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about . . .

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

National Institutes of Health

Public Health Service • U.S. Department of Health and Human Services

Scoliosis in 

Children and

Adolescents
This booklet is not copyrighted. Readers are encouraged

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Additional copies of this booklet are available from

National Institute of Arthritis and Musculoskeletal

and Skin Diseases

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1 AMS Circle

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You can also find this booklet on the NIAMS Web site 

at www.niams.nih.gov/hi/topics/scoliosis/scochild.htm.
Table of Contents

What Is Scoliosis? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 

Who Gets Scoliosis? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

What Causes Scoliosis? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

How Does the Doctor Diagnose Scoliosis? . . . . . . . . . . . . . 4

Does Scoliosis Have To Be Treated? 

What Are the Treatments? . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Are There Other Ways To Treat Scoliosis? . . . . . . . . . . . . . . 8

Which Brace Is Best? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

If the Doctor Recommends Surgery, 

Which Procedure Is Best? . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Can People With Scoliosis Exercise? . . . . . . . . . . . . . . . . . . 11

What Are Researchers Trying To Find Out 

About Scoliosis? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Where Can People Get More Information 

About Scoliosis? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Scoliosis in Children and Adolescents
Information Boxes

Normal Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Curve Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
This booklet defines scoliosis and provides information

about how it is diagnosed and treated in children and adolescents. You may be interested in contacting one or more of

the organizations referenced at the end of the booklet for

more information. 

What Is Scoliosis? 

Scoliosis is a musculoskeletal disorder in which there is a

sideways curvature of the spine, or backbone. The bones

that make up the spine are called vertebrae. Some people

who have scoliosis require treatment. Other people, who

have milder curves, may only need to visit their doctor for

periodic observation. The section starting on page 7, “Does

Scoliosis Have To Be Treated? What Are the Treatments?”

describes how doctors decide whether or not to treat scoliosis.

Who Gets Scoliosis?

People of all ages can have scoliosis, but this booklet focuses on children and adolescents. Of every 1,000 children, 3

to 5 develop spinal curves that are considered large enough

to need treatment. Adolescent idiopathic scoliosis (scoliosis

of unknown cause) is the most common type and occurs

after the age of 10. Girls are more likely than boys to have

this type of scoliosis. Since scoliosis can run in families, a

child who has a parent, brother, or sister with idiopathic

scoliosis should be checked regularly for scoliosis by the

family physician. 

Scoliosis in Children and Adolescents

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2
Idiopathic scoliosis can also occur in children younger than

10 years of age, but is very rare. Early onset or infantile

idiopathic scoliosis occurs in children less than 3 years old.

It is more common in Europe than in the United States.

Juvenile idiopathic scoliosis occurs in children between the

ages of 3 and 10.

What Causes Scoliosis?

In 80 to 85 percent of people, the cause of scoliosis is

unknown; this is called idiopathic scoliosis. Before concluding that a person has idiopathic scoliosis, the doctor looks for

other possible causes, such as injury or infection. Causes of

curves are classified as either nonstructural or structural.

• Nonstructural (functional) scoliosis—A structurally

normal spine that appears curved. This is a temporary, changing curve. It is caused by an underlying

Scoliosis in Children and Adolescents

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condition such as a difference in leg length, muscle

spasms, or inflammatory conditions such as appendicitis. Doctors treat this type of scoliosis by correcting the underlying problem.

• Structural scoliosis—A fixed curve that doctors treat

case by case. Sometimes structural scoliosis is one

part of a syndrome or disease, such as Marfan’s syndrome, an inherited connective tissue disorder. In

other cases, it occurs by itself. Structural scoliosis

can be caused by neuromuscular diseases (such as

cerebral palsy, poliomyelitis, or muscular dystrophy),

birth defects (such as hemivertebra, in which one side

of a vertebra fails to form normally before birth),

injury, certain infections, tumors (such as those

caused by neurofibromatosis, a birth defect sometimes associated with benign tumors on the spinal

column), metabolic diseases, connective tissue disorders, rheumatic diseases, or unknown factors 

(idiopathic scoliosis). 

How Does the Doctor Diagnose Scoliosis?

The doctor takes the following steps to evaluate a patient

for scoliosis: 

• Medical history—The doctor talks to the patient 

and the patient’s parent or parents and reviews the

patient’s records to look for medical problems that

4
might be causing the spine to curve, for example,

birth defects, trauma, or other disorders that can be

associated with scoliosis.

• Physical examination—The doctor looks at the

patient’s back, chest, pelvis, legs, feet, and skin. The

doctor checks if the patient’s shoulders are level,

whether the head is centered, and whether opposite

sides of the body look level. The doctor also examines the back muscles while the patient is bending

forward to see if one side of the rib cage is higher

than the other. If there is a significant asymmetry

(difference between opposite sides of the body), the

doctor will refer the patient to an orthopaedic spine

specialist (a doctor who has experience treating people with scoliosis). Certain changes in the skin, 

such as so-called café au lait (coffee-with-milk-colored) spots, can suggest that the scoliosis is caused by

a birth defect.

