When parents hear their child has scoliosis, one of their first questions is, “What does this mean?”

Fortunately, most children with scoliosis can continue to participate fully in sports and other activities, and the vast majority will never need surgery. Early diagnosis, however, can make a significant difference in treatment options available.

Scoliosis is an abnormal sideways curvature of the spine. Rather than appearing straight when viewed from behind, the spine curves into a “C” or “S” shape. The vertebrae also ro-tate, which can cause the ribs or muscles of the lower back on one side to appear more prominent than the other. One shoulder or hip may also appear higher than the other.

The most common form is adolescent idiopathic scoliosis, which typically develops around the growth spurt at or just before puberty. “Idiopathic” means that we do not know exactly why it occurs. Scoliosis is not caused by poor posture, carrying a heavy backpack or any-thing a child or parent did wrong.

Scoliosis is sometimes first noticed during a well-child visit or sports physical. Other times, a parent notices uneven shoulders, an asymmetric waist crease, one hip appearing higher, or one side of the rib cage becoming more prominent when the child bends forward. Parents may be especially likely to notice these changes during the summer, when children are wearing tank tops and bathing suits.

If scoliosis is suspected, an orthopedic evaluation and standing X-rays of the spine can confirm the diagnosis. The curve is measured in degrees using the Cobb angle. A curve measuring 10 degrees or more is considered scoliosis; curves measuring less than 10 degrees are considered spinal asymmetry.

The key issue is growth. Scoliosis is more likely to progress when a child has significant growth remaining. A small curve in a child who is nearly finished growing may require little more than observation until skeletal maturity. The same curve in a younger child who is still growing may require closer monitoring.

Detecting a progressive curve early may also allow us to use treatments designed to prevent it from worsening. Waiting until a curve becomes severe can limit those options.

Treatment depends on the size of the curve, the child’s age and skeletal maturity, and whether the curve is increasing over time.

Many small curves require only observation, with periodic examinations and X-rays during growth. For growing children with moderate curves – often beginning around 20 to 25 de-grees – a brace may be recommended. A brace is not intended to permanently straighten the spine, but when worn as prescribed, it can significantly reduce the risk that the curve will progress to the point that surgery is needed.

Physical therapy and scoliosis-specific exercises may also play a role for some patients, par-ticularly as part of an overall treatment plan. Families interested in this approach can look for a physical therapist trained in the Schroth method. Vitamin D deficiency is also common in adolescents, and maintaining adequate vitamin D is important for bone health, although vitamin D supplementation has not been established as a stand-alone treatment for scolio-sis.

For curves measuring approximately 50 degrees or more, or for curves that continue to pro-gress despite nonsurgical treatment, surgery may be recommended. The most common operation is posterior spinal fusion with instrumentation, which corrects much of the de-formity and prevents further progression. Newer surgical techniques may be appropriate for selected patients as well.

Most importantly, a diagnosis of scoliosis does not mean a child needs to stop being a kid. In most cases, we encourage children with scoliosis to remain active, play sports and par-ticipate fully in the activities they enjoy.

If you notice asymmetry in your child’s shoulders, back, waist or ribs – especially during a preadolescent growth spurt – mention it to your pediatrician or orthopedic provider. Find-ing scoliosis early gives a child the greatest opportunity for bracing, if needed, and reduces the risk that the curve will progress to the point where surgery is indicated.

Dr. Sheryl Handler-Matasar is a pediatric orthopedic surgeon at Akron Children’s. She sees patients in Beachwood and Boardman, Ohio.