What is scoliosis?

Short answer: Scoliosis is a three-dimensional change in the spine. The spine curves sideways and, at the same time, the vertebrae turn around their own axis. A diagnosis rests on two findings together: a Cobb angle (the degree of curvature measured on an X-ray) of 10 degrees or more on a standing film, and rotation that can be recognised. Asymmetries that stay below 10 degrees are called scoliotic posture rather than scoliosis. In childhood and adolescence the common form is idiopathic scoliosis, which cannot be traced to a single cause, and because it usually progresses without pain it is often noticed late.

What scoliosis describes in the spine

Seen from behind, a healthy spine follows a straight line from the base of the neck down to the pelvis. Seen from the side it has curves at the neck, the upper back and the lower back, and those curves belong there. What changes in scoliosis is the line you see from behind: the spine shifts sideways into an S or a C shape.

Describing scoliosis only as a sideways bend leaves out most of it. As the curve develops the vertebrae turn around their own axis, the rib cage follows that rotation, and the natural curves seen from the side change as well. This is why the word three-dimensional is used. The shift you notice on a child's back from behind is the visible surface of something that also has depth.

The 2016 SOSORT guideline asks for two conditions before the word scoliosis is used. On a standing full-spine X-ray the Cobb angle has to measure 10 degrees or more, and rotation around the axis of the spine has to be recognisable. In the same passage the guideline states plainly that a diagnosis of scoliosis should not be made below 10 degrees.

The second condition is the one families rarely hear about. A child whose report reads 8 degrees does not meet the guideline's definition, and a brace recommended on that basis does not follow it either. A small angle measured without recognisable rotation is not scoliosis on its own. Everything further down this page is built on those two conditions.

Structural scoliosis and scoliotic posture are not the same thing

For a parent who has spent an evening searching online, this is probably the most useful section on the page. Not every child whose back looks uneven when standing has a structural scoliosis. From the outside the two can look alike, but underneath they are separate situations, and one simple behaviour tells them apart.

In scoliotic posture, that is, in postural asymmetry, the vertebrae themselves are sound. The uneven appearance comes from a standing habit, from a muscle imbalance between the two sides of the body, or from one side of the pelvis sitting higher than the other. When the child lies on their back the appearance largely disappears, because the load that distorted the standing position has gone. The angle measured on an X-ray stays below 10 degrees.

In structural scoliosis the vertebrae are rotated, and that rotation does not resolve with a change of position. When the child bends forward with the knees straight and the arms hanging loose, one side of the back rises. That raised area is the rib hump, called a gibbosity in clinical writing and gibbozite in a Turkish report, and families usually describe it as a hump or a bump. It stays whether the child lies down or tries hard to stand tall.

The person who draws this distinction is a physician, and the decision rests on the examination and the X-ray read together. The spotting the signs at home page sets out step by step how the forward-bend check is done at home. Even so, checking at home is only a way of keeping an eye on things, and it does not replace a diagnosis.

The explanation families hear most often from the people around them is that the child slumps over a desk and the curve comes from there. There is no evidence that posture causes structural scoliosis. Poor sitting can imitate scoliotic posture, but structural scoliosis involves the shape and the position of the vertebral bodies themselves, and a sitting habit cannot produce that. Sitting upright is still worth encouraging for the sake of fatigue and comfort, though it cannot be offered as a way of preventing scoliosis.

The distinction cuts both ways. It lifts a weight off the parent who spent years saying stand up straight and then blamed themselves. Writing off an uneven-looking back as a posture problem, on the other hand, can keep a real curve out of sight for years.

Heavy school bags, a difference in leg length and the belief that swimming will straighten a curve are taken one at a time on the parents' questions and school, sport and daily life pages.

What the word idiopathic is saying

The word that stops most readers in a report is idiopathic. Its dictionary meaning is of unknown cause. Parents often take it to mean that the physician did not look hard enough, or that a test was skipped. That is not what it says.

There is no single cause behind idiopathic scoliosis. On present knowledge a number of factors act together, and a genetic predisposition is the closest available explanation. It cannot be pinned to one gene variant, and it cannot be pinned to one environmental factor either. The cause is unknown because it marks the present limit of what the field knows, and not because anything was left undone in the examination room.

