Scoliosis is a three-dimensional deformity of the spine, defined radiographically by a lateral curvature with a Cobb angle ≥10° and associated vertebral rotation. It can be idiopathic, congenital, neuromuscular or secondary to other conditions.

Types and Etiology

• Idiopathic scoliosis (infantile, juvenile, adolescent, adult) has no clear underlying structural cause and is the most common form, especially adolescent idiopathic scoliosis (AIS).
• Congenital scoliosis results from vertebral malformations (hemivertebrae, segmentation defects).
• Neuromuscular scoliosis arises from muscle imbalance or weakness (e.g. cerebral palsy, muscular dystrophy).
• Secondary curves can develop due to leg-length discrepancy, degenerative changes and other factors.

Genetic and environmental influences contribute to susceptibility and progression risk, particularly in AIS.

Pathophysiology and Biomechanics

Scoliosis involves:

• Lateral deviation of the vertebral column in the frontal plane.
• Rotation of vertebrae, producing rib hump deformity on forward bending.
• Altered loading of discs, facets and paraspinal muscles, приводя к асимметрии тонуса и усталости.

In progressive curves, asymmetric growth and loading may perpetuate deformity (vicious circle model).

Clinical Features

• Asymmetry of shoulders, scapulae, waist and trunk.
• Rib prominence on one side when bending forward (Adams test).
• In mild to moderate idiopathic scoliosis, pain may be minimal; in adults or degenerative scoliosis, pain and stiffness are more prominent.

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Assessment and Management

• Evaluation includes clinical exam, Cobb angle measurement on X-rays and monitoring of growth (in children/adolescents).
• Treatment depends on curve magnitude, skeletal maturity and progression risk:
  • Observation for small, stable curves.
  • Bracing for moderate curves in growing patients to limit progression.
  • Surgical correction and fusion for severe or progressive curves.

Rehabilitation and exercise (e.g. specific scoliosis physiotherapy methods) support posture, muscle balance and function.

Scoliosis thus represents a complex interaction of growth, biomechanics and neuromuscular control. Individualized assessment helps balance observation, conservative measures and surgery where truly necessary.