1. Idiopathic scoliosis affects about 2–4% of children aged 10–16 years.
2. Adolescent idiopathic scoliosis (AIS) is the most common form, accounting for 80–90% of all idiopathic cases.
3. Girls are more likely than boys to have scoliosis and to have curves that progress to require treatment (ratio ~7:1 for curves >30 degrees).
4. Infantile scoliosis is rare, more common in Europe than in North America.
5. Neuromuscular scoliosis
6. Syndromic Scoliosis
7. Adult scoliosis is increasingly diagnosed due to aging populations and better imaging.

1. Genetic predisposition (family history)
2. Gender (female predominance, especially in AIS)
3. Age (peak risk during puberty/growth spurts)
4. Underlying neuromuscular or congenital disorders

1. Uneven Shoulder Height: One shoulder appears higher than the other. This is often one of the most noticeable signs during an initial examination.
2. Asymmetry in the Rib Cage: When the person bends forward (Adams forward bend test), one side of the rib cage may appear more prominent or elevated compared to the other side. This occurs due to the rotation of the spine, a characteristic feature of scoliosis.
3. Uneven Hips: One hip may be higher or more prominent than the other, indicating an imbalance in the spine's curvature. This can cause the waist to appear uneven.
4. Visible Spinal Curvature: A visible curvature of the spine is often noticeable, especially when viewed from behind. The spine may form an "S" or "C" shape instead of being straight.
5. Asymmetrical Waist or Flank: The space between the arms and the body may appear unequal when standing. The waist on one side may seem more indented than the other.
6. Head Alignment: In individuals with scoliosis, the head may not be centered in line with the pelvis. The head might lean slightly to one side, indicating a misalignment caused by the spinal curvature.
7. Shoulder Blade Prominence: One shoulder blade (scapula) may protrude more than the other, particularly on the side where the curvature is most pronounced.
8. Trunk Rotation: The rotation of the vertebrae can cause the torso to rotate to one side. This rotation is particularly evident during the Adams forward bend test.
9. Leg Length Discrepancy: Although true leg length differences are rare, scoliosis can create the appearance of uneven leg length due to pelvic tilt caused by the spinal curvature.
10. Skin Changes (rare): In some cases, skin changes such as dimples or patches of hair may appear over the area of the curvature, which can indicate an underlying spinal condition such as congenital scoliosis.
11. Limited Range of Motion: Patients with scoliosis may exhibit reduced flexibility and a limited range of motion in the spine, particularly during bending or twisting movements.
12. Decreased Pulmonary Function (in severe cases): In severe scoliosis, the curvature may affect lung capacity, leading to reduced pulmonary function. This can be assessed clinically through breathing tests or observing signs of labored breathing.
13. Posture Imbalance: Individuals with scoliosis often have a noticeable posture imbalance, such as leaning to one side or having a forward head posture. These imbalances become more evident during physical activity or standing still for extended periods.

• Adams Forward Bend Test: The patient bends forward at the waist with arms hanging down, and the examiner looks for asymmetry or prominence in the rib cage or back.
• Scoliometer Measurement: A scoliometer can be used during the forward bend test to measure the degree of trunk rotation.
• Plumb Line Test: A vertical line drawn from the base of the neck should pass through the center of the buttocks. Deviation from this line may suggest scoliosis.

Adolescent idiopathic scoliosis (AIS) is an abnormal curvature of the spine that appears in late childhood or adolescence. Instead of growing straight, the spine develops a side-to-side curvature. It is scoliosis with Cobb angle >10degrees and age of onset >10years, in the absence of any underlying cause. It’s called idiopathic because we do not know what typically causes it.

AIS is the most common spine problem affecting children and commoner in the girl child (10times more than males). It is commonly diagnosed between the age 10-18years because this is the adolescent window of the growth spurt.

AIS nomenclature changes with age. It is called Young Adult Idiopathic Scoliosis (YAdIS) between age 18 to 30years and Adult Idiopathic Scoliosis (AdIS) from above 30years of age.

