Diagnose

What is scoliosis?

Scoliosis is a sideways curve of the spine. The curve can make the spine look like an “s” or a “c” rather than a straight line when viewed from the back. An x-ray of the spine is needed to determine if the condition has developed. Scoliosis is defined as a curve of 11 degrees or more.

Although scoliosis can develop at any age, the majority of the cases happen during adolescence, when most children are growing rapidly.

As the spine grows, it bends to the side and may twist or rotate. Since ribs are attached to the spine, they can rotate and make the chest look uneven. This twisting can also make the shoulders or waist look uneven. Girls and boys seem to be affected equally with smaller curves, but it is seven to eight times more likely a curve will progress in girls than boys.

Common signs of scoliosis include:

  • Uneven shoulders and shoulder blades
  • Unequal distance between arms and body
  • Uneven hips
  • Ribs prominence, or ribs that stick out in one area
  • Lower back muscle prominence, or muscles that bulge on one side
  • Uneven waist folds

Scoliosis is not always painful. Your child may not have pain at all, especially if the curve is mild or moderate. If your child has constant back pain, contact his doctor.

About 2 to 3 percent of children have scoliosis. The cause is usually not known. Most children will not have harmful long-term effects, but some will develop serious problems later in life if not treated. A curve in the spine may get worse during the adolescent growth spurt. Once a child is fully grown, a mild curve usually will not get worse.

Untreated scoliosis can cause:

  • Severe physical deformity
  • Chronic back pain 
  • Osteoarthritis
  • Heart problems
  • Lung problems

Severe cases of scoliosis can cause:

  • Curves in the spine that continue to get worse during adult life
  • Heart problems
  • Lung problems

If you think your child may have scoliosis, act now. Early detection and treatment can save your child from a lifetime of pain and other issues.

How we identify scoliosis

Scoliosis is usually noticed during routine health exams or as part of a school's screening program. Your child’s primary care provider should screen for scoliosis at the child's annual well checkup. Adolescents should be screened between the ages of 10 and 15. Georgia public schools offer free screenings during the middle school years. If a screening shows signs of scoliosis in your child, you will be notified.

Screening is simple and painless, and only takes about a minute. It only detects possible scoliosis, not other back problems. Occasionally an x-ray is required to more clearly identify a curve and confirm the diagnosis of scoliosis.

Be prepared:

  • A female child should wear a sports bra or a bra without underwire. These bras can be left on during the examination. This also makes it easier for the doctor to read the radiographs.
  • Bring shorts. Shorts will be worn during the exam. Paper shorts can be provided by our staff, but most patients feel more comfortable in their own athletic shorts.

Possible causes

Most of the time, no one knows what causes scoliosis. It occurs in healthy children, and the condition may be inherited.

There are several types of scoliosis:

  • Congenital: The bones in the spine did not form correctly before the child was born.
  • Neuromuscular: This type is related to problems with the nervous system or muscles, such as cerebral palsy, spina bifida and muscular dystrophy.
  • Mechanical: This occurs when a child has a leg length difference. This condition is treated differently than scoliosis. 
  • Idiopathic: This type is the most common and develops in children with otherwise healthy bones. No reason is known. There are three types:
    • Infantile: This form usually occurs in children under the age of four.
    • Juvenile: This form occurs between ages 4 to 10.
    • Adolescent: This form occurs between ages 11 to 18. It is the most common type of scoliosis.

Take Action

Steps to get help

A positive scoliosis screening does not mean that your child has scoliosis and will need treatment. It simply means that you should get your child checked by his primary care provider or at a Children's clinic. 

If your child has scoliosis, your doctor will help decide on the next steps. It is important for your child to be evaluated early so you have the most treatment choices. Scoliosis will not prevent your child from doing his regular activities or sports. Finding a curve in the spine early allows for more treatment options.

1. Contact your child's pediatrician or set up an appointment with Children’s Scoliosis Screening Program

2.Take action

If your child has scoliosis, your doctor will help determine the next steps.

  • Some children and teens require a follow-up recheck at six months or one year
  • A few children and teens may need medical treatment such as bracing or surgery
  • Your child can continue his sports or activities unless the doctor says to stop

3. Set up an appointment with a specialist

Your child’s doctor or our scoliosis screening staff can tell you if your child needs to see an orthopaedic surgeon.

Treat

Your child’s treatment will depend on the kind of scoliosis, size of the curve and how much he is likely to grow. The goal of treatment is to decrease the progression. Small curves in children at skeletal maturity have a very low risk of progression, while fairly large curves in skeletally immature patients have the highest risk of progression.

