Written and reviewed for scientific and factual accuracy byDr. Austin Jelcick, PhDandDr. Matthew Janzen, DC
Causes of Scoliosis
One question frequently asked by patients and their families after being diagnosed is howscoliosisis caused. Scoliosis is a type of spinal deformity that occurs in three dimensions. Instead of simply being a curve in two dimensions, there often is rotation, making scoliosis a three dimensional problem. In addition to being a 3D issue, there are different types of scoliosis which need to be treated differently. Some types only involve the spine and its muscles and connective tissues (ie. joints, ligaments and tendons) while others are what is known as “syndromic” meaning they are part of a larger syndrome of other symptoms and health problems. Additionally, other types of scoliosis include congenital scoliosis, neuro-muscular scoliosis (which often times is part of a syndrome, or syndromic), and last but not least, idiopathic scoliosis.
Now, you may have heard the term “idiopathic” or “idiopathic scoliosis” before. While the term “idiopathic” means that something “arises suddenly” or has an “unknown cause”; idiopathic scoliosis can be better thought of a case of scoliosis which does not fall under the other categories (ie. syndromic). This also highlights a myth: that adolescent idiopathic scoliosis has no cause.
This myth exists due to the doctors commonly calling a case of scoliosis “idiopathic” simply because they do not know the cause of a given case of scoliosis; often times because it is not immediately obvious. This is not to say that the scoliosis truly has some mystical unknowncause, but rather that the cause simply has not been identified YET.Here is an example:If you were to wake up with a sore neck, you could call your neck pain “idiopathic” because you don’t know what caused it. However, the real cause is not truly a mystery as you could have slept on it wrong, pulled a muscle, etc.; you simply have not figured out the causeYET.
The use (and over use) of the label “idiopathic” has somehow lulled the minds of doctors and clinicians into thinking that it is not possible to know what is causing scoliosis in most idiopathic cases. Unfortunately, sometimes parents and patients can misinterpret this to mean that “there is no cause” and that their case of scoliosis is caused by an absolute mystery; after all if the doctor says the case is idiopathic and the cause is unknown, who are we to question it?
The truth is, we can have a high level of certainty regarding how a scoliosis is caused; why the curve may be getting worse (progressing), and even what we might be able to doto address and controlthat “mysterious” cause.
Based on current medical and scientific research, scoliosis can be categorized into three major types; each with their own causes. For each type you can find the associated ICD 10 code as well. The ICD 10 codes which have been provided are scoliosis unspecified ICD 10 codes rather than specific (ie. thoracic) codes.
ICD 10 Code: 2018 ICD-10-CM Q67.5, Q76.3
Congenital scoliosis is a type of scoliosis that a child is born with. Typically with congenital patients, a morphological change (a physical, structural change) is present such as a structurally wedged vertebra, or an asymmetric vertebra. While not all congenital scoliosis cases have vertebra asymmetry, this is a very commonly understood reason why a child would be born with a scoliosis. The take-home lesson here is that the structural change (the asymmetry) may be how a congenital scoliosis is caused.
Structural asymmetry does not merely happen in the womb during a child’s development. These structural changes can also happen as a child develops and grows during childhood in an uneven or asymmetric way. One common developmental (happens with growth) asymmetry is when a child has one leg shorter than the other; also known as an anatomic short leg. In this case one leg grows faster than the other, leading to an uneven pelvis. The pelvis is no longer even or level, and as a result the spine becomes unlevel as well.
For the sake of simplicity and categorizing scoliosis types by what ultimately causes them, we would propose thatinstead of “Congenital” Scoliosis, referring to it as a “Structural Asymmetry Scoliosis” would be better. By doing this we more clearly state that a structural asymmetry is at the root cause of the problem.
