What is Scoliosis? Scoliosis Symptoms and Treatment Methods

Scoliosis is a spinal disorder characterized by a sideways curvature of the spine. This condition, which is usually noticed during adolescence, can range from mild curvatures to significant deformities. Early diagnosis of scoliosis is of great importance for the success of the treatment process. Symptoms of scoliosis include back and waist pain, asymmetry in the shoulders and posture disorders. Different scoliosis treatment methods, such as physical therapy, use of corsets and surgery, are planned according to the degree of the disease.

What is Scoliosis (Spinal Curvature)?

Scoliosis (curvature of the spine) is a condition in which the spine, which should be straight when viewed from the front, abnormally curves sideways in a C- or S-shaped curve. This condition, which usually occurs during growth spurts around age 10 and later, is frequently seen in adolescents and can be seen in the chest (thorax) or lumbar (lumbar) regions of the spine. While mild cases usually do not cause symptoms, progressive curvatures can put pressure on the rib cage and cause breathing difficulties.

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What are the Symptoms of Scoliosis (Spinal Curvature)?

Scoliosis is known as a sideways curvature of the spine in an S or C shape. This curvature sometimes turns forward or backward. It usually progresses without causing pain, but the curvature can lead to muscular imbalances, which can create a bulge in the back, asymmetry between the shoulders or hips, and muscle tension. Additionally, the lateral curvature of the spine causes rotation of the rib cage, which can make breathing difficult. The symptoms of scoliosis are listed below:

• Curvature of the spine to the right or left
• Back, waist and shoulder pain
• Shorthness Of Breath
• Difficulty walking
• Difficulty standing upright
• Visible curve
• Curvature in the hips and shoulders

What are the Causes of Scoliosis (Spinal Curvature)?

Although the causes of scoliosis (curvature of the spine) are not fully known, many different factors may be effective in the development of the disease. While the cause of scoliosis can be clearly identified in some individuals, in other cases it is completely idiopathic; that is, the cause is unknown. Many factors such as genetic predisposition, congenital anomalies, muscle and nerve diseases may play a role in the emergence of scoliosis. The main causes of scoliosis are listed below:

• Genetic Factors: A family history of scoliosis increases the risk of developing the disease. Genetic transmission plays an important role, especially in idiopathic scoliosis.
• Cerebral Palsy: This neurological disease, which affects muscle control, can lead to curvature of the spine due to spasticity.
• Muscular Dystrophy: Muscle weakness and loss can affect the muscles that support the spine, causing scoliosis.
• Congenital Causes: A baby may be born with scoliosis due to impaired spinal development in the womb.
• Infections: Certain spinal infections, especially tuberculosis, can weaken the spinal structure and lead to curvature.
• Tumors: Tumors around the spine can cause structural changes and scoliosis by creating pressure.
• Marfan Syndrome: This genetic disorder, which weakens connective tissues, can affect spinal stability and lead to curvature.
• Down Syndrome: Low muscle tone can reduce spinal support and increase the risk of scoliosis.
• Spinal Cord Injury: Spinal cord damage caused by trauma can disrupt the balance of the spine and lead to curvature.
• Muscle and Nerve Diseases: Conditions such as spinal muscular atrophy (SMA) can weaken the muscles that support the spine and cause scoliosis.

How Is Scoliosis Diagnosed?

The process of diagnosing scoliosis begins with the patient's growth stage, clinical history, and detailed physical examination. A neurological evaluation is then performed. Muscle weakness, sensory changes, and reflex abnormalities are tested. The Adams Forward Bend Test, a frequently used test in physical examination, detects "S" or "C" shaped curvatures and rib protrusions in the spine. Weight-bearing, standing anteroposterior (AP) and lateral x-rays of the entire spine are used for visualization. With this x-ray, the scoliosis curvature is measured with the Cobb angle system and the degree of the curvature is determined. While the progression of the curve is monitored in growing children, radiological control is recommended every 6–12 months in case of continued growth. If an underlying spinal cord or nervous system disease is suspected, a radiation-free MRI scan may be added.

What are the Degrees of Scoliosis?