• X-ray evaluation—Patients with significant spinal

curves, unusual back pain, or signs of involvement of

the central nervous system (brain and spinal cord)

such as bowel and bladder control problems need to

have an x ray. The x ray should be done with the

patient standing with his or her back to the x-ray

machine. The view is of the entire spine on one long

(36-inch) film. Occasionally, doctors ask for more

tests to see if there are other problems.

Scoliosis in Children and Adolescents

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• Curve measurement—The doctor measures the

curve on the x-ray image. He or she finds the vertebrae at the beginning and end of the curve and measures the angle of the curve (see “Curve Patterns”

diagram, page 3). Curves that are greater than 20

degrees require treatment, as described on page 7.

Doctors group curves of the spine by their location, shape,

pattern, and cause. They use this information to decide how

best to treat the scoliosis.

• Location—To identify a curve’s location, doctors find

the apex of the curve (the vertebra within the curve

that is the most off-center); the location of the apex is

the “location” of the curve. A thoracic curve has its

apex in the thoracic area (the part of the spine to

which the ribs attach). A lumbar curve has its apex

in the lower back. A thoracolumbar curve has its

apex where the thoracic and lumbar vertebrae join

(see “Normal Spine” diagram, page 2).

• Shape—The curve usually is S- or C-shaped. 

• Pattern—Curves frequently follow patterns that 

have been studied in previous patients (see “Curve

Patterns” diagram). The larger the curve is, the more

likely it will progress (depending on the amount of

growth remaining). 

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Does Scoliosis Have To Be Treated? 

What Are the Treatments?

Many children who are sent to the doctor by a school scoliosis screening program have very mild spinal curves that

do not need treatment. When a child does need treatment,

the doctor may send him or her to an orthopaedic spine

specialist.

The doctor will suggest the best treatment for each patient

based on the patient’s age, how much more he or she is likely to grow, the degree and pattern of the curve, and the type

of scoliosis. The doctor may recommend observation, bracing, or surgery.

• Observation—Doctors follow patients without treatment and re-examine them every 4 to 6 months

when the patient is still growing (is skeletally immature) and has an idiopathic curve of less than

25 degrees.

• Bracing—Doctors advise patients to wear a brace to

stop a curve from getting any worse when the

patient:

— is still growing and has an idiopathic curve that is

more than 25 to 30 degrees; 

— has at least 2 years of growth remaining, has an

idiopathic curve that is between 20 and 29

degrees, and, if a girl, has not had her first

menstrual period; or

Scoliosis in Children and Adolescents

7
— is still growing and has an idiopathic curve

between 20 and 29 degrees that is getting worse.

As a child nears the end of growth, the indications for

bracing will depend on how the curve affects the

child’s appearance, whether the curve is getting

worse, and the size of the curve.

• Surgery—Doctors advise patients to have surgery to

correct a curve or stop it from worsening when the

patient is still growing, has a curve that is more than

45 degrees, and has a curve that is getting worse.

Are There Other Ways To Treat Scoliosis?

Some people have tried other ways to treat scoliosis, including manipulation by a chiropractor, electrical stimulation,

dietary supplements, and corrective exercises. So far, studies

of the following treatments have not been shown to prevent

curve progression, or worsening:

• Chiropractic manipulation 

• Electrical stimulation 

• Nutritional supplementation 

• Exercise—Studies have shown that exercise alone

will not stop progressive curves. However, patients

may wish to exercise for the effects on their general

health and well-being.

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Which Brace Is Best?

The decision about which brace to wear depends on the type

of curve and whether the patient will follow the doctor’s

directions about how many hours a day to wear the brace. 

There are two main types of braces. Braces can be custommade or can be made from a prefabricated mold. All must 

be selected for the specific curve problem and fitted to each

patient. To have their intended effect (to keep a curve from

getting worse), braces must be worn every day for the full

number of hours prescribed by the doctor until the child

stops growing. 

• Milwaukee brace—Patients can wear this brace to

correct any curve in the spine. This brace has a

neck ring. 

• Thoracolumbosacral orthosis (TLSO)—Patients

can wear this brace to correct curves whose apex is at

or below the eighth thoracic vertebra (see “Normal

Spine” diagram). The TLSO is an underarm brace,

which means that it fits under the arm and around

the rib cage, lower back, and hips. 

Scoliosis in Children and Adolescents

9
If the Doctor Recommends Surgery, 

Which Procedure Is Best?

Many surgical techniques can be used to correct the curves

of scoliosis. The main surgical procedure is correction, stabilization, and fusion of the curve. Fusion is the joining

of two or more vertebrae. Surgeons can choose different

ways to straighten the spine and also different implants to

keep the spine stable after surgery. (Implants are devices

that remain in the patient after surgery to keep the spine

aligned.) The decision about the type of implant will depend

on the cost; the size of the implant, which depends on the

size of the patient; the shape of the implant; its safety; and

the experience of the surgeon. Each patient should discuss

his or her options with at least two experienced surgeons.