This is an angle which describes the magnitude of the curve. The Cobb angle is measured by finding the most tilted vertebrae above and below the apex of the curve. Then draw a line straight out from the superior endplate of the top vertebrae and another from the inferior endplate of the bottom vertebrae. Then we draw 90degree angles from each of those lines. The angle formed by the intersection of these two lines is called the Cobb angle.

There is usually a major curve (bigger) and a compensatory curve (smaller) that attempts to align the head over the pelvis. The Cobb angle of the major curve is a very important factor to be considered when planning treatment.

They are part of the factors that help determine the risk of progression and the recommended treatment option.

Other factors include the following: age, gender, time of the first menstrual period (menarche), skeletal maturity (we use something we call the “Risser Scale”).

Treatment of scoliosis is individualized and multi-disciplinary. This could be watched or observed, braced or surgery. Patients with Cobb angles less than 25degrees can be safely observed with physical therapy.

Bracing is usually attempted in patients with curves between 25 to 45degrees. It is usually more effective for patients that have a flexible curve or are skeletally immature. The success rate is poor, but it can improve muscle tones and stop the progression. Remember, the goal is to stop the progression of the curvature and not necessarily to correct it. The obvious problem with bracing in this patient population is compliance or getting the children to wear these braces. Some studies suggest up to a 50% reduction in the need for surgery in patients that were compliant with bracing for over 13hours in a day. Physical therapy and back exercises are important adjuncts to bracing.

 The factors considered very critical for surgery are the severity of curves, age of the patients, causes of the deformity, the skills and specialties available and associated symptoms

Surgery is usually recommended in patients with curves of over 45degrees in skeletally mature folks or over 40degrees in folks less than 2years into menarche (due to a high risk of progression). The goal of surgery is to correct the major curve only, because the compensatory curve would probably correct itself. Figure 2

It is important to stress that surgical recommendation in patients with scoliosis is a very emotional decision. This should be made between the patient’s doctor, the patient and the parents. The risks and benefits should be carefully weighed and decided upon. Long term complications of not correcting this deformity can be ongoing back pain, significant deformity and disability, and even pulmonary complications (especially in curves greater than 70degrees).

Curves greater than 50degrees in skeletally mature folks have a curve progression rate of 1degree per year.

Figure 2 X-ray of a patient with scoliosis after surgery (Picture source from Dr Anele)

There are unique challenges, including limited healthcare access, cultural barriers, and lack of awareness. While genetic predisposition and idiopathic scoliosis are not entirely preventable, early detection and management can help reduce the severity of the condition.

Key prevention strategies include:

1. Health Education: Community-based education programs can raise awareness about scoliosis, encouraging early detection. Schools and local health workers can educate parents and children on recognizing signs of spinal deformities.
2. School Screening Programs: Implementing routine screening in schools for early signs of scoliosis (e.g., uneven shoulders or back curvature) can lead to earlier intervention and referral.
3. Improved Access to Healthcare: Strengthening primary healthcare systems and training local health workers to identify scoliosis early can improve outcomes. Increasing access to diagnostic tools like X-rays in rural areas is essential.
4. Promoting Safe Lifting Practices: In regions where children carry heavy loads, educating families on safe practices to reduce strain on the spine may help prevent or lessen spinal curvature.
5. Physiotherapy and Exercise: Encouraging physical activity and postural exercises in communities with access to physiotherapists can support healthy spine development and prevent progression in mild cases.

Clinical signs of scoliosis are primarily observed through physical examination, focusing on the alignment of the shoulders, hips, spine, and trunk rotation. Most mild cases do not progress. Larger curves and those diagnosed earlier (before growth completes) are more likely to worsen. Severe cases can cause respiratory and cardiovascular issues if untreated.

Healthcare professionals often use tests like the Adams forward bend test to identify asymmetry, and further diagnostic tools such as X-rays are used to confirm the diagnosis and assess the severity of the condition. Early detection is important for effective management, particularly in growing children.