Scoliosis & Spine Deformity Center

Ask Dr. Francis

Frequently Asked Questions and Answers about Scoliosis

Through wide‐ranging discussions with Dr. Francis, we have compiled this collection of the most common questions people have about adult and child scoliosis into a single helpful reference.

Q:  What is scoliosis?
A:  There are many types and causes of scoliosis, including:

  • Congenital scoliosis: A result of a bone abnormality present at birth.
  • Neuromuscular scoliosis: A result of abnormal muscles or nerves, frequently seen in people with spina bifida or cerebral palsy or in those with various conditions that are accompanied by, or result in, paralysis.
  • Degenerative scoliosis: This may result from traumatic (from an injury or illness) bone collapse, previous major back surgery or osteoporosis (thinning of the bones).
  • Idiopathic scoliosis: The most common type of scoliosis, idiopathic scoliosis, has no specific identifiable cause. There are many theories, but none have been found to be conclusive. There is, however, strong evidence that idiopathic scoliosis is inherited.

Q:  What causes scoliosis?
A:  In most cases (85%), the cause of scoliosis is unknown (also called idiopathic). The other 15% of cases fall into two groups:

Q:  What are the health risks and dangers of scoliosis?
A:  Scoliosis occurring in the growing child is often a progressive condition which can, on occasion, if left untreated, result in severe deformity with disability or death from cardiovascular failure in adult life (Nilsonne & Lundgren 1968, Colles & Ponseti 1969). To prevent these possible complications, all curves should be recognized at an early stage because it is easier to prevent than correct severe deformity (McMaster 1982).

Q:  Is scoliosis hereditary?
A:  Scoliosis is hereditary in that people with scoliosis are more likely to have children with scoliosis; however, there is no correlation between the severity of the curve from one generation to the next. This is called variable penetrance, meaning that in each generation there is a variability in how strongly the genes are expressed, that is, how severe the curve is.

A valid question to ask is: Can it be passed on? Is it something that runs in families? And the answer is yes; scoliosis tends to run in families. You're 20% more likely to develop scoliosis if someone else in your family also has scoliosis (Walker 2009). It tends to run through generations in families, but to have variable effects in each generation. That is, you may have a mother with a mild curve who has a daughter with a more severe curve, or you may have a mother with a severe curve whose grandchildren then have scoliosis, but the intervening generation didn't really have any significant problem.

Q:  Is scoliosis a progressive disease?
A:  Information about scoliosis is changing. The accepted teaching used to be that once you reach adulthood, the curves become static and do not progress. And for most patients, that may still be the case. However, there's a subgroup of individuals where the curve continues to progress in adulthood.

Q:  Does scoliosis always develop during childhood?
A:  Although scoliosis is most commonly associated with children, adults can develop it, too. In some cases, they have actually had it their whole lives, but it has gone unnoticed or untreated until it started to cause pain or other problems. In other cases, age-related changes in the spine, such as disc degeneration, lead to scoliosis.

Q:  Is the incidence of scoliosis the same among men and women?
A:  The incidence of idiopathic scoliosis occurs equally in early adolescence for both boys and girls for small curves (less than 10 degrees). Curve progression is more common in girls and larger curves are more prevalent. The progression rate is seven to eight times more common among girls than it is among boys. We don't understand yet what issues cause that differential progression.

Q:  What are the common signs and symptoms of scoliosis? What should I look for?
A:  The symptoms of scoliosis aren't always easy to spot, and you may not notice the symptoms. Many schools screen students for scoliosis and school nurses or physical education instructors are often the first to discover symptoms. Although only a physician can accurately diagnose scoliosis, it is important for parents to be alert for any warning signs. If you notice any of the following signs of scoliosis, schedule an examination with our office:

  • Whole body leaning to one side
  • Uneven shoulder height
  • Uneven hips. One hip sticks up higher than the other (Parents often first notice possible scoliosis when they see that one pant leg is shorter than the other.)
  • Uneven rib cage
  • Rib protrusion on one side of the spine
  • Pay attention, too, to any symptoms your child reports such as "growing pains," fatigue, or back and/or leg pain.
  • These symptoms all apply to adult scoliosis, as well.