Scoliosis occurs when the spine curves sideways. It is divided into different levels according to the degree of curvature. Scoliosis cases are divided into four main groups: mild, moderate, severe and very severe scoliosis. The degrees of scoliosis are listed below:

• 10-25 Degrees (Mild Scoliosis)
• 25-40 Degrees (Moderate Scoliosis)
• 40+ Degrees (Severe Scoliosis)
• 80+ Degrees (Very Severe Scoliosis)

Mild Scoliosis

Mild scoliosis is a condition in which the spine curves between 10 and 25 degrees of Cob angle, and is usually asymptomatic and managed with monitoring. These types of curvatures frequently occur during the pubertal growth spurt and often do not require serious treatment; follow-up with physical examination and x-rays every six months is recommended, especially until growth is complete. Scoliosis braces are recommended if the curve exceeds 25 degrees as bones continue to grow; however, they are not usually used in mild scoliosis.

Moderate Scoliosis

Moderate scoliosis refers to a condition in which the spinal curvature is between 25 and 40 degrees of Cobb angle; that is, the spine is bent sideways by approximately 25 to 40 degrees. At this stage, most patients do not yet require surgery; the main goal is to stop the progression of the curve. Especially in growing children, age, the accompanying developmental rate and the maturation status of the spine are the basic criteria. Treatment usually involves the use of a corset and physical therapy exercises; the corset is used not only to correct the curvature but also to prevent its progression. With exercise and follow-up, it is possible to achieve a stable course in many patients, thus avoiding surgical intervention. This approach maintains the mechanical balance of the spine and provides positive effects on quality of life by preventing deterioration of lung functions.

Severe Scoliosis

Severe scoliosis is a continuous lateral curvature of the spine that is 40 degrees or more and is characterized by both lateral and rotational deformation of the vertebrae, which are its building blocks. At this degree of curvature, the rib cage and lungs can be severely affected; as a result, breathing difficulties, chest pain, and even impaired heart function can occur. In this type of scoliosis that progresses rapidly during childhood and adolescence, the use of a brace can stabilize the curvature until the growth process is completed; however, it does not prevent the curvature from returning. Surgical interventions applied in severe cases aim to stop the progression of the curve and maintain balance through spinal fusion, which joins the vertebrae using pedicle screws and metal rods, or dynamic methods that preserve movement. Factors such as curvature angle, growth status and flexibility of the spine determine the preferred method. After surgery, most patients can resume daily activities within 3–6 months. Early diagnosis, regular follow-up during growth, and appropriate treatment approaches are critical to prevent long-term adverse effects of severe scoliosis.

Very Severe Scoliosis

Very severe scoliosis is a condition that has a Cobb angle of 80 degrees or more in the spine and has a high risk of progression, often causing shortness of breath, back pain, and impaired chest cavity function. Curvatures at this level can affect respiratory and cardiac functions by putting pressure on the rib cage as the spine bends both sideways and rotationally. In childhood, while bones are still growing, severe curves between 40 and 65 degrees can be corrected with surgical procedures such as dynamic hernia surgery and spinal fusion, which both preserve range of motion and stop the progression of the curve. In adults, after bone development is completed, curves over 50 degrees are usually stabilized with spinal fusion and progression is prevented. In these surgical methods, the spine is straightened using screws, rods and necessary bone grafts and the curvature is prevented from getting worse.

What are the Classifications of Scoliosis?

Scoliosis is a musculoskeletal disease. While a healthy spine lies in a straight line when viewed from behind, in individuals with scoliosis the spine may exhibit a curve resembling the letter "C" or "S.” The classifications of scoliosis are listed below:

Idiopathic Scoliosis

“Idiopathic scoliosis,” which is frequently seen in adolescence (ages 10–18), is a condition in which the spine develops a sideways curvature in the shape of an “S” or “C” when viewed from the side, and there is no definitive information about its cause. Although genetic predisposition plays a role (e.g., certain gene variants), it interacts in complex ways with environmental factors. It is more common in girls than in boys, and the risk of progression is higher.

Congenital Scoliosis (Scoliosis from Birth)

Congenital scoliosis is the side curvature of the spine that occurs congenitally as a result of an anomaly in the development of the spine while the baby is in the womb. The treatment approach is planned depending on the degree of the curvature and the child's growth potential. While mild curvatures are closely monitored, methods such as bracing, growth rods or surgery may be applied in progressive cases.