ICD 10 Code: 2018 ICD-10-CM M41.40
Neuromuscular scoliosis is a type of scoliosis where a known neuromuscular problem ( a problem with the muscles and nerves) prevents the body from being able to hold the spine in an aligned position as the patient grows. This type of problem can be due to an issue somewhere in the muscles, in the nerves to the muscles, or somewhere in the brain as it orchestrates neuromuscular control. As we discussed earlier, neuromuscular scoliosis commonly occurs in individuals with other syndromes and can sometimes be thought of as “syndromic scoliosis” despite its neuromuscular nature. Some common conditions in this category are cerebral palsy, muscular dystrophy, or poliomyelitis. The list of genetic syndromes and diseases knownto cause or be associated with scoliosisis a long one, which grows each year as new research is conducted and pours in. One thing is agreed upon by all experts is that neuromuscular disorders, such as cerebral palsy, appear to be the rootCAUSEof some cases of scoliosis.
ICD 10 Code: 2018 ICD-10-CM M41.20
Idiopathic scoliosis is the classical “we don’t know” category:; the cause remains yet undiagnosed and so it is simply called idiopathic. Because of this, cases of idiopathic scoliosis can potentially represent a wide variety of underlying causes, possibly even including causes from the previously discussed categories (congenital and neuromuscular), simply because the underlying cause has not been properly diagnosed.
All sorts of varieties of scoliosis can end up in the idiopathic category when they are not yet diagnosed. In a perfect world, every patient that initially says “I don’t know the cause” would eventually be properly diagnosed and know how their scoliosis is caused. Unfortunately, most do not and their case is eternally referred to as idiopathic.
What is interesting about MOST cases of scoliosis that end up remaining in the idiopathic category, is that they clearly lack any obvious neuromuscular or structural asymmetry at their root. However, there is one more clue as to what causes most “idiopathic “ cases: The condition known as “tethered cord syndrome”.
Scoliosis Causes: Tethered Cord Syndrome
ICD 10 code: 2019 ICD-10-CM Q06.8
Tethered cord syndrome is a condition that occurs when the spinal cord becomes abnormally stuck to the bottom of the spinal canal during embryological development. So what happens as a result? Well, at birth the spinal cord is stuck, but in most cases no scoliosis occursUNTILthe patient begins to grow. As the patient grows during their childhood, their spinal cord (which is stuck) begins to pull on the spine (because it is stuck or “tethered”) which causes the spine to coil down, causing a scoliosis that worsens with growth (you can learn more about scoliosis worsening due to growth here).
This is a wonderful explanation about why patients with tethered cord syndrome can get scoliosis and how it causes it, but how does this relate to idiopathic cases? Well, the lesson we can learn from tethered cord syndrome is this:Tension along the spinal canal orneuraxiscan lead to scoliosis. This may sound like a new and radical idea, however you’ll be surprised to know this concept has been around for over 50 years!
How Scoliosis is Caused by Nerve Tension
Back in 1968, Dr. Milan Roth proposed that spinal cord tension, or a short spinal cord could be at the root cause of most idiopathic scoliosis,even if there was no obvious tethered cord syndrome. According to Dr. Roth’s research, the spinal cord and nerve roots may grow at a slower rate than the bones of the spine. Because the nervous system’s development is more complicated than the development of the spinal bones, it is more vulnerable to having issues. If the spinal cord and nerve roots lag behind, the spine grows faster than the nerves, the spine becomes longer, and thus needs to adapt to the shorter spinal cord.
Simply put, the bones of the spine are growing faster than the nerves can, which causes increased tension in the spinal cord, which then pulls down on the spine, ultimately causing scoliosis. What is interesting to note, is that during spinal fusion surgeries surgeons are often limited by a “stiff” spinal cord which restricts how straight they can make a spine during surgery. It is for exactly this reason why surgeons will monitor the spinal cord and nerves to make sure they don’t “over correct” the spine, accidentally causing paralysis.
This hypothesis on nerve tension has been growing in popularity. In fact, the nerve tension hypothesis has been placed as a possible central cause by some of the leading researchers in scoliosis causation. One such example is Dr. Burwell in his 2016 paper titled “Adolescent idiopathic scoliosis (AIS): a multifactorial cascade concept for pathogenesis and embryonic origin.”