Q:  What is the most common symptom in scoliosis?
A:  Scoliosis is first identified typically by appreciation of slight asymmetries of the shoulders or hips. Visible asymmetries in the contour of the back, or the observation that one shoulder or hip is higher than the other, are commonly the first clues that someone has scoliosis. In adolescence, these asymmetries are most commonly noticed during rapid growth spurts. In adults who previously did not suspect that they had any curvature of the spine, the realization that they are losing height may be the first clue that they have a progressive curvature of the spine.

Q:  What is the school scoliosis screening process?
A:  The screening process identifies students that have some physical findings that suggest a spinal curve. The screening process does not diagnose a spinal deformity. If there are positive physical findings of spine abnormality, the parents will be notified and should schedule an appointment for an extensive examination to confirm whether or not the child has an abnormal spinal curve.

Q:  When do schools screen for scoliosis?
A:  All states do some form of spinal screening to assure students needing evaluation and/or treatment get early attention. The state of Texas mandates spinal screening for students in the 6th and 9th grade using school nurses and other trained adults to screen all students. Careful training and understanding of spinal screening is essential for the success of this program. Schools may implement a program that includes screening in the 5th and 8th grades as an alternative to 6th and 9th. The intent of the state law is to maintain a three year gap between students’ spinal screenings. If your child’s school does not offer screenings, talk to your pediatrician. Early detection and treatment of scoliosis is important to preclude long-term effects. If you would like further detailed information regarding the screening procedure guidelines for the state of Texas, please click here.

Q:  What is the prognosis for a child with scoliosis?
A:  The prognosis for most children who come to my office is generally very good. The majority of children who are identified as having scoliosis may not need complex treatments, but they do need to be evaluated. Most often, we can assure parents that either we need to observe their child in four to six months or, in fact that their risk is so low that they should come back in one year.

Q:  When I was younger, my scoliosis didn’t bother me, but it has recently become more painful. What should I do?
A:  If you are in pain or suspect a possible progression of your scoliosis curvature, I would suggest making an appointment with our office right away.

Q:  What is the prognosis for adults with scoliosis?
A:  Pain in adult-onset or untreated childhood scoliosis often develops because of posture problems that cause uneven stresses on the back, hips, shoulders, necks, and legs. In one study conducted 20 years after growth had stopped, two thirds of adults who had lived with curvatures of 20 to 55 degrees reported they experienced back pain. In this study, most cases were mild, although others have reported that adults with a history of scoliosis tend to have chronic and more back pain than the general population (Everett & Patel 2007).

Nearly all individuals with untreated scoliosis at some point develop spondylosis, an arthritic condition in the spine. The joints become inflamed, the cartilage that cushions the disks may thin, and bone spurs may develop. If the disk degenerates or the curvature progresses to the point that the spinal vertebrae begin pressing on the nerves, pain can be very severe and may require surgery.

Q:  Does scoliosis have to be treated?
A:  My general rule of thumb for treating scoliosis is to monitor the condition if the curve is less than 20 degrees. Curves greater than 25 degrees, or those that progress by 10 degrees while being monitored, may require treatment. Whether scoliosis is treated immediately or simply monitored is a decision I make on a case by case basis. The percentage of patients that will progress more than 5 degrees can be as low as 5% in certain patients or as high as 50 - 90%, depending on the severity of the curve or other predisposing factors:

  • Age
  • Gender
  • Location of the Curvature
  • Severity of the Curvature
  • Presence of other Health Conditions

Q:  What are the treatment options?
A:  Scoliosis treatment is a subject that has been the cause of great debate for many years; unfortunately, there is not a definitive answer for all cases. The three basic types of treatments for scoliosis are as follows:

  • Observation: Patients are observed when the curvature of the spine is minimal (the cutoff is debatable, but depending on the age of the patient, the stage of skeletal development, and symptoms, it is somewhere between 20 and 30 degrees of curvature). Over this cutoff, more aggressive scoliosis treatment is usually pursued. When observation is chosen, I will see the patient every six months and observe the progression by means of spinal radiographs (X-Rays) and I will note the rate of progression until skeletal maturity is reached.
  • Orthopedic Bracing: Brace (orthotic) treatment for scoliosis is used to prevent spinal curve progression and to maintain the appearance of the back. The goal of brace treatment is to prevent the curve from getting worse. Bracing does not correct a curve. There may be some initial straightening of the spine and the appearance of correction when a brace is applied. However in most cases, once the patient stops wearing the brace for a long period of time, this correction is lost and the curve returns to its original shape (Roach 1999). If a patient is a candidate for bracing, I will recommend the most effective type of brace and how long it should be worn each day. Children undergoing treatment with orthopedic braces are encouraged to keep acting like kids. They are even able to participate in some physical and social activities without their brace as long if it is worn for the total number of hours throughout the rest of the day.

