Skoliosis (scoliosis) is where the spine twists and curves to the side, so it can look like the letter C or S from behind. It most often starts in children aged 10 to 15, and girls are more likely to have it and to develop larger curves. Signs include uneven shoulders, one hip or shoulder sticking out and the ribs sticking out on one side. In about 8 in 10 cases the cause is unknown; it is not caused by bad posture or a heavy school bag. Many people need only regular check-ups; some children need a back brace while they grow, and a small number need surgery. Most people with scoliosis live normal, active lives, and it does not usually affect pregnancy. This guide explains the signs, tests, treatment for children and adults, and what it means for pregnancy.
Apa itu skoliosis?
Scoliosis is where the spine twists and curves to the side (NHS). Everyone’s spine has natural curves, but in scoliosis the spine curves sideways and can look like the letter C or S (MedlinePlus). In Malay it is often described as tulang belakang bengkok (a crooked spine).
It can affect people of any age, from babies to adults, but most often starts in children aged 10 to 15 (NHS). It is not usually a sign of anything serious, and treatment is not always needed if it is mild (NHS).
The most common type is idiopathic scoliosis, which means the cause is not known (NHS). Doctors group it by the age it starts (MedlinePlus):
| Type of idiopathic scoliosis | Age it starts (MedlinePlus) |
|---|---|
| Infantile | 3 years and younger |
| Juvenile | 4 to 10 years |
| Adolescent | 11 to 18 years |
Girls are more likely than boys to have idiopathic scoliosis (NIAMS), and girls are more likely to develop larger curves that need medical care (American Academy of Orthopaedic Surgeons). Curves usually get worse during a growth spurt (MedlinePlus).
Skoliosis di Malaysia
Two studies from Malaysia show how common scoliosis is here and who is treated for it:
- School screening: in the largest school scoliosis screening study in Malaysia, 8,966 students aged 13 to 15 were checked with a forward bending test. About 5.0% of girls and 4.2% of boys screened positive and were referred for an X-ray, but only 38% of them went for the X-ray. The estimated rate of scoliosis was 2.55% for curves over 10 degrees, 0.59% for curves over 20 degrees and 0.12% for curves over 40 degrees (Deepak and others, 2017).
- Surgery: of 1,057 young people who had surgery for adolescent idiopathic scoliosis at a university hospital in Kuala Lumpur between 2012 and 2019, 917 (about 87%) were female. Their average age was 15.6 years (Kwan and others, 2021).
The first study is a reminder for parents: if your child is told at school or at a clinic that their back looks uneven, follow up with the X-ray or doctor visit that is recommended.
Tanda skoliosis pada anak dan remaja
Signs of scoliosis include (NHS):
- a visibly curved spine;
- leaning to one side;
- uneven shoulders;
- one shoulder or hip sticking out;
- the ribs sticking out on one side;
- clothes not fitting well.
Other signs are one shoulder blade standing out more than the other, one hip looking higher than the other (NIAMS), and an uneven waistline (American Academy of Orthopaedic Surgeons).
Most children and teens with mild scoliosis have no symptoms or pain (NIAMS). Back pain is more common in adults with scoliosis (NHS). If a curve is severe, it can rarely cause difficulty breathing (NIAMS).
Small curves often go unnoticed until a growth spurt during puberty (American Academy of Orthopaedic Surgeons). Teenagers are often self-conscious and may wear loose clothes, so scoliosis can go unnoticed until they wear more fitted clothes such as swimwear or T-shirts (American Academy of Orthopaedic Surgeons).
Cara ibu bapa boleh perasan
Parents can help with early detection. Look at your child’s back when they are wearing swimwear. If one shoulder looks higher than the other, or one side of the ribcage sticks out more than the other, see a doctor for a check (American Academy of Orthopaedic Surgeons).
The standard screening check is the Adams forward bend test. The child bends forward with feet together, knees straight and arms hanging down, and the doctor looks from behind for a difference in the shape of the ribs on each side (American Academy of Orthopaedic Surgeons). A curve is easiest to see in this position, but it may be hard to see in the early stages (MedlinePlus; American Academy of Orthopaedic Surgeons). This is a check, not a diagnosis; only an X-ray can confirm scoliosis and measure the curve.