That has one concrete consequence. Since the cause is unknown, there is no option of resolving a curve by removing its cause. What can be done is of a different kind: measure the course at set intervals, watch for progression, and act, if it is needed, before the growth window closes. That is what lies in a family's hands, and it is not a small thing.

Parents who had scoliosis themselves ask whether it is inherited. A genetic predisposition is accepted as playing a part, so where scoliosis runs in a family it is reasonable to have brothers and sisters who are still growing looked at as well. A specific rate of inheritance is not given on this page, because the sources behind this guide hold no verified figure for it.

The types of scoliosis

Scoliosis is not one single picture. It is classified by cause and by the age at which it begins. The distinction does real work, because it changes how often a child is reviewed and which route the follow-up takes.

By cause

• Idiopathic scoliosis (Turkish: idiyopatik skolyoz) is the form seen most often, and no single cause explains it. Most of the pages in this guide describe this type.
• Congenital scoliosis (konjenital skolyoz) arises from structural differences formed while the vertebrae were developing before birth, and it is present from birth onward. Its follow-up pattern is separate from that of idiopathic scoliosis.
• Neuromuscular scoliosis (nöromusküler skolyoz) accompanies conditions affecting the muscles and the nervous system, such as cerebral palsy, muscle diseases or a spinal cord injury. Here the curve is not handled on its own but as one part of the underlying picture.
• Syndromic scoliosis (sendromik skolyoz) can appear as a component of certain genetic syndromes that affect connective tissue.
• Degenerative scoliosis (dejeneratif skolyoz) emerges in adulthood as a result of age-related change in the spinal joints and discs. It should not be confused with a curve carried over from the growing years, and the detail sits on the scoliosis in adults page.

By age at onset

Idiopathic scoliosis is divided into three groups by the age at which it is first recognised. Broadly, the infantile period covers infancy and the first years of childhood, the juvenile period covers the preschool and primary school years, and the adolescent period runs from the beginning of puberty to the completion of skeletal growth. Classification systems draw these boundaries in different places, so which term a report uses, and what it corresponds to, is a fair question to put to the physician.

The three groups differ in more than age, because the curves also behave differently over time. That is why the adolescent group is taken up separately on the scoliosis in children and adolescents page. That period coincides with the growth spurt and calls for a follow-up discipline of its own.

The words used in the examination room and in the report

Part of what is said on the day of a diagnosis is made up of words a family has never heard before, and many people leave the room without finding a moment to ask. There is a second difficulty for a reader who does not speak Turkish: the X-ray report itself will be written in Turkish, and the words below are the ones you are most likely to meet, some of them on the report and some of them in the examination room. The list is limited to the ideas defined on this page. How to read a report from beginning to end, the Risser stage included, belongs to the diagnosis and follow-up page.

A child may have a single curve or two curves together. With one curve the trunk resembles the letter C, with two the letter S. Which of these is present, which region of the spine the curve occupies and which vertebra the apex falls on are all written in the X-ray report. Because those lines are hard to read, families often reduce the report to the line that gives the degree, even though the rest of it shapes the follow-up decision at least as much.

What the Cobb angle is

The Cobb angle is the degree of the curvature measured on the X-ray, and it is the yardstick used worldwide to describe how large a scoliosis is. To measure it, the most tilted vertebrae at the upper and lower ends of the curve are identified on a standing full-spine film. A line is then drawn along the upper surface of the uppermost of those vertebrae and another along the lower surface of the lowest one. The angle formed where those two lines meet is the degree written into the report.

It is natural for a parent to end up weighing everything against that one number, but reading it on its own is misleading. Measure the same X-ray twice and a difference of a few degrees can appear from the measurement itself. A three-degree change between two reports may sit inside that margin and does not count as progression on its own. A physician weighs the difference between two measurements together with that margin.

Knowing what the Cobb angle does not measure makes a report easier to read. The angle gives the sideways shift in the line of the spine as seen from behind. The turning of the vertebrae around their own axis is assessed separately, and that is precisely the second condition of the diagnosis. How the child's back looks from the outside does not map one-to-one onto the degree either, because the size of the curve is not the only thing that governs the appearance of the trunk. How much rotation there is, and which region of the spine the curve occupies, both feed into that appearance.