For more information regarding bracing, please click here.

  • Surgery: Surgery is an option in cases of continual pain, difficulty breathing, considerable disfigurement, a progressively worse curve and curves of more than 45 degrees. Scoliosis surgery is designed to reduce the patients’ curvature and fuse the spine to prevent any further progression of the deformity. The main surgery used to treat scoliosis is called spinal fusion with instrumentation. This surgery can be performed in a variety of ways. The type of surgery used depends on age, mobility of the spine, location and degree of the curve and any pressure on the nerve roots of the spine. In the last 40 years, there have been many major advances in the treatment of scoliosis and there is now virtually no severity of curvature which cannot be significantly improved by surgery. It should be remembered, however, that the necessity for the surgical salvage of severe deformity indicates a failure of management, and the key to successful treatment lies in the early detection and prevention of severe deformity (McMasters 1982). If we decide that surgery may be an option for you to consider, I will thoroughly explain my reasoning, answer any questions you may have and make sure that you have full understanding of the procedure and expectations after the procedure.

Q:  Will physical therapy a treatment option for scoliosis?
A:  Physiotherapy by itself has no part to play in the conservative management of scoliosis.
Its use is based on the misguided belief that it is possible to strengthen unilaterally the muscles on the convexity of the curve, so creating a muscle imbalance which would correct the deformity. This, however, is impossible because exercises strengthen all of the spinal muscles equally (McMasters 1982). Spinal bracing remains the key to the successful conservative management of scoliosis. I may recommend exercises in conjunction with brace treatment to maintain muscle tone while the torso is immobilized by the brace. These exercises are prescribed individually according to the age of the patient and the location and degree of the curvature.

Q:  Should I be concerned about a small curve?
A:  An appointment is recommended to examine any abnormal curve in the spine. Curves that measure less than 20 degrees are usually no cause for concern unless there are signs of further progression. However, in growing children and adolescents, mild curvatures can rapidly worsen, so continued observation is very important.

Q:  Is there any research being done regarding scoliosis?
A:  For information regarding current scoliosis research, please visit Scoliosis Research Society.

Q:  Can you recommend any good literature about scoliosis?
A:  Here are a few Internet resources and books that I highly recommend.  To view the

            * Scoliosis Books

Reference Organization Websites

-National Scoliosis Foundation
5 Cabot Place
Stoughton, MA 02072
(781) 341-6333
Fax: (781) 341-8333
Email: Scoliosis@aol.com
This nonprofit voluntary organization provides pamphlets, a newsletter, and other informational material on childhood and adult scoliosis. The foundation also provides support-group information and lists of doctors in each state who specialize in scoliosis.

-The Scoliosis Association, Inc.
PO Box 811705
Boca Raton, FL 33481-1705
(800) 800-0669
(561) 994-4435
Fax: (561) 994-2455
This association publishes a quarterly newsletter and pamphlets. The association also provides information about local chapters and support groups.

-The Scoliosis Research Society
6300 North River Road, Suite 727
Rosemont, IL 60018-4226
(847) 698-1627
Fax: (847) 823-0536
Email: Goulding@aaos.org
The society is a professional organization for orthopedic surgeons interested in scoliosis.
It provides pamphlets about the diagnosis and treatment of scoliosis. Price information for ordering pamphlets is available from the society. The society also can provide referrals to physicians.

-Spine-Health-Scoliosis Health Center
Articles and videos on symptoms, causes and treatment.

-SpineUniverse- Scoliosis Condition Center
Clinical trials, information regarding the anatomy of the spine, and detailed information regarding scoliosis, glossary terms and definitions.

-SpineKids
An online community dedicated to children and parents dealing with scoliosis.

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