When to check
- Scoliosis is most often found during a child’s growth spurt, at around 10 to 15 years old (American Academy of Orthopaedic Surgeons).
- The Scoliosis Research Society recommends that girls be screened twice, at 10 and 12 years, and boys once at 13 or 14 years (American Academy of Orthopaedic Surgeons). Experts do not all agree on the benefits of school screening (American Academy of Orthopaedic Surgeons).
- Because scoliosis runs in families, brothers and sisters of a child with scoliosis, and children of parents with scoliosis, should be checked at their regular check-ups, especially during growth spurts (American Academy of Orthopaedic Surgeons).
Jenis dan punca skoliosis
In around 8 in every 10 cases, the cause of scoliosis is unknown (idiopathic) (NHS). Researchers think a mix of factors plays a role, including genes, hormones and changes in cell structure (NIAMS). About 30% of young people with adolescent idiopathic scoliosis have a family history of it (American Academy of Orthopaedic Surgeons).
Less commonly, scoliosis has a known cause (NHS; NIAMS):
| Type | What happens |
|---|---|
| Congenital scoliosis | The bones of the spine do not form properly in the womb, so it is present from birth (NHS) |
| Neuromuscular scoliosis | Caused by a nerve or muscle condition, such as cerebral palsy or muscular dystrophy (NHS) |
| Degenerative scoliosis | Caused by wear and tear of the spine with age; it affects older adults (NHS) |
| Other causes | Genetic diseases, an injury to the spine or a tumour (NIAMS) |
Scoliosis is not caught from other people, and there is nothing a parent could have done to prevent idiopathic scoliosis (American Academy of Orthopaedic Surgeons).
Postur, beg sekolah dan mitos lain
Many parents worry that they caused their child’s scoliosis. The evidence says otherwise:
| Belief | What the evidence says |
|---|---|
| Bad posture causes scoliosis | Idiopathic scoliosis is not thought to be linked to bad posture, exercise or diet (NHS). The scoliosis may be the reason for leaning to one side, not the result of it (American Academy of Orthopaedic Surgeons) |
| A heavy school bag causes it | Sports activities and heavy backpacks do not cause scoliosis or make a curve worse. Heavy backpacks can be linked to back pain, so lighten the load and use both straps (American Academy of Orthopaedic Surgeons) |
| A leg length difference causes it | It does not cause scoliosis, but a large difference can make the curve look bigger (American Academy of Orthopaedic Surgeons) |
| Scoliosis comes from an injury | Idiopathic scoliosis is not caused by an injury (American Academy of Orthopaedic Surgeons) |
Bagaimana doktor mengesahkan skoliosis
See a doctor if you think you or your child has scoliosis. It is unlikely that anything is seriously wrong, but it is best to get it checked (NHS). The doctor will (NIAMS; American Academy of Orthopaedic Surgeons):
- ask about your child’s medical history and family history;
- look at their posture, check whether the shoulders and hips are level, and do the forward bend test;
- check for differences in leg length and for nerve problems, to rule out other causes;
- arrange an X-ray of the spine to see where the curve is and how big it is.
X-rays are important because the curve may be worse than it looks on examination (MedlinePlus). The size of the curve is measured in degrees. In the Malaysian school study, a curve of more than 10 degrees on X-ray was used to diagnose scoliosis (Deepak and others, 2017). Sometimes an MRI or CT scan is also needed (MedlinePlus).
Many parents worry about repeated X-rays. Modern X-ray technology keeps the radiation dose low, and most children get less radiation from their scoliosis X-rays each year than from natural background radiation and air travel (American Academy of Orthopaedic Surgeons).
If scoliosis is suspected, your child may be referred to a children’s orthopaedic surgeon or a spine specialist (NHS; American Academy of Orthopaedic Surgeons).
Rawatan skoliosis kanak-kanak dan remaja
Treatment depends on your child’s age, how big the curve is, where it is, and whether it is likely to get worse (NHS; American Academy of Orthopaedic Surgeons). Many children do not need treatment, and only a small number need surgery (NHS). Once a teenager has stopped growing, a curve is less likely to get worse quickly (American Academy of Orthopaedic Surgeons).
| Curve size (general guide) | Usual approach (American Academy of Orthopaedic Surgeons) |
|---|---|
| Less than 25 degrees, or almost fully grown | Monitoring: a check-up about every 6 to 12 months, with X-rays until the child stops growing |
| 25 to 45 degrees and still growing | A back brace may be recommended to stop the curve getting worse |
| More than 45 to 50 degrees, or the brace did not stop it | Surgery (spinal fusion) may be recommended |
These numbers are a guide only. Your child’s specialist will consider their age, growth and the type of curve.
