Scoliosis full analysis: From basic understanding to professional assessment

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1. What is Scoliosis? Are all curves Scoliosis?

Scoliosis is a complex three-dimensional spinal deformity, where the spine curves to one side more than 10 degrees, accompanied by three-dimensional deformation involving spinal rotation. It is not just "poor posture," but a spinal deformity that can affect appearance, function, and even health.

Scoliosis is specifically defined by the Scoliosis Research Society (SRS) as a three-dimensional spinal deformity where the spine curves to the side with an angle greater than 10° when measured using the Cobb method on a standing full-spine X-ray. This deformity involves not only lateral bending in the coronal plane (front and back direction) but also changes in sagittal plane (side view) curvature and rotation of vertebral bodies on the horizontal plane, forming a complex "three-dimensional sequence abnormality." Typical cases of scoliosis involve deformities in both the spine and rib cage, including characteristic features like rib hump.

Around 3-5% of the global population is affected by scoliosis, with adolescents, especially girls aged 10-18, being the most affected group. If parents or siblings have scoliosis, the child's risk of developing it increases by 3-5 times, so children with a family history should be more vigilant during adolescence!

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

2. Why does Scoliosis occur? Analysis of the four common causes

The causes of scoliosis are complex and mainly categorized into four types, understanding which can help us determine if further examination or treatment is needed.

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

• The cause is not clear, possibly related to genetics, hormones, or neurological abnormalities.

• It commonly occurs in adolescents (10-18 years old), especially in girls during rapid growth periods.

(2) Congenital Scoliosis (present at birth)

• Due to abnormal spinal development during fetal period (e.g., hemivertebrae, vertebral fusion).

• It is usually detected in infancy or early childhood and may require early intervention.

(3) Neuromuscular Scoliosis (associated with other diseases)

• Caused by conditions like cerebral palsy, muscular dystrophy, where muscles cannot support the spine properly.

• These types of curves usually progress rapidly and require close monitoring.

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

• Due to intervertebral disc degeneration, osteoporosis leading to unstable spinal structure.

• It may be accompanied by symptoms like back pain, nerve compression, etc.

Additionally, poor posture, leg length discrepancy, etc., can also lead to temporary "functional scoliosis," where there is no spinal deformity, only compensatory changes in muscles, bones, etc. Therefore, physical therapy, shoe inserts, etc., can effectively improve the condition.

3. What are the types of Scoliosis?

Scoliosis can be classified based on the shape, location, and direction of the curve, with different types requiring different treatment strategies.

By curve shape

• C-curve (single direction curve, 70%)

• S-curve (two curves in opposite directions, 30%)

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By Spinal Level

Based on severity (Cobb angle)

• Mild (10-20 degrees): Low risk of progression; observation + Schroth scoliosis exercises + physical therapy

• Moderate (20-40 degrees): Risk of worsening in adolescents; may require bracing + Schroth scoliosis exercises + physical therapy

• Severe (40-50 degrees): Potential impact on cardiopulmonary function; may need bracing + Schroth scoliosis exercises + physical therapy, possible surgery

• Very Severe (>50 degrees): High risk of chest deformity; may need bracing + Schroth scoliosis exercises + physical therapy, possible surgery

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Parents Alert⚠️**! If your child shows the following signs, early examination is necessary!**

Including:

• One shoulder higher than the other

• Asymmetrical back

• Protruding ribs

Who is more likely to worsen?

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

Alert⚠️: During the "rapid growth period" (such as adolescence), the patient's condition can worsen at a rate of over 1 degree per month, 12 degrees per year. Therefore, it is recommended to have a check-up every 6 months to prevent sudden worsening!

4. How to evaluate Scoliosis? What examinations do doctors and physical therapists perform?

The assessment of scoliosis includes 1) history taking, 2) physical examination, and 3) imaging studies in three steps to ensure an accurate diagnosis.

(1) Key points in history taking

• Family history (whether parents/siblings have scoliosis): 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

• Associated symptoms: Pain (reported by about 23% of AIS patients), difficulty breathing, neurological symptoms, etc.

• Menstrual history: High-risk period around menarche

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(2) Physical examination

• "Adam's Test": Measures ATR (Angle of Trunk Rotation) to observe if there is asymmetric protrusion in the back

• Scapular position and prominence (often more prominent on the convex side)

• Shoulder height, pelvic balance

• Leg length equality (discrepancy may lead to compensatory scoliosis)

• Deviation from spinal midline

• Breathing pattern

• Core strength assessment

• Fascial tension level

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(3) Imaging studies

• Full-spine standing X-ray (Golden Standard): Measures Cobb angle, assesses skeletal maturity (Risser Scale)

• MRI (in specific cases): Screens for spinal cord abnormalities

What can parents do?

🔍 Regularly observe your child's posture (e.g., check for symmetry during bathing)
🏥 If abnormalities are noticed, seek evaluation from a professional physical therapist early!

In summary: Key points about scoliosis

✅ Not all spinal curves are scoliosis (requires Cobb angle >10 degrees)
✅ Highest risk in adolescent girls, especially during rapid growth periods
✅ Mild curves can be observed, moderate to severe may require bracing
✅ Early detection + appropriate treatment can effectively control progression

Through early detection, accurate assessment, and personalized intervention, we can significantly improve the long-term prognosis of scoliosis patients, reduce the need for surgery, and enhance quality of life. Regular follow-up (every 4-12 months adjusted based on risk) is crucial for monitoring progression. We hope this article helps you understand scoliosis better! If you have any questions, feel free to consult a professional physical therapist.