What’s more likely than a scoliosis misdiagnosis is diagnosing scoliosis late in its progressive line. Despite the potential benefits of early detection, it can be difficult to achieve, particularly in children. Once the signs of scoliosis become noticeable, they are quite unique and difficult to misdiagnose, but the goal is diagnosing scoliosis while still mild.
There are a number of spinal conditions that cause a loss of its healthy curves, but the rotational component of scoliosis makes it different to other spinal conditions; a more pressing concern should be diagnosing scoliosis late, or leaving it untreated.
Before getting to the specific risks of not diagnosing scoliosis early, let’s talk generally about its progressive nature and how it affects the body.
What is Scoliosis?
Scoliosis causes the spine to curve and rotate to the side and can affect the body in a number of ways.
As a progressive condition, the nature of scoliosis is to become more severe, and it’s growth that triggers progression: why childhood scoliosis, in particular, needs to be treated proactively (1, 2).
Scoliosis can also affect all ages, and symptom severity increases alongside progression, so the goal is recognizing the early signs of scoliosis, prior to significant progression occurring and making scoliosis more complex to treat (1, 2).
Scoliosis can be highly treatable, and few things increase the likelihood of treatment success more than early detection and intervention, so what parents, in particular, should be more concerned with than a scoliosis misdiagnosis, is diagnosing it late, after valuable treatment time has been missed.
As scoliosis progresses, the spine’s unnatural curve and twist is increasing, and along with symptoms becoming more noticeable, the spine is becoming more rigid and less responsive.
So the best approach for parents to take is increasing awareness through education. Knowing if a child has risk factors in place and/or being aware of the early signs of scoliosis to watch for can lead to an early diagnosis and potential treatment success (2, 3).
Early Signs of Scoliosis in Children
Early signs of scoliosis shouldn’t be ignored because they can indicate that progression is occurring, or is going to occur, and treatment is needed for effective management (2, 3).
While adults can also benefit from early detection and treatment to minimise or stop progression (4), due to the role of growth in progression, the focus of early detection is on childhood scoliosis.
While misdiagnosis of any medical condition is always a concern, when it comes to childhood scoliosis, what’s more common is for scoliosis to go undiagnosed and untreated.
Scoliosis ranges from mild scoliosis to moderate and severe scoliosis, and its signs become more noticeable alongside progression, but in many cases of childhood scoliosis, the subtlety of its early signs can be missed (1, 2).
As scoliosis causes the spine to become misaligned due to a loss of its healthy curves and the spine’s rotation, there are visual effects to watch for.
If the spine becomes misaligned, the body does too, and this is evident in a person’s posture as the uneven forces of scoliosis can cause asymmetrical changes in the body (2, 3).
In most cases, the earliest signs of scoliosis to watch for are uneven shoulders, shoulder blades, and uneven hips (2).
Additional changes to watch for can include:
- The head appearing uncentered over the torso
- Development of a rib cage arch
- Arms and legs that appear unequal in length
- A prominent lean to one side
- Changes to gait, balance, and coordination
- A more prominent rib cage on one side compared to the other when the patient bends forward (2).
So as early detection keeps being mentioned, particularly in the context of childhood scoliosis, what can happen if a child’s scoliosis is left undiagnosed and/or untreated?
Untreated Scoliosis
When it comes to progressive conditions like scoliosis, it’s not just the type of treatment that’s important, but the timing of when it’s started (2, 3).
Untreated childhood scoliosis can easily become adult scoliosis which is more difficult to treat and can also be painful (5, 6).
Scoliosis becomes more compressive when growth stops, and this may contribute to scoliosis pain, so for children, compressive back pain isn’t a common factor, but once it develops, it’s the main symptom that leads to adults being assessed and diagnosed (4).
Adolescent idiopathic scoliosis is the most prevalent type of scoliosis, and if it’s left untreated, it’s likely to progress with time and growth, until its effects become noticeable enough to lead to a diagnosis (2, 3).
Adolescent scoliosis in adults (ASA) is also a concern, with many of these patients likely going undiagnosed during adolescence. This missed diagnosis during adolescence means that opportunity to treat the patient during growth has been lost.
There are benefits to starting treatment before significant progression has already occurred and effects are well established (1).
For those who choose to simply watch and wait following a diagnosis of mild scoliosis, the risk is wasting valuable treatment time. The risk is not managing progression. The risk is merely observing while scoliosis becomes more complex to treat.
The good news for parents is that childhood scoliosis can be highly treatable, and the best means of advocating for a child, when it comes to scoliosis, is through awareness and regular screening, and the good news for adults is that it’s not too late to start treatment (4).
So if the early signs of scoliosis are recognized in a child, what’s the next step?
