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Scoliosis can occur before age 10, but it's rare and is generally caused by some condition such as a spinal tumor, congenital heart disease, or a genetic disorder rather than by the idiopathic (unknown cause) form. Scoliosis that appears before adolescence may need an extensive diagnosis and workup. The most common form, idiopathic scoliosis, occurs during puberty and is relatively easy to diagnose; only a small percentage of cases require extensive treatment. Mild idiopathic scoliosis occurs in approximately 3 to 5 percent of teens. More severe curvature has a markedly smaller incidence.

In 80 to 85 percent of people, the cause of scoliosis is unknown; this is called idiopathic scoliosis.

Structural scoliosis can be caused by neuromuscular diseases (such as cerebral palsy, poliomyelitis, or muscular dystrophy), birth defects (such as hemivertebra, in which one side of a vertebra fails to form normally before birth), injury, certain infections, tumors (such as those caused by neurofibromatosis, a birth defect sometimes associated with benign tumors on the spinal column), metabolic diseases, connective tissue disorders, rheumatic diseases, or unknown factors (idiopathic scoliosis).

Curves that are greater than 20 degrees require treatment. Treatment may involve anything from close observation to bracing and even surgery, depending on the age of the patient and the location of the curve. The decision for bracing or surgery are best made by an orthopedic surgeon familiar with scoliosis and in conjunction with the parents and the adolescent.

This depends, however, on how much growth remains for the child.

Other criteria for a brace include a child who is still growing and has a curve of more than 25 to 30 degrees; and a child who is still growing and has a curve of 20 to 29 degrees that's getting worse.

Chiropractic manipulation, electric stimulation, nutritional supplements, and exercise have not been shown to be effective in stopping the progression of scoliosis.

Exercise does not make scoliosis worse. In fact, it is important for all people, including those with scoliosis, to exercise and remain physically fit. Girls have a higher risk than boys of developing osteoporosis (a disorder that results in weak bones that can break easily) later in life. The risk of osteoporosis is reduced in women who exercise regularly all their lives; and weight-bearing exercise, such as walking, running, soccer, and gymnastics, increases bone density and helps prevent osteoporosis. For both boys and girls, exercising and participating in sports also improves their general sense of well-being.

Fusion is the joining of two or more vertebrae. Surgeons can choose different ways to straighten the spine and also different implants to keep the spine stable after surgery. (Implants are devices that remain in the patient after surgery to keep the spine aligned.)