Monitoring
Very young children may not need treatment, because their spine may straighten as they grow. Older children with mild scoliosis may only need regular check-ups and X-rays to make sure the curve is not getting worse (NHS). In babies and toddlers, a plaster cast or brace may be used to stop the curve getting worse as they grow (NHS).
Back brace
- A brace will not correct the curve, but might help stop it getting worse (NHS). In a study of curves at high risk of getting worse, bracing greatly reduced the number of curves that progressed to needing surgery (American Academy of Orthopaedic Surgeons). There are still some uncertainties about how well braces work, so not all scoliosis specialists recommend them (NHS).
- The brace is custom-made, usually of rigid plastic, and designed to be hard to see under loose clothes (NHS).
- It usually needs to be worn for 23 hours a day, and only taken off for baths, showers, swimming and contact sports (NHS). The more hours the brace is actually worn, the better it works; wearing it for only 6 hours a day is nearly useless (American Academy of Orthopaedic Surgeons).
- Your child will usually wear it for as long as they are growing (NHS).
Surgery
Surgery may be recommended if the scoliosis keeps getting worse despite other treatment, or if it is severe and your child has stopped growing (NHS). Untreated severe curves could eventually affect the lungs (American Academy of Orthopaedic Surgeons).
- Spinal fusion (teenagers and young adults who have stopped growing): the spine is straightened with metal rods, screws, hooks or wires and bone grafts, which are usually left in place for good (NHS).
- Growing rods (younger children, usually under 10): rods are put alongside the spine and lengthened every few months as the child grows (NHS).
Most young people spend about a week in hospital, return to school after a few weeks and can play sports after a few months, although contact sports may need to wait longer (NHS). In the Malaysian study of 1,057 operations, patients stayed in hospital for an average of 3.5 days after surgery. Major complications happened in 0.95% and minor complications in 1.32%, with infection the most common (Kwan and others, 2021).
Like any major operation, spinal surgery has risks, including bleeding, wound infection, problems with the rods or grafts that need more surgery and, rarely, nerve damage that can cause permanent numbness or paralysis of the legs (NHS). Discuss the risks and benefits with the surgeon (NIAMS).
Senaman, fisioterapi dan rawatan alternatif
Regular exercise is important for children with scoliosis. It can help muscle strength and may help reduce back pain, and children with scoliosis can usually do most types of exercise (NHS) and take part in sports (American Academy of Orthopaedic Surgeons). Weight-bearing exercise such as walking or running also helps keep bones strong (NIAMS).
But exercise and other therapies have not been shown to straighten the spine:
- It is not yet clear whether specific back exercises or physiotherapy can help improve scoliosis (NHS). There is no high-quality evidence that physiotherapy alone stops a curve getting worse during growth. Methods such as the Schroth method have some low-quality evidence that they may help the body look straighter and improve breathing (American Academy of Orthopaedic Surgeons).
- There is little reliable evidence that osteopathy or chiropractic can correct a curved spine or stop it getting worse (NHS).
- Yoga, Pilates, massage, acupuncture and chiropractic care may help back pain, but have not been shown to reduce the curve or stop it getting worse (American Academy of Orthopaedic Surgeons).
The only treatments shown to affect idiopathic scoliosis are bracing and surgery (American Academy of Orthopaedic Surgeons). If your child has chiropractic treatment, they should still be seen by an orthopaedic or spine specialist for monitoring and treatment (American Academy of Orthopaedic Surgeons).
Skoliosis pada orang dewasa
Some adults have had scoliosis since childhood, while others develop degenerative scoliosis from wear and tear of the spine as they get older (NHS). Back pain is one of the main problems caused by scoliosis in adults, so treatment mainly aims to relieve pain. If it is not severe and not painful, treatment may not be needed (NHS). For other causes of back pain, see our guide to sakit pinggang.