In this scientific publication, Dr. Burwell also notes that other researchers have observed the spine growing faster than the spinal cord, supporting Dr. Roth’s studies. In the example cited, Dr. Chu et al. found that while the spinal cord was of normal length, the spine grew more than normal (overgrowth) which creates a tension or tethering effect, causing and also causing progression (worsening) of thoracic adolescent idiopathic scoliosis. The cause of this unequal growth of the spine and spinal cord is still being studied and likely has many contributing factors (multifactorial).
While all cases of scoliosis are similar in some ways: a three dimensional deformity, lateral curve in the spine, etc. no two cases are the same and there are distinct types of scoliosis. Just as there are scoliosis types, how scoliosis is caused varies depending on the underlying cause and type. Scoliosis can be part of a syndrome while also being of a neuromuscular nature. Similarly, scoliosis can occur very early in childhood and be congenital due to structural abnormalities in the spine. Lastly, scoliosis can appear to have an unknown cause and be dubbed “idiopathic”, when in fact there IS a knowable underlying cause; the cause simply being undiagnosed.
We know that for over 50 years, scientists have thought that a tension in the nerves due to an unequal growth of the spine versus the nerves can be an underlying root cause of idiopathic scoliosis. This unequal growth, also known asuncoupled neuroosseous developmentcreates tension along the spine, causing it to coil down into a scoliotic shape. Recent scientific studies have suggested many things are involved in this uncoupled development.
It does not matter what type of scoliosis a patient has. Whether it be congenital, neuromuscular, syndromic, or idiopathic, every case of scoliosisDOEShave an underlying cause justWAITINGto be discovered and diagnosed. With improved screening methods designed to look not only for scoliosis, but also for underlying nerve tension; and withradiation-free methods (MRI)to visualize the spine and help detect other underlying issues, the term “idiopathic” will hopefully be a thing of the past sooner rather than later. If we understand the cause, we caneffectively treat itrather than the symptom, increasing quality of care. Additionally, if we know the cause, we can intervene earlier, potentially preventing a problem before it has time to occur.
After all, “Anounceofpreventionis worth a pound of cure.” –Ben Franklin.
- Burwell, R. Geoffrey; Clark, Emma M.; Dangerfield, Peter H.; Moulton, Alan (2016):Adolescent idiopathic scoliosis (AIS): a multifactorial cascade concept for pathogenesis and embryonic origin. In Scoliosis and spinal disorders 11, p. 8. DOI: 10.1186/s13013-016-0063-1.
- Chu, Winnie Cw; Lam, Wynnie Mw; Ng, Bobby Kw; Tze-Ping, Lam; Lee, Kwong-Man; Guo, Xia et al. (2008):Relative shortening and functional tethering of spinal cord in adolescent scoliosis – Result of asynchronous neuro-osseous growth, summary of an electronic focus group debate of the IBSE. In Scoliosis 3, p. 8. DOI: 10.1186/1748-7161-3-8.
- Roth, M. (1968):Idiopathic scoliosis caused by a short spinal cord. In Acta radiologica: diagnosis 7 (3), pp. 257–271.
- Roth, M. (1981):Idiopathic scoliosis from the point of view of the neuroradiologist.In Neuroradiology 21 (3), pp. 133–138.
- van Loon, P. J. M.; van Rhijn, L. W. (2008):The central cord-nervous roots complex and the formation and deformation of the spine; the scientific work on systematic body growth by Milan Roth of Brno (1926-2006). In Studies in health technology and informatics 140, pp. 170–186.
