What is Scoliosis?

Dr. Clayton J Stitzel
Factually accurate & verified by
Dr. Clayton J. Stitzel
Last updated on
July 15, 2020

Idiopathic scoliosis, which makes up over 80% of all cases, has no known cause — but that doesn't mean we don't know much about the condition or its treatment. Below is an up-to-date summary of facts to answer the question of what is scoliosis.

Idiopathic scoliosis appears to be primarily a "neuro-hormonal condition" driven by genetic predisposition. The three-dimensional change in the spine's alignment — the spine curvature — is the primary and most obvious symptom of the condition. That is why scoliosis should be considered a whole-body condition that requires a comprehensive treatment for scoliosis. This is one of the great obstacles that has challenged health care professionals worldwide for centuries.

How Common Is Scoliosis?

Scoliosis occurs most often in children age 10 to 14, affecting females 7 times more frequently than males. Scoliosis is a broad term that may describe a spinal curve of 10 degrees or higher. The curve occurs at different points of the spine in each case but generally develops in one of four common curve patterns. It may or may not tilt the pelvis.

Scoliosis causes a bent spine, curvy spine, or even an S-shaped spine. Scoliosis may only have a curve on one side, elevate one shoulder, or make one shoulder blade prominent, but it is not life-threatening after the age of 5, prompting many doctors to conclude it does not require treatment.

The spine condition is progressive in many cases; however, we know more about and how to treat scoliosis symptoms now than ever before.

What Is the Main Cause of Scoliosis?

Is scoliosis hereditary? Is scoliosis genetic? Curvature of the spine (scoliosis meaning "crookedness") has been documented in medical records dating back to 450 BC and, until recently, has been considered and treated exclusively like an abnormal curvature of the spine — but a growing and overwhelming volume of evidence supports curves of the spine are so much more than just a curved spine.

Adolescent idiopathic scoliosis stems from a family history of genetic variant patterns that affect neurotransmitter production and hormone metabolism which combine to create an incorrect "posture memory" of spine alignment during periods of rapid growth. These clinical findings are the suspected causes of scoliosis and result in a twisted spine. Non-invasive, home-collected saliva and urine samples can be analyzed to help determine if scoliosis in children who are still growing could become severe or possibly get worse as they grow.

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What Scoliosis Looks Like

Scoliosis patients lose some degree of curvature in their necks, resulting in forward head posture. The sideways curve of a scoliosis spine is greater than 10 degrees. It causes the rib cage to twist and the normal curve of the spine to flatten. A scoliosis curve looks flat where the spine is normally curved when viewed from the front or side. It appears twisted where there is typically no twist when viewed from the top down.

Understanding the faulty "postural memory" of a scoliosis spine on an x-ray is similar to watching the wind outside a window; you cannot actually see the wind, yet you can tell the direction and force in which it is blowing by the way it affects the grass, trees, and leaves.

There are four types of scoliosis:


Idiopathic Scoliosis

The most common type of scoliosis, idiopathic means of unknown origin. Depending on the age of onset, it may be infantile (birth to 3 years), juvenile (age 3 to 8), adolescent (age 9 to 18), or adult scoliosis (after age 18)


Congenital Scoliosis

A rare form of scoliosis, affecting one in 10,000 babies in utero


Neuromuscular or Syndromic Scoliosis

Developed by children who have neuromuscular disorders like muscular dystrophy or cerebral palsy


Degenerative Scoliosis

Adult scoliosis; a degenerative condition that typically occurs after age 40

What Are the Early Signs of Scoliosis?

Catching scoliosis early is critical because once a curve measures 25 degrees or more, there is a 68 percent chance scoliosis may get worse. You may detect signs of mild idiopathic scoliosis in its early stages by observing five different points on your child's body.

  • Eye line Are your child's eyes level or is the eye line tilted?
  • Shoulder level Do your child's shoulders hang evenly or is one higher than the other?
  • Hips Are your child's hips even or is one hip higher or more pronounced?
  • Forward head posture When you look from the side, does your child's mid-ear line up with the tip of the shoulder?
  • Head to hip line Would a line from the center of your child's eyes line up horizontally to the center of the hips?

You may also use a detection method called Adam's forward bend test. Have your child do a full forward bend to see if the rib cage (shoulder blade) sticks out on one side, especially on the right side. If your child appears out of line using any of these views, he or she may have a spinal curvature. A trained posture analysis expert will help you determine if your child needs early-stage scoliosis intervention. Make sure any evaluation for scoliosis includes a standing full spine x-ray.

Scoliosis often is associated with family history. Although progressive scoliosis of the spine afflicts girls more often, your boys will be just as likely to develop it. Remind your pediatrician to check your children for scoliosis, especially if it runs in the family. Many parents are opting for genetic testing for scoliosis in children who are still growing. This very simple and safe saliva test may predict if patients are at higher risk for severe scoliosis, differentiate different types of scoliosis, determine their need for treatment, and possibly even predict symptoms of scoliosis.

