Many parents are accustomed to their child’s spine being examined during an annual well-child visit, starting at a young age. Typically, this entails having the child bend forward while the doctor looks at the spine to ensure that the spine is straight when viewed from behind. So how can the spine can appear straight one year, yet a young girl may return to her primary care provider the next year, only to learn that there is a curve in the spine that is significant enough to warrant a referral to a specialist?
Scoliosis is not a disease but rather a descriptive term referring to a curvature of the spine. Scoliosis is a lateral or side-to-side curvature of the spine that makes the spine look more like an "S" or "C" than a straight "I”, when viewed from the back. The most common form of scoliosis is Adolescent Idiopathic Scoliosis (AIS), which usually becomes evident in the early adolescent years. Currently, AIS has no known cause and may have a hereditary component since it tends to run in families. Girls also run a higher risk for the disorder than do boys.
The development of scoliosis is often gradual, but it is not uncommon for a curve to seem to suddenly appear. Since scoliosis typically develops prior to puberty, it is normal for a parent to rarely to see their child’s bare back. During early adolescence, children tend to be more self-conscious and prefer their privacy when bathing. Also adolescents tend to wear more baggy clothing, especially in the winter. If a child also goes through a growth spurt, changes in the spine that occur over the winter may not be noticed until summer.
A scoliosis screening often occurs in a physician’s office, nurses’ clinic, or school. In the
USA, less than half the states mandate scoliosis screening in the schools. The effectiveness of routine scoliosis screening in the schools is controversial, as studies have both supported and discouraged routine screenings. The Bozeman School District used to perform annual scoliosis screenings but now screenings are only done by a school nurse when a referral is made.
A scoliosis screening is normally done efficiently and without any high-tech equipment and allows a physician or nurse to make more appropriate referrals when necessary.
Also, a doctor or parent may observe signs and symptoms including: shoulders or hips and waist appear uneven, one shoulder blade appears more prominent, the head is not centered over the body or the entire body leans to one side.
Like most health care issues, early detection is important. Most cases of scoliosis are mild and generally just need to be monitored closely, usually with X-rays, to see if the curve is getting worse. Physical therapy may be prescribed to help maintain good trunk strength and flexibility. Those children diagnosed with severe curves or curve patterns that worsen over time may require a back brace or even surgery to straighten the spine.
To view references for this article and a list of scoliosis sites on-line, please see epicentertherapy.com . Also, consult your health care provider with concerns or questions regarding your child.

Patient with S curved spine.
Normal spine on left. Notice shoulder height differences on right spine.