Is scoliosis developed or born with? ›
While scoliosis most commonly occurs during adolescence, it is occasionally the case that a visible spinal curvature is present from birth. Babies born with scoliosis are said to have congenital scoliosis, a condition that occurs when the baby's spine doesn't develop properly in the womb.Can a person with scoliosis live a normal life? ›
Some children and teens may need to wear a brace to keep the curve from getting worse. Physical therapy can help strengthen muscles. In some severe cases, surgery may be needed. Most people with scoliosis can have normal, active lives with treatment.When does scoliosis develop? ›
Scoliosis can develop in infancy or early childhood. However, the primary age of onset for scoliosis is 10-15 years old, occurring equally among both genders. Females are eight times more likely to progress to a curve magnitude that requires treatment.Is scoliosis can be cured? ›
So, overall, it is more realistic to say that while scoliosis cannot be fully “cured” it's entirely possible for the patient to live the rest of their life “scoliosis free” – as long as the curve is caught early enough to be corrected.Who gets scoliosis the most? ›
Who Gets Scoliosis? Anyone can get scoliosis. However, idiopathic scoliosis, which is the most common type, usually occurs in children age 11 and older. Girls are more likely than boys to have this type of scoliosis.What should I avoid if I have scoliosis? ›
- Looking down at your phone. ...
- Lifting heavy objects. ...
- Certain exercises. ...
- One-sided / impact sports. ...
- High heels, flip-flops, and other shoes that don't provide much support.
- Exercise. Specific exercises can help scoliosis patients, whether children or adults, in a number of ways. ...
- Yoga and Stretching. ...
- Nutrition. ...
- Herbal Remedies and Supplements. ...
- Physical Therapy or Chiropractor.
Low-impact exercises such as Pilates, yoga,` and tai chi can help improve trunk flexibility and range of motion. Some scoliosis exercise programs, such as the Schroth method, may help teens reduce the magnitude of their spinal curve.What are the 3 types of scoliosis? ›
- Thoracic scoliosis: The curve is located in the mid (thoracic) spine. ...
- Lumbar scoliosis: The curve is located in the lower (lumbar) spine.
- Thoracolumbar scoliosis: Vertebrae from both the thoracic and lumbar spinal sections are involved in the curvature.
As we know that growth and development affect scoliosis progression more than other factors, we also know that girls have more rapid and hormone-driven growth spurts than boys do; these differences have the potential to make females more highly susceptible to developing idiopathic scoliosis than males.
When does scoliosis stop? ›
In most cases of idiopathic scoliosis, the curve develops around the time the patient hits puberty, then continues to progress throughout their adolescence until their spine has finished growing (usually at age 16-18).What exercises make scoliosis worse? ›
- Long-distance running.
- Long jump.
- Horseback riding.
In moderate to severe cases, scoliosis may be corrected through bracing and/or surgery. If you suspect scoliosis, you should consult your doctor about an appropriate treatment plan.What helps scoliosis go away? ›
- Babies and toddlers may not need treatment as the curve might improve over time. ...
- Older children may wear a back brace to stop the curve getting worse until they stop growing. ...
- Adults may need treatment to relieve pain, such as painkillers, spinal injections and, very occasionally, surgery.
Children are more likely to inherit scoliosis from their fathers than their mothers.How can I know if I have scoliosis? ›
If you have scoliosis, it might look like you are leaning to one side. Some people have one shoulder higher than the other or one shoulder blade that sticks out more than the other. If your spine is twisted, one side of your ribcage might stick out more when you bend over. Often, scoliosis isn't obvious.Is scoliosis passed from mother or father? ›
There is no clear evidence or hardcore proof that parents can pass a “scoliosis gene” onto their children. In contrast with other hereditary diseases, there exists a huge difference in the type and severity of the illness that develops from one generation to the next.Can scoliosis go away naturally? ›
When giving a scoliosis diagnosis, a common question I'm asked is if it's curable, or if it's possible that it could go away on its own. As scoliosis is an incurable and progressive condition, it will neither go away, nor fix itself without treatment.Does sleeping position affect scoliosis? ›
For those wondering if sleep position can actually improve or affect scoliosis structurally, the answer is no. A person's condition is impacted by its individual characteristics such as the type of curve, size or curve, location of curve, and their age, not how they sleep.Is scoliosis a brain disease? ›
Scoliosis is a side-to-side curvature of the spine. Neuromuscular scoliosis is a particular type of scoliosis caused by problems with the muscles and the nervous system (the brain, spine, and nerves).
