The most common scoliosis brace is the Boston brace, but other more specialized braces, including the Charleston brace or the SpineCor brace, may be preferred based on the nature of the condition. A scoliosis brace will be custom-designed for the patient’s body and the nature of the curve. While braces are a standard treatment option, there is some disagreement about their effectiveness, particularly since patient compliance is low.
Physical therapy
Even for mild scoliosis, physical therapy and exercise are often used to supplement treatment in patients with curves less than 50˚. Specific exercises, called physiotherapy scoliosis-specific exercise (PSSE), are used to correct posture, strengthen muscles, improve breathing, and stabilize and straighten the spine. The effectiveness of physical therapy is controversial but has been shown to improve outcomes when combined with bracing.
Scoliosis surgery
Spinal fusion surgery is used to correct spinal curves greater than 45˚ in adolescents or 50˚ in adults. To correct the curve, spine surgeons (either neurosurgeons or orthopedic surgeons) will join, or “fuse,” some of the vertebrae together using bone grafts from the hip or other part of the body. The fused vertebrae will be supported temporarily with mechanical devices, such as rods, screws, or hooks. Spinal fusion will partly straighten the spine, but with some loss of movement depending on the location of the fusion. Complications of spinal surgery include nerve injury, breathing problems, heart complications, and infection.
While there are many different spinal fusion procedures and devices, research has shown that the success of scoliosis surgery almost solely depends on the skill and experience of the surgeon.
Psychosocial support
The psychological and social impact of scoliosis can be serious, particularly for adolescents, and these impacts are often overlooked. Behavior problems, depression, low self-esteem, and social isolation are common, so scoliosis patients require both family and psychosocial support.
Scoliosis medications
Scoliosis is not treated by medications. It is largely a mechanical problem treated with braces, exercise, and, in extreme cases, surgery. Nine out of ten scoliosis patients will simply be observed to monitor curve progress.
Analgesics
Back pain does not seem to be more prevalent in scoliosis patients than the population as a whole except in more severe cases. Patients with degenerative scoliosis, however, may experience more pain than other people because of the underlying disc degeneration rather than the scoliosis curve. This pain will typically be managed with over-the-counter pain relievers such as acetaminophen or NSAIDs (aspirin or ibuprofen). Pain due to more advanced disc degeneration or a severe curve will involve prescription NSAIDs or opiates in the most extreme cases.
Other medications
Neuromuscular scoliosis or syndrome-related scoliosis are secondary effects of other conditions such as cerebral palsy, myelodysplasia, Duchenne muscular dystrophy, or neurofibromatosis. These conditions will be treated with condition-specific medications, but these drugs will not affect scoliosis (which will be treated with braces or surgery).
What is the best medication for scoliosis?
Scoliosis is not treated with medications. However, patients with degenerative scoliosis or a severe curve will experience pain which may be debilitating, Over-the-counter pain relievers such as acetaminophen or ibuprofen, prescription NSAIDs, and, in rare cases, opioids may be prescribed to relieve the back pain.
| Best medications for scoliosis | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Tylenol (acetaminophen) | Analgesic | Oral | 2, 325 mg tablets every 4-6 hours | Nausea, stomach pain, loss of appetite |
| Motrin (ibuprofen) | NSAID | Oral | 2 tablets every 4 hours | Stomach pain, upset stomach, nausea |
| Diclofenac | Prescription NSAID | Oral | 2-3, 50 mg tablets divided into 2 doses daily | Abdominal pain, constipation, diarrhea |
| Ultram (tramadol) | Opioid | Oral | 1, 50 mg tablet twice per day | Dizziness, nausea, constipation, risk of addiction |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA). Dosage is determined by your healthcare provider based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of scoliosis medication?
Scoliosis is not treated by medications other than analgesics to treat back pain in severe scoliosis or degenerative scoliosis. Back pain associated with scoliosis is usually managed with over-the-counter pain relievers such as acetaminophen or aspirin or prescription NSAIDs.
NSAIDs can cause gastrointestinal problems in a surprisingly large number of patients, including stomach pain, ulcers, and bleeding. However, the most serious side effects of NSAIDs are bleeding problems. NSAIDs interfere with the body’s ability to form blood clots, so bleeding and bruising can be common. Acetaminophen, however, resolves pain in much the same way as an NSAID but without the increased risk of stomach pain, ulcers, or bleeding. Acetaminophen can cause liver damage if taken in excess amounts.
What is the best home remedy for scoliosis?