Neuromuscular Scoliosis

Neuromuscular scoliosis is a type of scoliosis that develops due to dysfunction of the muscular and nervous system that supports the spinal structure, and is especially observed in individuals with neuromuscular diseases such as cerebral palsy or muscular dystrophy. In these cases, the spine becomes abnormally curved to the side in an S or C shape as a result of the muscles not being able to properly support the spine. The curvature can progress and affect lung function, causing breathing problems. To prevent the progression of the curvature, patients, especially those in adolescence, should be followed regularly with physical examinations, imaging, and, if necessary, with braces. In severe cases, surgical intervention may be necessary.

What is the Cobb Angle Method?

The Cobb angle method, which is considered the “gold standard” for determining the degree of curvature of the spine, is calculated by measuring the angle between the perpendicular lines drawn on the upper and lower plates of the end vertebrae where the curvature begins and ends on spinal X-rays. The angle determined by this method is used to evaluate the severity of scoliosis and to create a follow-up and treatment plan.

What are the Types of Scoliosis?

Scoliosis is a condition characterized by a sideways S or C-shaped curvature of the spine and is usually diagnosed when the diameter measurement is greater than 10 degrees. The types of scoliosis are listed below:

C-Shaped Scoliosis

C-shaped scoliosis refers to a unilateral side curvature of the spine that resembles the letter “C” and is usually seen in the thoracic or lumbar region. On X-ray, this type of curvature is clearly identified as the spine forming a single curve in one direction axis, and when evaluated with basic measurements in medicine (curvature over 10 degrees), scoliosis is diagnosed. In this type of scoliosis, asymmetry at the shoulder or hip level, bending of the trunk, and mild or progressive pain are possible. The treatment plan takes into account the degree of curvature and the patient's growth status; regular follow-up, physiotherapy and special exercise programs (e.g. Schroth exercises for C-shaped scoliosis) are recommended in the initial phase. If the curvature progresses rapidly or has reached a serious size, conservative methods (corrigerative corsets) or, in advanced stages, surgical options are considered for stabilizing and straightening the spine. The importance of C-shaped scoliosis is that early diagnosis and individualized treatment can minimize the negative effects on both posture and quality of life.

S-Shaped Scoliosis

S-Shaped scoliosis is a type of structural disorder in which the spine forms side-by-side curvatures in the form of the letter S in both the thoracic and lumbar regions when viewed from behind. Diagnosis is usually made by detecting an asymmetrical S or C shape on x-ray; the angle value of this curvature is accepted as 10 degrees or more. It has been stated that “Adolescent Idiopathic Scoliosis”, the most common type seen in adolescence, can occur due to familial and genetic effects and is more common especially in girls. S-shaped curves exhibit a more complex structure because they involve both the thoracic and lumbar regions; in this case, lung/rib harmony may be disrupted, and problems such as chronic back pain and appearance deterioration may be observed. When the degree of the curve is below 20 degrees, conservative methods such as medical supervision and physical therapy/corset are preferred, while in cases above 20 degrees and at risk of progression, surgical intervention may be considered. If left untreated, advanced S-shaped scoliosis can strain breathing capacity and lead to health problems such as chronic back/shoulder imbalance.

Thoracic Scoliosis

Thoracic scoliosis is a three-dimensional sideways curvature in the chest (thoracic) region of the spine; this condition most often occurs during the pre-pubertal growth spurt, particularly between the ages of 10 and 18. Unlike the types that start from the waist area alone, the curvature involves rotation with the ribs, which can lead to rib protrusions that are visible from the side.

Lumbar Scoliosis

Lumbar scoliosis is defined as an abnormal sideways S or C-shaped curvature of the spine in the lumbar region. This type of scoliosis is usually diagnosed during the growth spurt after the age of 10 and is often an idiopathic condition. If this curvature progresses, it can lead to physical changes such as back pain, shortness of breath, and asymmetry in the shoulders and hips. A physical examination and often radiological imaging (X‑ray) are used to make the diagnosis; imaging every six months is recommended to monitor the progression of the curve, especially in growing children. Treatment is determined by the degree of curvature, the person's age, and growth potential.