Can scoliosis damage organs? ›
Severe scoliosis (80+degrees) can potentially affect not only the spine and rib cage, but also, may eventually affect the heart, lungs, and other internal organs.How do I straighten my scoliosis spine? ›
Bracing is the only non-surgical treatment proven to reduce the progression of idiopathic scoliosis curves, but exercise is a good way to keep your back strong and flexible and encourage healthy posture.What foods help scoliosis? ›
For people with scoliosis, nutrition experts recommend a healthy, balanced diet filled with fresh fruits, vegetables and organic meats. Avoiding the foods listed above—and limiting citrus—can help minimize inflammation and maximize mineral absorption to support a healthy spine.Can sitting cause scoliosis? ›
“There isn't one known cause for most cases of scoliosis, but research indicates that poor posture is not a factor.” Dr. Devito explains, “And in general, scoliosis isn't due to weak muscles, either. Slouching or leaning to one side while sitting, playing or studying does not cause a permanent curve of the spine.”Can I lift weights with scoliosis? ›
Strength training, as a rule, is positive for scoliosis sufferers, as it can help strengthen muscles which support the spine. Caution is needed here, as resistance exercise can exacerbate scoliosis if performed improperly. We recommend strength training, but see your scoliosis professional for recommendations first.Is sitting good for scoliosis? ›
Sitting with scoliosis
You should also aim to sit in chairs offering lower back support and arm rests. Note that sitting for extended periods of time may result in greater back pain or discomfort, so you should try to get up and take a short walk after sitting for a half hour.
Scoliosis is a lifetime condition. It is sometimes described as a diagnosis that patients carry “from cradle to cane.” People with scoliosis in early childhood through the end of adolescence do not commonly have a lot of pain.Is scoliosis a permanent? ›
There are two general categories for scoliosis: Structural scoliosis is by far the most common category of scoliosis. It involves spinal rotation in addition to the side-to-side curvature of the spine. This type of scoliosis affects the spine's structure and is considered permanent unless the spine receives treatment.Do you lose height with scoliosis? ›
So to clearly answer the question, can scoliosis make you shorter: yes, it can. The worse a curvature gets, the more it bends unnaturally to the side, and this structural change can decrease height. That being said, for some patients, treatment can help regain some, or all, of those lost inches.Why do skinny people have scoliosis? ›
The study results indicated that having a lower BMI results in less muscle mass, which then adversely affects the musculoskeletal system and increases the risk of scoliosis onset. Based on this study's findings, there is a strong correlation between low weight and scoliosis development.
Can scoliosis disable you? ›
This sideways curvature of the spine can have many side effects and health problems. So, the Social Security Administration (SSA) offers benefits for scoliosis disorder. If you are wondering whether scoliosis is a disability, the answer is YES! It is a disability, and you can get disability benefits for it.Is scoliosis a serious condition? ›
With scoliosis, the spine rotates and develops a side-to-side curve. Curves may be as mild as 10 degrees, or as severe as 100 degrees or more. Most cases of scoliosis are mild and don't need treatment. In adults, the degree of the spinal curve may or may not determine treatment.Can you prevent scoliosis? ›
Most cases of scoliosis have no known cause.
“Parents tend to ask what they could have done to prevent scoliosis,” says Sponseller, “but scoliosis is a very interesting disease because there is currently no known cause or prevention method.”
