Scoliosis: Symptoms, Types, Causes and Treatment

Scoliosis, a condition marked by a sideways curvature of the spine, is more than just a spinal issue—it can affect people physically, emotionally, and socially. Understanding scoliosis requires delving into its symptoms, various types, underlying causes, and the range of treatments available. This comprehensive article synthesizes current scientific knowledge to help patients, families, and healthcare professionals better understand this complex condition.

Symptoms of Scoliosis

Scoliosis symptoms can be subtle or pronounced, varying by age, curve type, and severity. While some individuals may notice visible changes in posture, others experience discomfort or pain. Recognizing these symptoms early can make a significant difference in outcomes, especially for children and adolescents.

Symptom	Description	Typical Location	Sources
Asymmetry	Uneven shoulders, waist, or hips	Back/trunk	1 4 6
Back pain	Localized or radiating pain	Curve apex, lumbar	1 3
Cruralgia	Radiating pain in the front of the thigh	Thigh	1
Postural change	Visible trunk or rib cage shift	Trunk/ribs	4 6

Table 1: Key Symptoms

Understanding Scoliosis Symptoms

Physical Signs

• Asymmetry in the Back or Trunk: The most common early sign is unevenness in the shoulders, waist, or hips. One shoulder blade may protrude more than the other, or the ribs may be more prominent on one side when bending forward 4 6.
• Visible Curve: In moderate to severe cases, the spinal curve can be seen or felt when running a hand down the spine.
• Trunk or Rib Cage Shift: Sometimes the whole trunk or rib cage appears shifted to one side.

Pain

• Back Pain: Adults with scoliosis often report localized back pain, typically around the apex of the curve. The pain may be asymmetrical, and in adults, lumbar and thoracolumbar curves are more likely to cause discomfort than thoracic curves 1 3.
• Radiating Pain: Some may experience radiating symptoms, such as cruralgia (pain in the front of the thigh), which is more specific to scoliosis than classic sciatica 1.
• Leg Pain and Claudication: Especially in adult scoliosis, pain may radiate to the leg, sometimes accompanied by numbness or cramping when walking 3.

Other Symptoms

• Fatigue: Muscular fatigue or imbalance may develop due to altered biomechanics.
• Cosmetic Concerns: Many adolescents are first diagnosed due to cosmetic issues rather than pain, especially since pain is less common in children 4 6.

Types of Scoliosis

Scoliosis is not a single entity; it includes several types, each with distinct characteristics, causes, and age of onset. Understanding the types of scoliosis is crucial for accurate diagnosis and treatment planning.

Type	Key Features	Common Age	Sources
Idiopathic	No known cause; most common	10–18 yrs	4 5 6
Congenital	Vertebral malformations	Birth–3 yrs	4 5 6
Neuromuscular	Associated with neuromuscular disease	Any	5 6
Degenerative	Due to spinal wear and tear	Adults	3 15

Table 2: Major Types of Scoliosis

Exploring Scoliosis Types

Idiopathic Scoliosis

• Definition: The most common form, especially in adolescents (Adolescent Idiopathic Scoliosis, or AIS), with no identifiable cause despite extensive research 4 5 6.
• Subtypes by Age:
  • Infantile Idiopathic Scoliosis (0–3 years)
  • Juvenile Idiopathic Scoliosis (4–10 years)
  • Adolescent Idiopathic Scoliosis (>10 years)

Congenital Scoliosis

• Origin: Caused by abnormalities in vertebral development during fetal growth 4 5 6.
• Features: Often detected in early childhood and may be associated with other organ system anomalies (e.g., heart or kidney).

Neuromuscular and Syndromic Scoliosis

• Neuromuscular: Results from conditions like muscular dystrophy, cerebral palsy, or spinal muscular atrophy, where muscle weakness or imbalance leads to curvature 5 6.
• Syndromic: Associated with broader syndromes (e.g., Marfan's, neurofibromatosis) and often presents with complex medical needs 5.

Degenerative (Adult) Scoliosis

• Primary Degenerative/De Novo: Develops in adulthood due to asymmetric degeneration of the discs and facet joints, often accompanied by back pain and sometimes spinal stenosis 3 15.
• Progressive Idiopathic: Adolescent idiopathic curves that worsen or become symptomatic in adulthood 3.
• Secondary Adult Curves: Result from factors like leg length discrepancy, hip pathology, or osteoporosis 3.

Classification Systems

• Curve Patterns: Scoliosis is further classified by curve location (thoracic, lumbar, thoracolumbar) and pattern, using systems such as the Lenke classification for surgical planning 2.

Causes of Scoliosis

The causes of scoliosis are diverse, ranging from genetic and congenital factors to degenerative changes. While some types have clear origins, idiopathic scoliosis remains enigmatic, with research pointing toward a multifactorial genesis.

Cause	Description	Evidence Level	Sources
Genetic	Familial clustering, twin studies	Strong	5 7 8 9
Congenital	Vertebral malformations at birth	Strong	4 5 6
Neuromuscular	Muscle or nerve disorders	Strong	5 6
Degenerative	Age-related spinal changes	Strong	3 15
Hormonal	Melatonin, calmodulin imbalances	Emerging	7 9
Growth Imbalance	Disproportionate vertebral/sternal growth	Emerging	10

Table 3: Causes of Scoliosis

Unpacking Scoliosis Causes

Genetic Factors

• Familial Patterns: Idiopathic scoliosis frequently runs in families, with higher concordance in twins, supporting a significant genetic component 5 7 8 9.
• Multifactorial Nature: No single gene has been identified; it likely results from the interplay of multiple genes and environmental influences 9.

