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Look at a standing person from the side and you see the spine's natural curves. The lower back bends slightly inward and the upper part of the spine bows a little outward. Viewed from behind, however, the spine appears straight with little side-to-side curvature � except in people who have scoliosis. With scoliosis, the spine curves to one side.

Of every 1,000 children, 3 to 5 develop spinal curves that are severe enough to need treatment. Scoliosis occurs rarely in adults. Sometimes, it's a worsening of a condition that began in childhood but wasn't diagnosed or treated. In other cases, adult scoliosis may result from a degenerative joint condition in the spine.

Usually scoliosis is painless. Most cases are mild, requiring only follow-up and observation. In more severe cases, the spine can rotate as well, resulting in prominent ribs on one side of the body and narrowed spaces between ribs on the other. Severe scoliosis can cause ongoing back pain and difficulty breathing. Surgery may be necessary.

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Signs and symptoms

Signs of scoliosis may include:

Uneven shoulders
Prominent shoulder blade or shoulder blades
Uneven waist
One hip elevated as compared to the opposite side
Leaning to one side

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Causes

Very young children may have scoliosis, but adolescent idiopathic scoliosis � which is scoliosis of unknown cause with onset at 10 years of age or older � is the most common type. Doctors define scoliosis in a particular person based on a number of factors related to the curve, including:

Shape. Aside from appearing like the letter C or S, a curve may occur in two or three dimensions. A nonstructural curve is a side-to-side curve. A structural curve involves twisting of the spine and occurs in three dimensions.

Location. The curve may occur in the upper back area (thoracic), the lower back area (lumbar) or in both areas (thoracolumbar).

Direction. The curve can bend to the left or to the right.

Angle. Doctors figure out the angle of the curve using the vertebra at the apex of the curve as the starting point.

Cause. About 80 percent of scoliosis cases are idiopathic, meaning the cause is unknown.

Many theories have been proposed regarding the causes of scoliosis. They include connective tissue disorders, hormonal imbalance and abnormality in the nervous system.

Scoliosis runs in families and may involve genetic (hereditary) factors. But researchers haven't identified the gene or genes that may cause scoliosis. Doctors also recognize that spinal cord and brainstem abnormalities play a role in some cases of scoliosis.

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Risk factors

Most scoliosis is of unknown cause (idiopathic), but there does appear to be a developmental connection in many cases. Most cases of scoliosis occur just before and during adolescence, when children are going through a growth spurt.

Infantile idiopathic scoliosis (ages 0 to 3 years) is more common in boys, whereas juvenile idiopathic scoliosis (ages 3 to 10 years) and adolescent idiopathic scoliosis (ages 10 years and up) are more common in girls.

Risk factors for curve progression in scoliosis include:

	Sex. Girls are more likely to experience curve progression than are boys.
	Age. The younger the child when scoliosis appears, the greater the chance of curve progression.
	Angle of the curve. The greater the curve angle, the higher the likelihood that it will get worse.
	Location. Curves in the middle to lower spine are less likely to progress than those in the upper spine.

Spinal problems at birth. Children who have scoliosis at birth (congenital scoliosis) may experience rapid advancement of the curve.

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