Not all scoliosis curves are the same

Scoliosis, a spine condition that causes a curve in the spine's natural structure, can cause lifelong complications and, in some cases, be life-threatening if left untreated.

According to Ronald Roiz, MD, a pediatric spine surgeon at Loma Linda University Health, understanding the different causes of scoliosis and recognizing early warning signs can help families seek care before serious complications develop.

"The earlier we identify scoliosis, the more opportunities we have to guide growth, preserve lung development, and achieve the best possible outcome for the child," Roiz says.

Key takeaways

• Adolescent idiopathic scoliosis is the most common form of scoliosis, which appears during puberty and is most common in girls.

• Scoliosis can sometimes develop due to a patient's underlying conditions.

• Parents should monitor their children for uneven shoulders, rib humps, waist asymmetry, and the body shifting to one side.

Types of curves

Scoliosis can develop without a known cause or due to an underlying medical condition. When no specific cause is identified, it is called idiopathic scoliosis.

The most common form of scoliosis, adolescent idiopathic scoliosis, typically appears during preteen or teenage years in otherwise healthy children and causes certain vertebrae to grow excessively in the front rather than the back, causing the spine to curve atypically. While both boys and girls are diagnosed at the same rate, girls are 8 to 10 times more likely to require surgical treatment.

"Even though adolescent idiopathic scoliosis is the most diagnosed form, scoliosis can also develop because of muscle imbalance, congenital abnormalities, or other medical conditions," Roiz says.

A common non-idiopathic cause of scoliosis is cerebral palsy. Children with cerebral palsy often experience significant muscle imbalance, which can gradually pull the spine out of alignment and lead to severe curves over time.

Scoliosis can also occur because of congenital spinal abnormalities, where the vertebrae are abnormally shaped at birth and the spine curves as the child grows.

"Congenital scoliosis can present very early," Roiz says. "The scoliosis itself can take some time to develop, but the underlying issue can be seen early on."

In other cases, infantile idiopathic scoliosis can emerge within the first few months of life. While most infantile idiopathic scoliosis resolves on its own, if left untreated, it can affect the normal developmental growth of the chest and lungs.

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Early detection matters

The earlier a spinal curve develops, the greater the risk of long-term complications.

When severe scoliosis develops during a child's growth years, it can interfere with lung function, mobility, and quality of life.

"What we worry about most with curves that start early in life is lung function," Roiz says.

Severe curves greater than 100 degrees can significantly impair lung function, while curves over 120 degrees can affect heart function. While very rare, in most serious cases, the effects can become permanent and lead to early death.

"We want children to grow and develop their lungs properly and develop normal torso height," Roiz says. "That often means using different strategies than we would for older children."

Although scoliosis can persist beyond puberty, most cases are identified before children reach adulthood.

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Treatment for scoliosis

Treatment is tailored to the type of curve, the child's age, the severity of the condition, and the likelihood that the curve will continue progressing. Treatment options include:

• Observation: Some mild curves simply require monitoring with regular physical exams and, in some cases, imaging.

• Bracing: External braces that prop up the spine can help slow progression in certain patients and maintain alignment during growth.

• Surgery: For older children with more severe curves, the most common treatment is surgical fusion. This operation uses metal rods and screws to stabilize the spine and prevent further curvature. The fused vertebrae become one solid bone over time, halting motion in that segment. In younger children, growth-preserving strategies are needed.

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Signs to watch for

For cases of scoliosis not discovered during infancy, symptoms are most often noticed by parents or a pediatrician during routine screening. Common signs include:

• Uneven shoulders

• A rib prominence

• Asymmetry at the waist

• The body appearing shifted to one side

Though these signs might seem obvious, delayed recognition does not necessarily mean parents were inattentive.

"I've had families come in with curves that were already 70 degrees and say they can't believe they didn't notice it before. Once someone points it out, it's all they can see," Roiz says.

While not every curve requires treatment, early diagnosis can help prevent complications.

If you're worried your child has scoliosis, Loma Linda University Children's Hospital can help. To learn more, visit our website here or call 877-558-6248.