Scoliosis can sometimes irritate or press on the nerves in the spine, causing pain, numbness and tingling from the lower back down to the feet (NHS). See our guide to kebas kaki for other causes of numb feet.
| Treatment for adults | What it involves (NHS) |
|---|---|
| Painkillers | Anti-inflammatory painkillers (NSAIDs) such as ibuprofen are usually tried first; they are not suitable for everyone, so check the leaflet or ask a pharmacist |
| Exercise | Activities that strengthen and stretch the back may help the pain; physiotherapy exercises may help pain but are unlikely to change the curve |
| Spinal injections | Steroid and local anaesthetic injections may help nerve pain, but the benefit usually lasts only weeks or months |
| Back brace | Not often used in adults, but may give pain relief if surgery is not possible |
| Surgery | Rarely needed; considered if the curve is severe or getting worse, pain is severe, or nerves are squashed. Recovery can take a year or more |
Once you have stopped growing, curves under 30 degrees tend to stay the same, while curves over 50 degrees almost always get slowly worse, by about 1 degree a year (American Academy of Orthopaedic Surgeons). People with curves under 30 degrees have the same risk of back pain as people without scoliosis (American Academy of Orthopaedic Surgeons). See a GP if your scoliosis gets worse (NHS).
Skoliosis dan kehamilan
Many women with scoliosis worry about pregnancy. The American Academy of Orthopaedic Surgeons says:
- Many studies on scoliosis and pregnancy have not shown difficulties in childbearing, and there is no increase in fetal distress, premature birth or problems with delivery.
- Pregnancy does not usually make the curve much worse in a spine that has not had surgery.
- Spinal fusion surgery does not increase the risk of complications in future pregnancies or birth.
- You can usually have an epidural for childbirth. A very severe curve can make it harder to place. If you have had spinal fusion, make sure your obstetrician and anaesthetist know which part of your spine was fused.
- Your children have a higher chance of developing scoliosis, so they should be checked at routine check-ups. About 1 in 3 children of parents with scoliosis develop it.
Tell your doctor at your antenatal check-ups that you have scoliosis, and ask a doctor or pharmacist before taking any painkiller while pregnant. If you are planning a pregnancy, our guide to tanda-tanda mengandung explains the early signs.
Hidup dengan skoliosis
Most people with scoliosis can live normal lives and do most activities, including exercise and sports. It does not usually cause significant pain or other health problems (NHS). People who have had surgery can usually have the same jobs and do the same sports as before, but should check with their doctor before starting new activities (American Academy of Orthopaedic Surgeons).
Having scoliosis or wearing a brace can be hard, and may affect body image and self-esteem, especially for children and teenagers (NHS). Teens may feel self-conscious or embarrassed in a brace, but it is important to wear it as directed; if your child refuses, talk to the doctor about other options (NIAMS). A support group for children, teens or parents can help (NIAMS).
A brace is designed to be hard to see under loose-fitting clothes (NHS), and most braces can be taken off for sports if the doctor agrees (American Academy of Orthopaedic Surgeons).
Bila perlu jumpa doktor
See a doctor if:
- you think you or your child has scoliosis (NHS);
- your child was told at a school or clinic check that their back looks uneven;
- scoliosis that has already been diagnosed is getting worse (NHS);
- back pain is severe or comes with weakness or numbness in the arms or legs, as this needs checking for other causes (American Academy of Orthopaedic Surgeons);
- neck or shoulder pain does not settle; see our guide to sakit bahu dan leher.
Frequently asked questions (FAQ)
Apa itu skoliosis (what is scoliosis)?
Skoliosis (scoliosis) is where the spine twists and curves to the side (NHS), so from behind it can look like the letter C or S (MedlinePlus). It can affect people of any age, but most often starts in children aged 10 to 15 (NHS). In around 8 in 10 cases the cause is unknown, which is called idiopathic scoliosis (NHS). Girls are more likely than boys to have this type (NIAMS). Many people do not need treatment, and most people with scoliosis can live normal lives (NHS).
Apa tanda awal skoliosis (what are the early signs of scoliosis)?