Congenital Causes

• Developmental Anomalies: Abnormal vertebral formation during embryogenesis leads to congenital scoliosis, often detected early and sometimes linked to cardiac or renal anomalies 4 5 6.

Neuromuscular and Syndromic Origins

• Underlying Conditions: Scoliosis can result from neuromuscular diseases (e.g., muscular dystrophy, cerebral palsy) or connective tissue disorders (e.g., Marfan’s syndrome, neurofibromatosis) 5 6.

Degenerative Changes

• Adult Scoliosis: In older adults, scoliosis often develops due to asymmetric degeneration of spinal structures, sometimes compounded by osteoporosis or a history of adolescent scoliosis 3 15.

Hormonal and Biomechanical Influences

• Melatonin and Calmodulin: Recent studies suggest low melatonin or elevated calmodulin levels may play a role in curve progression, especially in adolescent idiopathic scoliosis 7 9.
• Growth Hormone: The rapid growth spurt in adolescence may influence the onset and progression of curves 9.

Structural and Biomechanical Theories

• Imbalanced Growth: Disproportionate growth between the thoracic vertebrae and sternum has been proposed as a physical trigger for scoliosis, supported by animal models and imaging studies 10.
• Other Theories: Changes in intervertebral discs, ligaments, or paraspinal muscles may contribute, but many findings are secondary rather than primary causes 9.

Treatment of Scoliosis

Treatment for scoliosis is highly individualized, based on the type of scoliosis, curve severity, risk of progression, symptoms, and patient age. Approaches range from observation to bracing, physical therapy, and surgery. Advances in both conservative and surgical care have improved outcomes for many people with scoliosis.

Treatment	Indication	Goal/Outcome	Sources
Observation	Mild, low-risk curves	Monitor progression	6 12
Bracing	Moderate, growing children/adolescents	Prevent progression	6 12
PSSE (exercises)	Mild/moderate curves, adjunctive	Stabilize, improve posture	12 14
Surgery	Severe/progressive curves, failed conservative	Correct deformity, relieve symptoms	11 13 15

Table 4: Scoliosis Treatment Options

Treatment Modalities Explained

Observation

• Who: Patients with small curves (typically <20°), especially if still growing, are often monitored with periodic exams and X-rays 6 12.
• Why: Many mild curves do not progress and do not require intervention.

Bracing

• Who: Children and adolescents with moderate curves (20–40°), significant growth remaining, and risk of progression 6 12.
• How: Braces are worn for many hours daily to slow or halt curve progression. Success depends on adherence 12.
• Types of Braces: Several designs exist (e.g., Boston, Milwaukee), tailored to curve location and patient needs.

Physiotherapy Scoliosis-Specific Exercises (PSSE)

• Who: Mild to moderate idiopathic scoliosis, or as an adjunct to bracing 12 14.
• What: Exercises designed to promote three-dimensional spinal self-correction, improve posture, and stabilize the corrected alignment. PSSE is not a replacement for bracing or surgery, but part of a comprehensive care model 14.
• Benefits: May reduce curve progression, improve posture and muscle balance, and enhance quality of life 14.

Surgery

• Who: Patients with severe curves (>40–50° while growing, or >50–60° in adults), rapid progression, or disabling symptoms unresponsive to conservative care 6 11 13 15.
• Procedures: Involves spinal fusion and instrumentation with rods and screws to correct and stabilize the spine 11.
• Goals: Prevent further progression, correct deformity, relieve pain or neurological symptoms, and improve function.
• Adult Surgery: In adults, surgery can address pain and disability, particularly when conservative measures fail. Surgical planning is complex and tailored to the individual's symptoms, curve characteristics, and overall health 3 13 15.

Nonoperative vs. Operative Care in Adults

• Nonoperative Management: May include pain medications, physical therapy, and limited interventions. Satisfactory for patients with mild symptoms 13.
• Surgical Outcomes: For those with significant symptom burden, surgery offers greater improvement in pain and function, though with higher risk of complications and need for careful selection 13 15.

Conclusion

Scoliosis is a multifaceted condition that demands an individualized, evidence-based approach. Early recognition and understanding of its types and causes enable targeted interventions and better outcomes. Whether managed conservatively or surgically, treatment aims to preserve function, relieve symptoms, and improve quality of life.

Key Takeaways:

• Scoliosis symptoms range from subtle postural changes to pain and functional impairment, varying by age and type 1 3 4.
• Major types include idiopathic, congenital, neuromuscular, and degenerative scoliosis, each with distinct features and implications 3 4 5 6 15.
• Causes are multifactorial, with strong genetic, congenital, neuromuscular, and degenerative components, and emerging evidence for hormonal and biomechanical influences 5 7 8 9 10.
• Treatment is tailored to the individual, incorporating observation, bracing, physiotherapy exercises, or surgery based on curve severity, progression risk, and patient needs 6 11 12 13 14 15.

Empowering patients and clinicians with knowledge is the first step toward effective management and improved quality of life for those affected by scoliosis.