Ten, thirty and fifty degrees: what the thresholds say

The 2016 SOSORT guideline gives three numbers, and the three of them say different things.

What the three numbers share is that all of them speak about the likely course. None of them decides a course of treatment by itself. Whether monitoring is enough, whether scoliosis-specific exercise comes into the picture and whether a brace is needed are not answered by looking at the degree alone. How much growth the child has left, the type of the curve and the change between two measurements are weighed together. As for what is discussed at which threshold, the follow-up intervals are covered on the diagnosis and follow-up page, and how a brace decision is reached and who reaches it on the bracing and exercise page.

The aim of monitoring during the growing years is not framed as returning a child to a former state. The goal is for the degree that remains when skeletal growth is complete to be as low as it can be, because the number measured on that day goes a long way towards setting the course of the decades that follow. That is exactly why the 30 and 50 in the table carry meaning.

The question of the surgical threshold is asked by almost every family on the day of the diagnosis. Forty-five and 50 degrees are limits widely accepted in Scoliosis Research Society and SOSORT practice, and once those values are exceeded a surgical assessment comes onto the table. Beyond that point sits an answer this page cannot give. How the operation goes, how long it takes, its risks, the size of the scar, whether rods and screws stay in place for life, and how bending and returning to sport work afterwards are questions for a spine surgeon. The sources behind this guide hold no verified data on any of those headings, and nothing will be estimated here. The surgery decision page carries the list of concrete questions to take to a surgeon.

Which guideline these thresholds come from

All of the numbers above come from a single document. That document is the 2016 SOSORT guideline for the non-surgical treatment of idiopathic scoliosis during growth, and its text was published at the beginning of 2018. SOSORT produced its first guideline in 2005, renewed it in 2011, and updated it in 2016.

One claim in circulation online needs clearing up here. In the search carried out for this guide, no new full-scope clinical guideline replacing the 2016 text could be found. There are recent joint SRS and SOSORT documents, but one of them is an expert consensus on the use of bracing and another is a methodology document describing how research should be designed and reported. Presenting a document written for researchers to a parent as a newly published treatment guideline would be wrong.

The opposite is not true either. That the guideline is dated 2016 does not make it invalid, because reviews published in the years since have broadly supported its main recommendations. It is, on the other hand, a document that deserves a critical reading. In 2024 an independent group examined the text with AGREE II, the instrument used to appraise the quality of guidelines. It is ordinary for a guideline to be appraised in this way, and it is a reason to keep a distance from the attitude that says the guideline has settled the matter and there is nothing left to discuss.

A family can put that to use. When a centre or a web page quotes you a threshold, you can ask which document the number comes from. A number whose source can be named gives you more reason to trust it.

Who to see if you suspect something

One of the sentences heard most often on the day of a diagnosis is a parent asking how on earth they did not notice earlier. There is no neglect to look for in this picture. Scoliosis causes no pain in the great majority of children, so nobody thinks of examining a back while there is no complaint, and everyday clothing hides a curve well. The person who sees the change every day is also the one who finds it hardest to see. Why a curve escapes notice, and how and how often to look at home, is covered on spotting the signs at home. What follows here concerns what to do once you do suspect something.

The first step is always an assessment by a physician, and a reader who did not grow up with the health system here will not necessarily know the route. Families usually begin at a family health centre (aile sağlığı merkezi), where the family physician they are registered with, or a paediatrician, examines the child and writes a referral onwards. Three specialties assess this picture: physical medicine and rehabilitation (fiziksel tıp ve rehabilitasyon), orthopaedics and traumatology (ortopedi ve travmatoloji, and in particular physicians who work in spine surgery), and paediatric orthopaedics. Imaging follows only if the physician asks for it, and which specialty you reach first is usually settled by what is available to you, which is not a wrong start, because the first step is the same in every case.

Appointments at state and university hospitals are made through the national appointment system, and private clinics are booked with the clinic directly. What you pay yourself depends on the insurance you hold, so if you are covered by a private or an employer policy rather than the general health insurance scheme, it is worth checking that cover before the appointment. The two routes also differ in how long you wait, and how the route runs in practice in İzmir is set out on the Bornova and Evka 3 page.