Treatments may include:

Observation and rechecks

Small curves require regular rechecks by your child's doctor or at our Scoliosis Screening Clinic. Rechecks determine if the curve is getting worse as your child gets taller. If the small curve does not change, no treatment will be needed. 

Younger scoliosis patients with larger curves have a much greater risk of curve progression. Every 6 to 12 months, skeletally immature patients with curves less than twenty-degrees should receive a clinical examination and a radiograph.

Radiographs 
Spinal X-rays are used to confirm diagnosis and will show skeletal maturity. Some things to note:

  • A standing view of the spine is the most exact way to see the degree and direction of the curve.
  • The primary curve is quantified using the Cobb Method. This means we measure the degree of maximal tilt of the curved part of spine.
  • Skeletal maturity can be estimated using the Risser scale. This scale helps us look at the amount of bone on top of the pelvis. The Risser scale starts at stage 0 (immature) and progresses to stage 5 (mature). It helps us learn how much more a child may grow.

Bracing

Bracing is only used when your child is still growing and is used for moderate or progressive curves. Bracing keeps curves from getting worse. Body casting is a specific treatment that is used for infants and very young children with severe scoliosis. 

Learn more about spinal bracing at Children’s

Surgery

Large curves will most likely require surgery, especially if your child is still growing. Spine fusion surgery joins, or fuses, some of the bones of the spine to prevent the curve from getting worse.

We often consider surgery for children whose bones are not yet mature and who have curves greater than 40 to 45 degrees. Our team uses advanced technology and surgical implants to provide the safest and most helpful surgery we can. Our goal is to get kids and teens back to their routine activities, including most sports, as soon as possible. We work with your family to decide on your child’s goals and any restrictions that will help your child have a better recovery.

Of the common treatments offered to children with scoliosis, spinal fusion surgery aims to:

  • Stop the curve’s progression.
  • Balance the spine and pelvis region.
  • Help your child sit upright again.
  • Help improve lung function. 

This surgery is performed either laparoscopically or through one large incision (cut).

If surgery is needed, our spine surgeons will use modern technology and instruments to speed healing and reduce complications.

Surgical technology may include:

  • Advanced spinal robotics or computed tomography (CT)-based 3-D navigation to help visualize the spine.
  • Vertical expandable prosthetic titanium rib (VEPTR) surgery, to expand and support the chest wall for children with severe chest deformities and congenital scoliosis. Children’s is one of a few pediatric hospitals in the U.S. that has experience with this surgery.
  • Growing rods to help control curve progression without a fusion in young children whose spines are still growing. This treatment may include the MAGEC® (MAGnetic Expansion Control) system, which uses a magnetic remote control to help lengthen the spine.
  • Other minimally invasive techniques without spine fusion in young children whose spines are still growing.

Learn more about these spine surgery technologies

Physical therapy

Our physical therapy team includes specialists certified in the Schroth Method, a type of exercise especially for scoliosis. The Schroth Method is designed to increase strength and improve posture, and is especially helpful along with your bracing program.

Contact us to learn more about the Schroth Method

If your child needs surgery, our pediatric-trained therapists will work with you and your child to help him stay mobile and learn how to do things safely after he goes home from the hospital.

A physical therapist can teach your child how to reduce pain and move around as easily as possible. 

An occupational therapist may work with your child to help him learn how to dress and care for himself after surgery.

Learn more about our rehabilitation program

Meet the Team

Meet the team

Some physicians and affiliated healthcare professionals on the Children's Healthcare of Atlanta team are independent providers and are not our employees.

Helpful Resources

Download our scoliosis resources

Scoliosis (en Español)

Fast facts about scoliosis (en Español)

Backpack safety: Don't let backpacks get you down (en Español)

External resources

The Scoliosis Research Society

Medical professional resources

We offer resources for medical professionals and school health professionals.

Medical professional resources

School health resources 

Scoliosis Screening Conferences

We offer annual conferences on scoliosis for healthcare professionals. It focuses on screening techniques, research and treatment methods.

Learn more about our scoliosis screening conferences

Locations

Our Scoliosis Screening Program provides specialty clinics at six of our locations below for children with a positive scoliosis screening in school or at their doctor’s office.

Children's at Forsyth

410 Peachtree Parkway, The Collection at Forsyth

Cumming, GA 30041-7407

Children's at Hudson Bridge

1510 Hudson Bridge Road

Stockbridge, GA 30281-5020

Children's at North Point

3795 Mansell Road

Alpharetta, GA 30022-8247

Children's at Satellite Boulevard

2660 Satellite Blvd.

Duluth, GA 30096-5803

Children's at Town Center

625 Big Shanty Road NW

Kennesaw, GA 30144-6812

Children's at Webb Bridge

3155 North Point Parkway, Building A

Alpharetta, GA 30005-5481