Patients and parents who are thinking about surgery may

want to ask the following questions:

• What are the benefits from surgery for scoliosis?

• What are the risks from surgery for scoliosis?

• What techniques will be used for the surgery?

• What devices will be used to keep the spine stable

after surgery?

• Where will the incisions be made?

• How straight will the patient’s spine be after surgery?

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• How long will the hospital stay be?

• How long will it take to recover from surgery?

• Is there chronic back pain after surgery for scoliosis?

• Will the patient’s growth be limited?

• How flexible will the spine remain?

• Can the curve worsen or progress after surgery?

• Will additional surgery be likely?

• Will the patient be able to do all the things he or she

wants to do following surgery?

Can People With Scoliosis Exercise?

Although exercise programs have not been shown to affect

the natural history of scoliosis, exercise is encouraged in

patients with scoliosis to minimize any potential decrease

in functional ability over time. It is very important for all

people, including those with scoliosis, to exercise and remain

physically fit. Girls have a higher risk than boys of developing osteoporosis (a disorder that results in weak bones that

can break easily) later in life. The risk of osteoporosis is

reduced in women who exercise regularly all their lives; and

weight-bearing exercise, such as walking, running, soccer,

and gymnastics, increases bone density and helps prevent

Scoliosis in Children and Adolescents

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osteoporosis. For both boys and girls, exercising and participating in sports also improves their general sense of wellbeing.

What Are Researchers Trying To Find Out

About Scoliosis?

Researchers are looking for the cause of idiopathic scoliosis.

They have studied genetics, growth, structural and biochemical alterations in the discs and muscles, and central

nervous system changes. The changes in the discs and 

muscles seem to be a result of scoliosis and not the cause.

Scientists are still hopeful that studying changes in the central nervous system in people with idiopathic scoliosis may

reveal a cause of this disorder. 

Researchers continue to examine how a variety of braces,

surgical procedures, and surgical instruments can be used to

straighten the spine or to prevent further curvature. They

are also studying the long-term effects of a scoliosis fusion

and the long-term effects of untreated scoliosis. 

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Where Can People Get More Information

About Scoliosis?

■ National Scoliosis Foundation

5 Cabot Place

Stoughton, MA 02072

Phone: 617–341–6333 or 

800–NSF–MYBACK (673–6922) (free of charge)

Fax: 617–341–8333

E-mail: scoliosis@aol.com 

This is a nonprofit voluntary organization that provides

pamphlets, a newsletter, and other information materials

on childhood and adult scoliosis. The foundation also

provides support group information and lists of physicians in each state who specialize in scoliosis.

■ The Scoliosis Association, Inc.

P.O. Box 811705

Boca Raton, FL 33481–1705

Phone: 561–991–4435 or 800–800–0669 (free of charge) 

Fax: 561–994–2455

E-mail: normlipin@aol.com

www.scoliosis-assoc.org 

This association publishes a quarterly newsletter and

pamphlets. A single copy of their fact sheet is available

free by sending a self-addressed, stamped envelope. The

association also provides information about local chapters and support groups.

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■ Scoliosis Research Society

611 East Wells Street

Milwaukee, WI 53202

Phone: 414–289–9107

Fax: 414–276–3349

E-mail: goulding@aaos.org

www.srs.org

This is a professional organization for orthopaedic surgeons interested in scoliosis. It provides pamphlets about

the diagnosis and treatment of scoliosis. Their free pamphlet is offered on their Web site as well as through the

mail. The society also can provide referrals to physicians.

■ American Physical Therapy Association 

Scoliosis

1111 North Fairfax Street

Arlington, VA 22314–1488

E-mail: svcctr@apta.org

www.apta.org

To obtain a copy of the American Physical Therapy Association’s brochure about scoliosis, in English or Spanish,

write to the above address or visit their Web site.

Acknowledgments

The NIAMS gratefully acknowledges the assistance of Dr. Stuart Weinstein, Professor of Orthopedic Surgery, University of Iowa, in the preparation and review of this

booklet, and Dr. John Lonstein, Department of Orthopaedic Surgery, University of

Minnesota, and Dr. James Panagis, NIAMS, in the review of this booklet.

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The mission of the National Institute of Arthritis and 

Musculoskeletal and Skin Diseases (NIAMS), a part of the

National Institutes of Health (NIH), is to support research

into the causes, treatment, and prevention of arthritis and

musculoskeletal and skin diseases, the training of basic and

clinical scientists to carry out this research, and the dissemination of information on research progress in these diseases.

The National Institute of Arthritis and Musculoskeletal and

Skin Diseases Information Clearinghouse is a public service

sponsored by the NIAMS that provides health information

and information sources. Additional information can be

found on the NIAMS Web site at www.niams.nih.gov.
U.S. Department of Health and Human Services

Public Health Service

National Institutes of Health

National Institute of Arthritis and 

Musculoskeletal and Skin Diseases

NIH Publication No. 01–4862

July 2001