Family history of scoliosis? Click here to learn how to break the cycle.

What Will Happen If Scoliosis Is Not Treated?

Understanding that adolescent idiopathic scoliosis is a neurological-hormonal condition rooted a genetic predisposition is vital when it comes to scoliosis treatments. Usually, a doctor who only measures a Cobb angle will recommend no treatment — just observation — for a curve measuring less than 24 degrees, hoping it won't get any worse. They may recommend a rigid spinal brace for up to 23 hours a day for a curve measuring 25 to 39 degrees. Fusion surgery may be recommended for people with curves measuring over 50 degrees using the Cobb angle.

All three options may be limiting and frustrating to you and your child. These are not the only options, nor the best. The ScoliSMART Clinics doctors prefer to retrain the brain and the body to react in a way that corrects scoliosis. We don't wait for a curve to get worse, use rigid braces, or recommend surgery unless it is a last resort.

Don't Wait & Watch Mild Scoliosis

ScoliSMART Clinics doctors never recommend waiting and watching because all large curves begin as small curves. Scoliosis is a chronic, progressive disease. It often progresses throughout childhood and into adulthood, so we opt to start lifelong muscle retraining through the Early Stage Scoliosis Intervention (ESSI) program as soon as your child's curve is detected.

ESSI is a one-week "Small Curve Camp" program, followed by a home exercise program. Thousands of children have had their scoliosis curve reduced and progression stopped with this muscle retraining.

what is scoliosis early stage intervention

The Cobb Angle

Historically, doctors have used a measurement called a Cobb angle to determine the degree of scoliosis. The doctors at ScoliSMART Clinics use this measurement along with a gravitational comparison line to further understand the biomechanics of a patient's curvature. The Cobb angle measurement only shows the degree of lateral bending on an x-ray. Highly specialized genomic and clinical testing can provide additional personalized data to determine the root causes of childhood scoliosis and determine if it will remain mild scoliosis or possibly progress to severe scoliosis.

Plus, you need to consider the impact of scoliosis on your child or yourself before considering treatment. How does it affect breathing, digestion, mobility, daily activities, and psychological health? How much back pain is involved? Often, patients don't have pain or symptoms of scoliosis.

Why We Don't Support Full-Time Scoliosis Bracing

Bracing is commonly recommended for children with a scoliosis curve measuring 25 to 40 degrees. We do not support the dated treatment of rigid scoliosis bracing for 23 hours a day or at nighttime, nor do we support newer/softer braces. Here are a few reasons why:

  • Scoliosis braces cause the muscles to weaken or atrophy because they aren't used
  • The joints around the spine need movement, or other degenerative issues may develop
  • The brace stresses the ribs and often creates or worsens a rib-hump deformity
  • Bracing is not proven to stop scoliosis progression or reduce the need for scoliosis surgery
  • Studies show that bracing significantly decreases lung function, causing respiratory distress
  • Respiratory distress causes headaches, anxiety, sleep problems, and cognitive dysfunction

Hard braces and softer "dynamic corrective braces" often cause pain, which is disturbing since many children have no scoliosis pain before bracing. Since all of the corrective benefits of bracing fade as soon as your child stops wearing the brace, it seems counterintuitive to risk the side effects and pain for the possibility of a short-term solution.

Scoliosis Surgery

Spinal fusion is rarely recommended for children who have a curve measuring less than 50 degrees. Even then, surgery is risky, comes with many complications (short- and long-term), and is almost never medically necessary because of heart or lung compromise. Typically, it is primarily recommended to reduce the cosmetic spine deformity. Despite the risks, though, about 20,000 children and teens have spinal fusion annually.

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German researchers in 2002 found that 40 percent of people who had surgery were severely handicapped within 17 years. A study done at the University of Iowa found that adults who don't have scoliosis surgery have a much better quality of life. In 2007, another report stated that no studies prove that scoliosis patients get long-term benefits from surgery.

What is scoliosis related to spinal fusion

While doctors may debate statics, most agree that the hardware used in spinal fusions cannot last 60+ years. The ScoliSMART Clinics doctors only recommend surgery in rare cases of an extreme curvature because research cannot prove the benefits of spinal surgery and we have talked to thousands of adults who developed lifelong chronic pain after surgery (many of whom had no pain prior to surgery).

Do Orthopedic Specialists Support the ScoliSMART Approach?

Our goal is to help families catch scoliosis early so children can start muscle retraining exercises that halt progression and reduce curvature. Early Stage Scoliosis Intervention is the answer; however, we help children with curves measuring over 25 degrees and adults, too.

Need more information about the ScoliSMART Approach?

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Meet the ScoliSMART Doctors

Click the images below to get more information about the ScoliSMART Doctors.

Dr. Clayton J Stitzel

Dr. Clayton J. Stitzel

Dr. Mark Morningstar

Dr. Mark Morningstar

Dr. Brian T Dovorany

Dr. Brian T. Dovorany

Dr. Aatif Siddiqui

Dr. Aatif Siddiqui