A diagnosis requires a standing X-ray of the whole spine, taken from front to back with the child upright, and the Cobb angle is measured on that image. A Turkish request form or report will usually describe it as an ön-arka (front-to-back) film of the whole spine. The person who requests the imaging and interprets it is the physician. A physiotherapist neither requests X-rays nor makes diagnoses.

If a child has marked back pain, that pain should not be set aside as the pain of the scoliosis, because another condition can lie underneath it. Some findings do not even allow for waiting until the next scheduled review. The full list, and why each item on it is assessed separately, is written out on spotting the signs at home.

When you go to the appointment, take any earlier X-rays themselves rather than the reports alone, because the measurement is made on the image. If the old film is not at hand it can be requested from the centre where it was taken. The date on a report matters as well, since any comparison rests on the change between two measurements.

Turkey runs no national screening programme for scoliosis. The national screening programmes published by the Ministry of Health cover newborn screening, hearing, vision, developmental hip dysplasia and a small number of other conditions, and scoliosis is not among them. Where school screening does take place, it runs through protocols signed at province level between the provincial health and education directorates. Whether a child is screened at school therefore depends on which province they are studying in, and in which year. For a family living here that has one practical consequence: the assumption that a school would have picked it up is not something to lean on, and a parent's own observation through the growing years carries more of the weight. What this places on the family during the growth years is covered on scoliosis in children and adolescents.

Where physiotherapy stands in this picture

The place of physiotherapy in scoliosis is clear, and so is its boundary. The physician makes the diagnosis and sets the follow-up calendar, and the brace decision is the physician's. A physiotherapist does not diagnose or prescribe a brace. Physiotherapy works alongside those decisions rather than replacing them.

On the physiotherapy side the work is defined by scoliosis-specific exercise approaches. These form a group distinct from general back exercise and are built for the individual according to the pattern of the curve. What the approach is founded on, and how it works, is described on the Schroth method page.

Being open about the evidence is of more use than making a promise. There are randomised trials showing that scoliosis-specific exercise may contribute to slowing the progression of a curve. Those trials are small, however, and the reviews that pool them have judged the certainty of the evidence to lie between low and very low. Where a brace is indicated, exercise is added to it rather than used instead of it. The whole evidence discussion, with its numerical results, is set out on the bracing and exercise page.

What physiotherapy cannot do belongs here too. It does not remove a structural curve, and it does not alter a brace decision made by a physician. In a curve that has reached the surgical threshold it does not take the surgeon's place. Where a situation falls outside those limits, the work that is done is referral. Curves needing a surgical assessment are referred to a spine surgeon, and signs such as unexplained night pain or a progressive neurological finding are referred back to a physician.

At the practice in Bornova, Evka 3, a scoliosis assessment begins with a free fifteen-minute introductory call, followed by an appointment and a one-to-one session of sixty minutes. Consultations can be held in English. What the assessment covers and how the sessions proceed is on what happens in a session, and how to reach the practice, along with the route as it runs in İzmir, is on the Bornova and Evka 3 page.

The rest of this guide

This page sets out what scoliosis is. From here you can carry on wherever your own question is most pressing.

• Scoliosis in children and adolescents: why the growth period is decisive, what the epidemiological data from Turkey show, and the factors that raise the risk of progression.
• Spotting the signs at home: how the forward-bend check is done at home, what to look at, and which finding does not allow for waiting.
• Diagnosis and follow-up: the X-ray, the wording of the report, the Risser stage and the intervals between reviews.
• Bracing and exercise in scoliosis: whose decision a brace is, why the daily number of hours is decisive, and how the two run together.
• The Schroth method: what scoliosis-specific exercise is founded on and where the evidence stands today.
• What happens in a session: the introductory call, the first assessment, privacy and the home programme.
• The surgery decision: the thresholds, the questions to put to a surgeon, and the headings this guide cannot answer.
• School, sport and daily life: physical education lessons, one-sided sports, bags and seating.
• Parents' questions: what parents actually ask, and the misconceptions in circulation.
• Scoliosis in adults: degenerative scoliosis, pain and goals for function.
• For families in Bornova and Evka 3: the location, getting there, and the patient route as it runs in İzmir.