Scoliosis is defined as curves greater than 10 degrees. Once a curve has progressed to 45-50 degrees surgery may recommended by your surgeon. Curves typically progress at a rate of 1 degree a month during the adolescent growth spurt (with the fastest rate of progression just before the start of menses or puberty).Can I correct my scoliosis with exercise? ›
General exercise alone has not been shown to reduce scoliosis, but scoliosis-specific exercises that are customized to a patient with a fair amount of flexibility in their spine, can have the ability to help reduce a small curve.Can chiropractor fix scoliosis? ›
A chiropractor for scoliosis can develop a non-invasive, drug-free scoliosis treatment plan that addresses multiple symptoms. While chiropractors are unable to straighten your spine completely, studies have shown a marked improvement in spine curvature, pain, and disability rating among those with scoliosis.How common is scoliosis? ›
Scoliosis, a common, sometimes hereditary spinal condition, is a curvature of the spine that affects 2% to 3% of the population in the United States, or an estimated 6 million to 9 million people.What is the fastest way to cure scoliosis? ›
Put simply, the fastest way to treat scoliosis is Active bracing – with a brace like ScoliBrace. Scoliosis specific exercise will reduce scoliosis over time, but only at a much slower rate.Can scoliosis be cured 100%? ›
Myth #2: Surgery Cures Scoliosis
There is no magic cure for scoliosis. That being said, there are treatment methods that can work to reduce the curve in the spine, relieve pain and improve your body's ability to function.
Most of the time, scoliosis develops around the time of puberty. Adolescent girls get scoliosis more than boys, and children more than adults. In rare cases, scoliosis can also develop during adulthood. Your spine has natural curves, like an S, that gently support your body and its movement.
Can you develop scoliosis out of nowhere? ›
Many adults develop scoliosis, and live with it for many years without even knowing they have it. Others keep it at bay with regular exercise and healthy living. However, surgery may be necessary when painful, debilitating symptoms exist.Is scoliosis a birth defect? ›
What is congenital scoliosis? Congenital scoliosis is a spinal deformity in which a sideways curvature of the spine is caused by a defect present at birth. The spine may also be rotated or twisted, pulling the ribs along with it to form a multidimensional curve.Is scoliosis genetic or acquired? ›
The short answer is this: scoliosis does have a genetic component, and scoliosis can be hereditary and run in families. However, as is often the case with health, the answer is not that simple. Scoliosis can be hereditary but it can also appear in families with no history of scoliosis.Can sitting too much cause scoliosis? ›
“There isn't one known cause for most cases of scoliosis, but research indicates that poor posture is not a factor.” Dr. Devito explains, “And in general, scoliosis isn't due to weak muscles, either. Slouching or leaning to one side while sitting, playing or studying does not cause a permanent curve of the spine.”Can sleeping position cause scoliosis? ›
He states that sleeping on your stomach can “push the natural curvature of the spine out of the alignment and into the abnormal scoliosis curve,” which can lead to increased back and neck pain, among other symptoms.How do I know if I'm developing scoliosis? ›
The most common symptoms of scoliosis in adults is pain and, often, a visible bulge on the back at the site of this pain. Less often, people may experience fatigue, a loss of height, or a feeling of fullness when, in fact, the stomach is empty.Which parent passes scoliosis? ›
With scoliosis, there's no clear evidence that parents can pass it onto their children. Unlike true hereditary diseases, there can be a wide variation in the types and severity of scoliosis that develop from generation to generation — if it even develops at all!Can scoliosis get pregnant? ›
Scientists have determined scoliosis doesn't cause any particular complications — pregnancy, labor, delivery, or fetal — compared to women without it. It also doesn't appear to diminish fertility or increase the risk of miscarriage, stillbirth, or birth defects.What are the 4 types of scoliosis? ›
There are four types of scoliosis: congenital, idiopathic, neuromuscular, and degenerative2. In congenital scoliosis, the misalignment occurs as a result of deformed vertebrae or ribs present at birth. A variety of developmental factors can cause this deformity2. About 80% of cases are considered idiopathic1.Is scoliosis caused by the brain? ›
Scoliosis is a side-to-side curvature of the spine. Neuromuscular scoliosis is a particular type of scoliosis caused by problems with the muscles and the nervous system (the brain, spine, and nerves).