Thoracolumbar Scoliosis

Thoracolumbar scoliosis (an S-shaped curvature of the thoracic and lumbar spine) usually appears in childhood or adolescence, occurring with a growth spurt and causing the spine to curve sideways and frontally, with the vertebrae also rotating. The risk of progression of the curve is determined by evaluating the magnitude of the curve and the child's bone maturation status. For moderate curves during the growth process, monitoring with X-ray checks is usually sufficient; for moderate or severe curves, a supportive brace (13–18 hours per day) can halt this process. Once bone maturation is complete (age 14 in girls, age 16 in boys), bracing treatment is generally not necessary if the curvature is not progressing. Thoracolumbar scoliosis, especially in curves greater than 50 degrees, can put pressure on the lungs and cause shortness of breath, so it should be treated with appropriate timing.

Combined Scoliosis

This type of scoliosis is characterized by the presence of multiple curves in different areas of the spine; for example, the upper thoracic curve may merge with the lower lumbar curve. Combined scoliosis is particularly difficult to treat because the curves interact and require a comprehensive, personalized treatment approach.

Structural Scoliosis

Structural scoliosis is a side-to-side curvature of the spine that is rigid and usually involves rotation; this curvature is fixed due to structural changes in the spinal bones and is more common during adolescence. Structural scoliosis is treated with monitoring, bracing, or surgery, taking into account the type and degree of curvature and the patient's bone age.

Functional (Non-Structural) Scoliosis

In functional scoliosis, the spine does not involve actual rotation or bone shape change; instead, muscle imbalances that bend the spine laterally, different leg lengths, inflammatory conditions, or habitual postural disorders play a role. Because this type of scoliosis primarily affects the surrounding musculoskeletal system, not the spinal structure itself, the treatment approach is generally directed at correcting the underlying cause: Strengthening of weak or short muscles through physical therapy, postural training, use of orthopedic foot support if necessary, and elimination of inflammation.

Degenerative Scoliosis

Degenerative scoliosis is a type of spinal curvature that usually occurs after the age of 40 due to the wear and tear of intervertebral discs and joints, osteoporosis, or imbalances of the spine. With age, the discs dry out and thin, and the spinal joints lose their mobility, forming asymmetrical structures and bone protrusions (osteophytes), which can cause the spine to curve to the sides. Symptoms can often include nerve root compression, such as lower back pain, numbness or weakness in the legs; patients may also experience poor posture and muscle imbalances due to the curvature of the spine.

What is the Frequency of Scoliosis?

Scoliosis is one of the most common spinal diseases worldwide. Studies show that approximately 2% to 3% of the population is affected by this disorder. Although scoliosis can be seen in both women and men, it is known to be more common in girls. Furthermore, the risk of progression is significantly higher in girls than in boys. It has been found that the disease tends to progress 8 to 10 times more in girls, especially in cases of adolescent idiopathic scoliosis where the cause is unknown.

When examined according to age groups, it is seen that scoliosis occurs in different types at different periods. Scoliosis is quite rare in infancy and early childhood and is usually defined as congenital scoliosis due to congenital spinal developmental disorders. Adolescent idiopathic scoliosis, the most common form of scoliosis, occurs during adolescence, especially in individuals between the ages of 10 and 18. In adults, age-related degenerative scoliosis attracts attention. Conditions such as wear and tear on the spine over time, disc problems and calcification are among the main causes of scoliosis in this age group. The incidence rate in adults varies between 10% and 15%.

How to Understand Scoliosis?

Scoliosis is usually noticed by significant asymmetry in the back or waist. Particularly in the forward bending test, one of the ribs being higher than the other or the shoulder and hip alignment being unequal are notable factors. Scoliosis symptoms are listed below:

• Visible curvature in the back or waist area
• Inequality in shoulder levels
• Difference in hip heights
• A distinct bulge on one side of the ribs
• Head misalignment relative to the body
• Clothes that do not fit properly
• Fatigue quickly during physical activity
• Discomfort during prolonged standing or sitting

What are the Treatment Methods of Scoliosis (Spinal Curvature)?

The method to be used in the treatment of scoliosis depends on the degree of the curvature, the rate of progression, and the age of the patient. While mild curvatures can be controlled only with regular follow-up and exercise, more advanced levels may require the use of a corset or surgical intervention. Today, both surgical and non-surgical methods are used in the treatment of scoliosis.