Scoliosis can be significantly helped with lifestyle changes. As always, discuss anything you do at home to treat scoliosis with your healthcare provider.
1. Wear a brace
Low compliance is a big problem with scoliosis braces. They are uncomfortable and interfere with many daily routines. However, the best home remedy by a long margin is to wear a brace during the hours prescribed. The healthcare provider will usually leave the afternoons free from bracing so that the patient can be more active. All other times the brace is scheduled, the patient must make sure it is on.
2. Exercise
Exercise in general is a good idea for any condition. However, there are scoliosis-specific exercises developed by physical therapists. Patients learn these exercises in physical therapy, and many of them are supposed to be performed at home several times a week. If you don’t have physical therapy, they can be learned from free videos online and performed in front of a mirror.
3. Support the spine during sleep
While there is no proof that sleep position can help scoliosis, an orthopedist or spine specialist will frequently instruct on correct sleep positions. The mattress should be firm enough to support the spine. Sleep in a neutral spine position on your back or side. Never sleep on your stomach and avoid large pillows that throw the spine out of alignment.
Frequently asked questions about scoliosis
Can you fix scoliosis?
Treatment for scoliosis focuses on preventing the progression of the curve in the spine. The curve itself will not be straightened out. That being said, some patients do experience a reduction in the curve using braces, exercise, or surgical treatment.
Can you reverse scoliosis?
A scoliosis curve in the spine can be decreased in mild and even moderate scoliosis with postural exercises, called physiotherapy scoliosis-specific exercise (PSSE). Some braces, such as the Charleston brace, which overcorrects the spinal position, has been shown to slightly reduce the spinal curve. In other words, yes, scoliosis can be reversed, but not fully. Planking, yoga poses, Pilates exercises, postural exercises, massage therapy, acupuncture, and chiropractic treatment have all been proposed as treatments that reverse scoliosis, but there is only anecdotal evidence for their effectiveness.
What is the best exercise for scoliosis?
The only exercises with scientific evidence of their effectiveness are physiotherapy scoliosis-specific exercises that are specifically designed to stretch and strengthen muscles responsible for posture and spinal stability. The most widely used are the Schroth method, the Dobosiewicz method (“DoboMed”), and the Scientific Exercise Approach to Scoliosis (SEAS). Many of these are performed in a physical therapy setting but can easily be done at home in front of a mirror. Videos are available for sale or for free on YouTube.
What is the best treatment for scoliosis?
Scoliosis treatment consists of observation, bracing, physical therapy, and surgery. The best treatment will be the treatment option that conservatively helps to prevent further progression of the curve. This will depend on the severity of the curve, age of onset, underlying condition, and the number of growth years left.
What will happen if scoliosis is not treated?
Most patients with untreated scoliosis will develop spondylosis, or arthritis of the spine involving swelling, disk degeneration, bone spurs, and severe pain if the vertebrae press down on a nerve. They are also at a higher risk for osteoporosis. The risk for curve progression, however, is harder to quantify. Patients who are not treated for scoliosis are at a higher risk for progression, but it depends on the extent of the curve.
What can be done for severe scoliosis?
Severe scoliosis involves a curve of the spine greater than 50˚. The risk of progression is very high. The only effective treatment for severe scoliosis is spinal fusion surgery to reduce the severity of the curve and prevent further progression of the curve.
How do you fix scoliosis without surgery?
Almost all cases of scoliosis will never involve surgery. Mild scoliosis is treated with observation only. Moderate scoliosis is treated with bracing and scoliosis-specific physical therapy.
How can I treat scoliosis at home?
The most effective home treatments for moderate scoliosis are wearing the scoliosis brace and performing scoliosis-specific exercises that are learned in physical therapy.
How should you sleep if you have scoliosis?
There is no evidence that sleep position improves or worsens scoliosis. However, there are good postural sleep habits for all people, including scoliosis patients. Sleep in a neutral position on your back or side, but never on your stomach. Small pillows help maintain a neutral spine position while large pillows, though comfortable, put the spine out of alignment. Finally, use a high quality, firm mattress that provides sufficient spine support.
Related resources for scoliosis
- Adolescent and idiopathic scoliosis
- Scoliosis
- Scoliosis: Review of diagnosis and treatment
- Scoliosis conservative treatment: A review of literature
- Scoliosis—the current concepts
- Classifications in brief: The Lenke classification for adolescent idiopathic scoliosis
- Is there a body of evidence for the treatment of patients with adolescent idiopathic scoliosis (AIS)?