Scoliosis

In children

The clinical signs of scoliosis are often subtle at first and are not always associated with pain. It is often parents, teachers, or school health professionals who notice an asymmetry in the trunk. The most common manifestations include:

• misaligned shoulders, with one appearing higher than the other;
• a prominent shoulder blade or asymmetrical waist;
• a more prominent side or hip;
• a general tilt of the trunk to one side;
• prominent ribs on one side when bending forward.

In adults

In adults or in cases of progressive scoliosis, chronic back and lower back pain, pain related to narrowing of the lumbar canal, respiratory discomfort, or postural disorders may occur.

The most common cause of scoliosis is known as idiopathic, meaning that there is no clearly identified cause. This type accounts for around 8 out of 10 cases and mainly affects children and adolescents. However, research suggests that there is a probable genetic component, as a family history of the condition is often reported.
Other forms include:

• degenerative scoliosis, seen in adults, often secondary to osteoarthritis or advanced osteoporosis;
• congenital scoliosis, linked to a spinal malformation present at birth;
• neuromuscular scoliosis, resulting from disorders affecting the muscles or nervous system (such as cerebral palsy or muscular dystrophy).

Although idiopathic scoliosis has no identifiable cause, several factors can increase the likelihood of its onset. The most recognized factor is heredity: a family history of scoliosis increases the risk of developing this condition, particularly in girls.
The onset during growth, particularly during adolescence, is a critical period, as rapid growth can aggravate spinal curvature. In general, girls are at greater risk than boys of developing idiopathic scoliosis.
In addition, certain neurological or muscular disorders (such as cerebral palsy, muscular dystrophy, or spina bifida) predispose individuals to forms of scoliosis known as “neuromuscular.”

The diagnosis of scoliosis requires a thorough clinical analysis and imaging tests. It often begins with a visual screening, where asymmetry of the trunk or rib prominence can be detected during the Adam's test (the person bends forward while standing).
The doctor then conducts a detailed physical examination, accompanied by a medical and family history. Medical imaging is the central element of the diagnosis, in particular low-radiation total spine X-ray (EOS), which measures the Cobb angle and confirms the presence of scoliosis (angle > 10°).
Other tests may be considered in cases of atypical scoliosis, such as an MRI to detect congenital malformations, or a CT scan to better visualize bone structures in cases of doubt.

Treatments for children

Pediatric treatment depends on several factors: the child's age, the severity of the curvature, and remaining growth potential. In cases of mild scoliosis, active monitoring is often sufficient, with regular examinations to track the progression of the curvature.
In moderate cases, wearing an orthopedic brace may be prescribed. This device aims to limit the worsening of the deviation during growth, without correcting the existing curvature.
In very rare cases, particularly when the scoliosis is severe (generally > 50°) and progresses rapidly despite the brace, a specialized pediatric orthopedic evaluation may be considered. These situations are exceptional and are handled in university hospitals with pediatric surgical expertise.

Treatments for adults

In adults, the treatment strategy varies depending on the severity of the curvature and the presence of symptoms. Mild or moderate scoliosis can be managed conservatively with pain medication, physical therapy, or spinal injections to relieve pain. At Hôpital de La Tour, the Pain Clinic plays a central role in this conservative approach. This approach helps stabilize symptoms, reduce local inflammation, and optimize functional abilities without immediately resorting to invasive solutions. When scoliosis causes significant pain, neurological damage (often a symptom of lumbar spinal stenosis), or major functional impairment (difficulty walking due to back pain), more invasive treatments such as corrective surgery may be considered. This is more complex in adults due to degenerative changes in the spine and the risks associated with the procedure. It aims to stabilize and partially straighten the spine and relieve compression of the spinal nerves.

Scoliosis surgery: what are the options?