Non-Surgical Scoliosis Treatment

When scoliosis is detected in the early stages, the curvature can be controlled without the need for surgery. Among the non-surgical treatment options, the following stand out:

• Regular Follow-up: The most important step in mild curvatures is regular follow-up and observation. The condition of the spine is monitored with x-rays, usually taken every 6 months.
• Exercise and Physical Therapy: Exercise programs and physical therapy practices specifically developed for scoliosis can slow the progression of the curve and reduce pain by strengthening the muscles that support the spine.
• Use of Corset: Corsets, especially recommended for growing children, can fix the curvature by preventing the spine from developing in the wrong position.

Scoliosis Treatment with Surgical Intervention

When the spinal curvature exceeds 40 degrees, surgical intervention may be considered. Surgery is recommended, especially for curvatures over 50 degrees, as they can put pressure on the respiratory and circulatory systems. The two most commonly performed surgical methods are:

• Spinal Fusion: The vertebrae are fixed with metal rods and screws and fused with the help of bone grafts. This procedure stops the progression of scoliosis and corrects the curvature. It is generally a permanent solution for individuals who have completed puberty.
• Expandable Rod System: In this method, which is applied to children in the growing age, special rods that can be adjusted over time are placed in the spine. As the child grows, these rods are lengthened to ensure proper development of the spine.

What are Scoliosis Exercises?

Scoliosis exercises are scientifically based approaches that aim to stop the progression of the curvature of the spine, maintain postural balance and strengthen the back-lumbar muscles. The Katharina Schroth method, one of the most well-known methods among scoliosis exercises, aims to restore muscle symmetry by using three-dimensional correction techniques and “rotational angular breathing”, thus reducing the curvature and eliminating posture deterioration. In growing children, for Cobb curvatures of 15–20 degrees, classical stretching and strengthening exercises are applied along with methods such as “Bobath, Vojta, Katharina Schroth”, thus preventing the progression of scoliosis.

Which Department Deals with Scoliosis?

The main department that deals with the diagnosis and treatment of scoliosis is the department of orthopedics and traumatology. Individuals with scoliosis can apply to the Orthopedics departments of Medipol Hospitals. Additionally, in some advanced or special cases of scoliosis, the following departments may also be involved in the process:

• Physiotherapy and Rehabilitation: Exercise programs, corsets and muscle strengthening
• Neurosurgery: If there is spinal cord compression or nerve root involvement
• Pediatric Orthopedics: For scoliosis cases in children

Frequently Asked Questions About Scoliosis

What Does 10, 20, 30, 40 and 50 Degree Scoliosis Look Like?

A 10-degree scoliosis image has a relatively straight appearance in the spine. A slight C/S curve can be observed. In the 20-degree scoliosis image, asymmetry is present and the curves begin to become apparent. In the 30-degree scoliosis image, a significant crossover in the shoulders and hips is observed, and the body changes. In the 40-degree scoliosis image, sideways bending is clearly observed. In the 50-degree scoliosis image, clear curvature and trunk asymmetry are observed both radiologically and clinically.

Can Scoliosis Be Corrected?

Although scoliosis cannot be completely corrected, the curvature can be controlled with physical therapy, exercise, corsets, or surgery with braces (without fusion), especially during childhood and adolescence.

Which Sport is Good for Scoliosis?

Swimming is recommended to slow down the progression of the curve by supporting spinal balance and muscle strength.

Until What Age Does Scoliosis Progress?

Scoliosis can progress around the age of 18–20.

Does Sitting Slouched Cause Scoliosis?

Sitting slouched does not cause scoliosis.

How Does Scoliosis Occur in Children?

Scoliosis in children usually occurs idiopathic (cause unknown) during the growth spurt and shows a genetic predisposition.

Does Wearing a Backpack Cause Scoliosis?

If the weight increases, it can cause pain, but it will not cause scoliosis on its own.

Where Does Scoliosis Pain Affect?

Scoliosis often causes chronic pain in the back, waist, or neck areas, muscle spasms, and discomfort that worsens when lying down.

How Should Scoliosis (Spinal Curvature) Patients Sit?

Scoliosis patients should use an ergonomic chair with lumbar support, feet flat on the floor, and knees slightly higher than hips.

Is Scoliosis a Chronic Disease?

Scoliosis, especially in adult and genetic types, can be chronic and may require lifelong monitoring.

What is Minimal Scoliosis?

Minimal scoliosis is a mild curvature, usually up to 10 degrees, which usually does not cause any obvious symptoms and is clinically classified as mild.