Ask the doctors: Most cases of scoliosis have no root cause

Dear Doctor: Can you please explain scoliosis? My 11-year-old daughter was recently diagnosed with it, and though it’s mild, we’re very worried. Why did she get it? Will she need surgery?

Dear Reader: Scoliosis is a condition in which the spine gradually takes on a lateral curve in the shape of either an S or a C. It can occur at any age, but scoliosis is most common in young people between the ages of 10 to 14. It’s estimated that between 2 and 4 percent of youths will develop scoliosis during the growth spurt that accompanies the onset of adolescence. And while the condition is equally common in boys and girls, girls are 10 times more likely than boys to develop more severe spinal curvature.

Most cases of scoliosis are mild and require only ongoing monitoring of the existing curvature, making sure it doesn’t escalate. In more severe cases, treatment with a brace or surgery is often required. For anyone who saw footage of her royal wedding last fall, the U.K.’s Princess Eugenie wore a low-backed dress designed specifically to show the scar from her own scoliosis surgery at age 12.

When someone has or is developing scoliosis, it becomes visible in their posture. Signs of the condition include uneven shoulders, visible differences in arm length, a shoulder blade that becomes more prominent than its partner, a tilted waistline, or uneven hips. In serious cases, the curving spine may cause the torso to rotate or twist. Since this affects posture, the condition can result in the rib cage pressing against the lungs and heart, which can interfere with breathing and cardiac activity. For adults who had scoliosis as children, chronic back pain can become a problem later in life.

The condition develops gradually and without pain, so it can be difficult to identify. Diagnosis typically begins with a neurological exam to assess strength and reflexes, and to check for numbness that occurs due to pinched nerves. This is followed by imaging tests to visualize the spinal structure.

The type of treatment depends on multiple factors, including the age and sex of the patient, and the location and pattern of the curve. For children with a mild curve and who are still growing, like your daughter, “watchful waiting” may be the most appropriate approach. In some cases, to prevent the condition from worsening, they may be fitted with a custom-made brace. In severe cases, when the spinal curvature is progressing rapidly or is causing pain or dysfunction, surgery may be required.

As for what causes scoliosis, the answer remains unclear. It has been associated with neuromuscular conditions like muscular dystrophy and cerebral palsy, can be a birth defect, and may occur as a result of spinal injury or infection. But the majority of cases are considered idiopathic, which means the root cause is unknown.

Emerging research suggests a link between some cases of scoliosis and a rare gene variant that may interfere with the absorption and use of manganese, a mineral required for growing bones and cartilage. Initial research, which was done on zebrafish, has been intriguing enough that further studies are already in the works.