When conservative treatments fail to control the progression of the curvature, several surgical approaches may be considered. These procedures aim either to stabilize the spine or to correct the curvature while preserving, where possible, a certain degree of mobility.
When pain becomes debilitating or nerve compression is identified (e.g., a narrow lumbar canal), a targeted, minimally invasive surgical approach may be considered. These focal endoscopic treatments are particularly indicated for radicular decompression procedures (nerves in the lumbar spinal canal). This approach effectively relieves radiating pain in the lower limbs without disturbing the entire spine.
In more complex cases, particularly in the presence of spinal instability or severe curvature, spondylodesis (spinal fusion) may be indicated.

Spinal fusion (spondylodesis)

This is the oldest and most widely used surgical technique for severe scoliosis. Spondylodesis involves fusing several vertebrae together using metal rods, screws, and bone grafts. The goal is to permanently stabilize the spine, prevent the curvature from progressing, and partially correct the existing deformity.
This technique is very effective, but it eliminates mobility in the operated area. It is most often performed at the end of bone growth, or in adults when scoliosis is painful or neurologically compromising.

Scoliosis progresses at different rates depending on age, the cause of the curvature, and growth potential. In children and adolescents, moderate to severe curvatures can worsen rapidly, especially during growth spurts. Without treatment, some cases of scoliosis can become debilitating.
In adults, progression is generally slower but continuous. Degenerative forms can lead to chronic lower back pain, stiffness, and loss of postural balance.
Notable complications include:

• respiratory problems in cases of chest compression;
• persistent back pain, sometimes disabling in adulthood;
• noticeable aesthetic alterations (imbalances in the trunk, asymmetrical shoulders or hips);
• psychological impact, particularly in adolescents faced with a distorted body image.

In severe cases, untreated scoliosis can also affect lung capacity and reduce exercise tolerance.

At La Tour Hospital, for adolescents aged 14 and over, a medical consultation may be recommended when scoliosis is confirmed by X-ray and its progression is objectively assessed by comparing images taken at different times. Regular monitoring then allows the stability or progression of the curvature to be assessed.
In adults, scoliosis most often manifests itself through functional symptoms, which should prompt a visit to a specialist:

• Chronic or radiating lower back pain, often linked to biomechanical imbalance.
• Walking difficulties, which may indicate a narrow lumbar canal, common in degenerative scoliosis.
• Postural imbalance with progressive forward tilting of the trunk (sagittal imbalance) or sideways tilting (coronal imbalance).
• Fatigue when standing, discomfort when walking for long periods, or limitation of daily activities.

These symptoms may be indicative of advanced scoliosis, biomechanical imbalance, or spinal stenosis. A specialized consultation allows for an accurate diagnosis and the proposal of an appropriate treatment strategy, primarily conservative.
Medical follow-up is also recommended for anyone with a family history of scoliosis or who was diagnosed as a child without subsequent treatment.

At Hôpital de La Tour, scoliosis is treated using a rigorous, personalized approach. Patients benefit from the expertise of specialists in orthopedics, radiology, interventional pain management, and functional rehabilitation. The hospital has state-of-the-art technical facilities enabling comprehensive care, from diagnosis to post-operative follow-up.

What is the most common form of scoliosis?
The most common cause is idiopathic, meaning that there is no identifiable cause. It accounts for more than 80% of cases.

Is scoliosis painful?
In children, it is often painless. In adults, it can cause chronic back pain, especially in cases of spinal degeneration.

Can scoliosis be corrected with exercise?
Exercise does not correct the curvature, but it helps improve posture and muscle comfort.

Can a brace cure scoliosis?
No. It slows the progression of the curvature without completely correcting it. It is only recommended for children and adolescents.

When is surgery considered?
When the curvature exceeds 45 to 50 degrees or progresses rapidly despite the brace. In cases of lumbar spinal stenosis or debilitating low back pain in adults.

Are there hereditary forms of scoliosis?
Yes. Idiopathic scoliosis often runs in families.

How can scoliosis be detected in children?
A simple forward bending test can reveal any asymmetry in the back.

Can scoliosis worsen in adulthood?
Yes, especially in patients with untreated forms in childhood or degenerative scoliosis.