Diagnosing Scoliosis
Diagnosing scoliosis while mild isn’t always easy, but once overt postural and movement changes start to occur, they are unique and difficult to misdiagnose (1, 2).
In addition, a scoliosis X-ray is needed to officially diagnose scoliosis, (2).
A common scenario for parents is noticing a child’s uneven posture during vacation while spending extended periods of time with a child in a bathing suit.
Adolescents are known to conceal postural changes if they are embarrassed by them and/or don’t understand them. Adolescents are also known for poor posture, so it can be difficult to distinguish between a mere slouch or an asymmetrical postural change (3).
If a parent notices sudden changes in posture and/or movement, and particularly if there are risk factors in place, a screening examination should be conducted (1, 2).
Risk Factors and Screening
Children who have a family history of scoliosis, are approaching puberty, and are female are the most at risk for developing scoliosis, so screening can prove to be very beneficial (1).
A scoliosis screening examination can be performed by a general practitioner as part of a child’s routine check up, or a trained ScoliCare Clinician.
A scoliosis screening examination will involve taking a patient’s medical history, family history, performing a postural and movement assessment, and an Adam’s forward bend test.
A patient’s spine and any related trunk asymmetries are more visible when in a forward-bend position, and if indicators of scoliosis are present, further testing in the form of a scoliosis X-ray may be warranted and recommended (2).
An X-ray is needed to confirm the size of the scoliosis, the presence of rotation, and to further classify conditions (2).
The rotational component distinguishes scoliosis from a number of other conditions that cause spinal misalignment, making it difficult to misdiagnose.
Conclusion
So what are the signs of scoliosis you shouldn’t ignore? In children, asymmetrical postural changes should be taken seriously, as should unexplained back and radiating pain in adults.
While misdiagnosis can be of concern and there is nothing wrong with getting a second opinion, when it comes to a scoliosis misdiagnosis, not recognizing its early signs is far more common; the prevalence of adolescent scoliosis in adults highlights this.
The earliest signs of childhood scoliosis to watch for include postural and movement changes, with uneven shoulders and hips considered a primary early indicator.
Important risk factors to be aware of are family history, gender, and age, so adolescent females with another sibling or family member diagnosed are the most at risk and should undergo regular scoliosis screening.
Regular scoliosis screening examinations look for indicators of scoliosis, and considering the benefits associated with early detection and intervention, adding an Adam’s forward bend test to a child’s regular routine check ups is more than warranted.
So if someone you care about is showing signs of scoliosis, the time to act is now, and contacting a ScoliCare Clinic for assessment may put patients on the road to early detection, intervention, and treatment success.
References:
- Weinstein S. L. (2019). The Natural History of Adolescent Idiopathic Scoliosis. Journal of pediatric orthopedics, 39(Issue 6, Supplement 1 Suppl 1), S44–S46. https://doi.org/10.1097/BPO.0000000000001350
- Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, Diers H, Grivas TB, Knott P, Kotwicki T, Lebel A, Marti C, Maruyama T, O’Brien J, Price N, Parent E, Rigo M, Romano M, Stikeleather L, Wynne J, Zaina F. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018 Jan 10;13:3. doi: 10.1186/s13013-017-0145-8. PMID: 29435499; PMCID: PMC5795289
- Negrini, S., Grivas, T. B., Kotwicki, T., Maruyama, T., Rigo, M., Weiss, H. R., & Members of the Scientific society On Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) (2006). Why do we treat adolescent idiopathic scoliosis? What we want to obtain and to avoid for our patients. SOSORT 2005 Consensus paper. Scoliosis, 1, 4. https://doi.org/10.1186/1748-7161-1-4
- Palazzo, C., Montigny, J. P., Barbot, F., Bussel, B., Vaugier, I., Fort, D., … & Marty-Poumarat, C. (2017). Effects of bracing in adult with scoliosis: a retrospective study. Archives of Physical Medicine and Rehabilitation, 98(1), 187-190.
- Lenz, M., Oikonomidis, S., Harland, A., Fürnstahl, P., Farshad, M., Bredow, J., … & Scheyerer, M. J. (2021). Scoliosis and Prognosis—a systematic review regarding patient-specific and radiological predictive factors for curve progression. European Spine Journal, 30(7), 1813-1822.
- Zaina F, Marchese R, Donzelli S, Cordani C, Pulici C, McAviney J, Negrini S. Current Knowledge on the Different Characteristics of Back Pain in Adults with and without Scoliosis: A Systematic Review. J Clin Med. 2023 Aug 9;12(16):5182. doi: 10.3390/jcm12165182. PMID: 37629224; PMCID: PMC10455254
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