Scoliosis: A Comprehensive Analysis – From Basic Understanding to Professional Assessment

Author: Chloe Mo Founder & Registered Physiotherapist

1. What is scoliosis? Are all spinal curves scoliosis?

Scoliosis is a complex three-dimensional spinal deformity, referring to a lateral curvature of the spine exceeding 10 degrees, accompanied by rotation of the vertebrae. It is not merely "poor posture," but a spinal deformity that can affect appearance, function, and even health.

Scoliosis is clearly defined by the Scoliosis Research Society (SRS) as: a three-dimensional spinal deformity where the lateral curvature of the spine, measured by the Cobb method on a standing anteroposterior X-ray of the entire spine, is greater than 10 degrees. This deformity not only involves lateral curvature in the coronal plane (front-back direction) but is also accompanied by changes in the physiological curvature in the sagittal plane (side view) and rotation of the vertebrae in the horizontal plane, forming a complex "three-dimensional sequence abnormality." Typical cases of scoliosis will simultaneously exhibit deformities of the spine and chest, including characteristic manifestations such as a rib hump.

Approximately 3-5% of the global population is affected by scoliosis, with adolescents having the highest proportion, especially girls aged 10-18. If parents or siblings have scoliosis, the child's risk of developing the condition increases by 3-5 times, so children with a family history should pay extra attention during puberty!

Diagnosing scoliosis requires an X-ray examination, where doctors will measure the "Cobb angle" to determine the severity of the curve. If the angle is less than 10 degrees, it is usually not considered scoliosis, but rather diagnosed as spinal instability; if it exceeds 10 degrees, it will be diagnosed as scoliosis and requires further observation or treatment.

2. Why does scoliosis occur? Analysis of four common causes

The causes of scoliosis are complex and are mainly divided into four categories. Understanding these can help us determine whether further examination or treatment is needed.

(1) Adolescent Idiopathic Scoliosis (AIS) (most common, accounting for 80%)

• The etiology is still unclear, possibly related to genetics, hormones, or abnormal neural control.
• It is common in adolescents (10-18 years old), especially girls during rapid growth spurts.

(2) Congenital Scoliosis (present at birth)

• Due to abnormal spinal development during the fetal period (e.g., hemivertebrae, fused vertebral blocks).
• Usually discovered in infancy or early childhood, and may require early intervention.

(3) Neuromuscular Scoliosis (associated with other diseases)

• Caused by conditions like cerebral palsy or muscular dystrophy, where muscles cannot adequately support the spine.
• This type of scoliosis usually progresses rapidly and requires close monitoring.

(4) Degenerative Scoliosis (common in middle-aged and elderly individuals)

• Caused by spinal instability due to intervertebral disc degeneration and osteoporosis.
• May be accompanied by symptoms such as low back pain and nerve compression.

In addition, poor posture, leg length discrepancy, and other factors can also lead to temporary "functional scoliosis," where the patient's spine has no deformity but muscles, bones, etc., compensate. Therefore, physical therapy, insoles, and other treatments can effectively improve the condition.

3. What are the types of scoliosis?

Scoliosis can be classified by _curve shape, location, and direction_. Different types of scoliosis require different treatment strategies.

Classified by curve shape

• C-curve (single direction curve, accounts for 70%)
• S-curve (two opposite direction curves, accounts for 30%)

Spinal Level Classification

Classified by severity (Cobb angle)

• Mild (10-20 degrees): Low risk of progression; Observation + Schroth scoliosis exercises + physical therapy
• Moderate (20-40 degrees): Adolescents may worsen; Requires bracing + Schroth scoliosis exercises + physical therapy
• Severe (40-50 degrees): May affect cardiopulmonary function; Requires bracing + Schroth scoliosis exercises + physical therapy, may require surgery
• Very severe (>50 degrees): High risk of chest wall deformity; Requires bracing + Schroth scoliosis exercises + physical therapy, may require surgery

Parents please note: If your child has any of the following conditions, they must be examined as early as possible

Including:

• Uneven shoulders
• Asymmetrical back
• Protruding ribs

Who is more likely to worsen?

• Girls (higher risk than boys)
• Skeletally immature (Risser sign 0-1, early development)
• Thoracic curve (more likely to progress than lumbar curve)
• Positive family history (parents or siblings with scoliosis)

 Note: If a child is in a "rapid growth spurt" (e.g., puberty), the patient's condition can worsen by more than 1 degree per month, or 12 degrees in a year. Therefore, it is recommended to have a follow-up examination every 6 months to prevent sudden exacerbation! 

4. How is scoliosis evaluated? What examinations do doctors and physical therapists perform?

The evaluation of scoliosis involves a three-step process: 1) medical history, 2) physical examination, and 3) imaging tests, to ensure an accurate diagnosis.

(1) Key points of medical history

• Family history (do parents/siblings have scoliosis? ): A positive family history increases the risk by 3-5 times.
• Age of onset: The earlier the onset (e.g., <10 years old), the higher the risk of progression.
• Accompanying symptoms: Pain (approximately 23% of AIS patients report pain), dyspnea, neurological symptoms, etc.
• Menstrual history: The period before and after menarche is a high-risk period for progression.

(2) Physical Examination

• “Adam's Test”: Measure ATR (Angle of Trunk Rotation) and observe if there is asymmetric elevation of the back.
• Scapular position and prominence (often the scapula on the convex side is more prominent)
• Shoulder height, pelvic balance
• Leg length equality (leg length discrepancy can lead to compensatory scoliosis)
• Spinal midline deviation
• Breathing pattern
• Core strength assessment
• Fascial tension

(3) Imaging Tests

• Full-spine standing X-ray (Golden Standard): Measure the Cobb angle and assess skeletal maturity (Risser Scale)
• MRI(special cases): Rule out spinal cord abnormalities

What can parents do?

1. Regularly observe your child's posture (e.g., check for back symmetry during bathing).
2. If an abnormality is found, consult a professional physical therapist for evaluation as soon as possible!

Summary: Key knowledge points about scoliosis

• Not all spinal curvature is scoliosis (Cobb angle must be >10 degrees)
• Adolescent girls have the highest risk, especially during rapid growth spurts.
• Mild scoliosis can be observed, moderate to severe cases may require bracing.
• Early detection + correct treatment can effectively control progression.

Through early detection, accurate evaluation, and individualized intervention, we can significantly improve the long-term prognosis for scoliosis patients, reduce the need for surgery, and enhance their quality of life. Regular follow-ups (every 4-12 months, adjusted according to risk) are crucial for monitoring progression. We hope this article helps you better understand scoliosis! If you have any questions, please consult a professional physical therapist.

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