Signs include uneven shoulders, one shoulder or hip sticking out, leaning to one side, the ribs sticking out on one side, a visibly curved spine and clothes not fitting well (NHS). One side of the rib cage may look higher than the other when your child bends forward (NIAMS). Mild scoliosis usually causes no pain (NIAMS), so it is often first noticed by a parent or during a school or doctor check (American Academy of Orthopaedic Surgeons).
Adakah postur buruk atau beg sekolah berat menyebabkan skoliosis (does bad posture or a heavy school bag cause scoliosis)?
No. Idiopathic scoliosis is not thought to be linked to bad posture, exercise or diet (NHS). Bad posture does not cause scoliosis, and sports and heavy backpacks do not cause scoliosis or make a curve worse, although heavy backpacks can be linked to back pain (American Academy of Orthopaedic Surgeons). Your genes may make you more likely to get it, as it sometimes runs in families (NHS).
Boleh ke skoliosis hilang sendiri (can scoliosis go away on its own)?
Some very small curves may improve without treatment, but this is the exception rather than the rule (American Academy of Orthopaedic Surgeons). In babies and toddlers, the spine may straighten as they grow (NHS). A brace can help stop a curve getting worse, but it is not expected to straighten an existing curve, and surgery is the only treatment that can reduce the curve (American Academy of Orthopaedic Surgeons). Scoliosis tends to stay the same after you stop growing (NHS).
Bila anak perlu pakai brace (when does a child need a back brace)?
A brace may be recommended if the curve is getting worse and your child is still growing (NHS). As a general guide, bracing may be suggested for curves between 25 and 45 degrees in a child who is still growing (American Academy of Orthopaedic Surgeons). A brace will not correct the curve, but might help stop it getting worse (NHS). It usually needs to be worn for many hours a day, often up to 23 hours, for as long as your child is growing (NHS).
Boleh ke senaman, urut atau kiropraktik betulkan skoliosis (can exercise, massage or chiropractic fix scoliosis)?
There is no good evidence that they straighten the spine. It is not clear whether specific back exercises or physiotherapy can help improve scoliosis, and there is little reliable evidence that osteopathy or chiropractic can correct a curved spine or stop it getting worse (NHS). Yoga, Pilates, massage, acupuncture and chiropractic care may help back pain, but have not been shown to reduce the curve or stop it getting worse (American Academy of Orthopaedic Surgeons). General exercise is still good for health and should not be avoided unless your doctor advises it (NHS).
Boleh ke wanita dengan skoliosis mengandung dan bersalin (can women with scoliosis get pregnant and give birth)?
Yes. Many studies on scoliosis and pregnancy have not shown difficulties in childbearing, and there is no increase in fetal distress, premature birth or problems with delivery (American Academy of Orthopaedic Surgeons). Pregnancy does not usually make the curve much worse in a spine that has not had surgery (American Academy of Orthopaedic Surgeons). Spinal fusion surgery does not increase the risk of complications in future pregnancies or birth (American Academy of Orthopaedic Surgeons). If you have had spinal fusion, make sure your obstetrician and anaesthetist know which part of your spine was fused (American Academy of Orthopaedic Surgeons).
Disclaimer
This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor. Talk to a doctor or spine specialist about your own or your child’s treatment, and ask a doctor or pharmacist before taking any medicine, especially if you are pregnant.
References
- Scoliosis — NHS
- Scoliosis: treatment in children — NHS
- Scoliosis: treatment in adults — NHS
- Scoliosis — MedlinePlus, US National Library of Medicine
- Scoliosis: overview, symptoms and causes — National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
- Scoliosis: diagnosis, treatment and steps to take — NIAMS
- Idiopathic scoliosis in children and adolescents — American Academy of Orthopaedic Surgeons (OrthoInfo)
- Introduction to scoliosis — American Academy of Orthopaedic Surgeons (OrthoInfo)
- Nonsurgical treatment options for scoliosis — American Academy of Orthopaedic Surgeons (OrthoInfo)
- Deepak AS, et al. The clinical effectiveness of school screening programme for idiopathic scoliosis in Malaysia. Malays Orthop J. 2017;11(1):41-46.
- Kwan MK, et al. Perioperative outcome and complications following single-staged posterior spinal fusion (PSF) using pedicle screw instrumentation in adolescent idiopathic scoliosis (AIS): a review of 1057 cases from a single centre. BMC Musculoskelet Disord. 2021;22(1):413.
