Causes of Scoliosis and Treatment Options for Each Case

Scoliosis is a structural change in the spine that creates abnormal curves instead of the continuous straight axis running from the C7 cervical vertebra down to the tip of the coccyx seen in a healthy spine. It typically begins during puberty, with girls at higher risk than boys. Based on curve shape, it is classified into two main types: a single C-shaped curve, forming one arc with a magnitude and Cobb angle that vary by severity; and a double S-shaped curve, consisting of two arcs that can differ in size, though in severe cases they tend to be nearly symmetrical.

As for causes, about 85% of cases have no identifiable cause and mostly begin during adolescence. The remaining 15% may involve genetic factors, where genes inherited from parents or earlier generations influence abnormal spinal development starting in the womb; muscular and neurological conditions such as muscle atrophy, muscular dystrophy, cerebral palsy, or motor neuron disorders, which weaken the muscular system's ability to support and stabilize the spine; and, notably, flat feet — estimated to affect around 30% of children in Asia — which can create musculoskeletal imbalance in the lower limbs, triggering a compensatory mechanism in the spine that contributes to scoliosis.

As for treatment, for mild curves not yet requiring intensive intervention, physical therapy plays an important role, strengthening the core muscle groups — back, abdominal, and paraspinal muscles — while improving the flexibility of the vertebrae and surrounding soft tissue; for those already wearing a brace, physical therapy also serves as an active support. For cases requiring active correction, orthotic bracing is currently the optimal treatment — highly effective and safe, capable of helping patients avoid permanent surgery, consistent with the BrAIST trial published in the New England Journal of Medicine (2013), which found a 72% success rate in the braced group versus 48% in the observation-only group. Surgery is reserved for severe cases that cannot be effectively managed with bracing and where bone maturity is appropriate for intervention.

Two real cases illustrate the difference across severity levels. A girl just over 5 years old was found to have a 30 Cobb-degree curve along with significant flat feet and arch collapse; she was treated simultaneously with a spinal brace and a flat-foot orthotic insole, showing clear improvement after just four months of addressing both issues together. By contrast, an 11-year-old girl with a milder single curve of 14 Cobb degrees initially needed only physical therapy; however, because her older sister had previously required spinal surgery and she herself was about to enter puberty — the period of highest risk for scoliosis onset — her family proactively chose to add a night brace as a precaution, underscoring that the choice of treatment should always weigh each patient's specific context and risk factors.