Mid-Back (Thoracic)
Idiopathic Thoracic Scoliosis
흉추 측만증 (특발성)
Idiopathic 3D spinal deformity with lateral curvature and rotation
- How common
- 2–3% of adolescents
- Typical age
- Ages 10–18, female predominant
What is it?
During growth, idiopathic lateral curvature with axial rotation produces 3D spinal deformity.
Commonly affected: Right thoracic curve most common
How it develops
- Asymmetric GrowthAsymmetric vertebral/disc growth
- Lateral CurvatureC- or S-shape in coronal plane
- Vertebral RotationActive rotation creates rib hump
- Progresses During Growth SpurtCobb angle progresses rapidly in pubertal spurt
Symptoms
- Rib humpAsymmetric back with forward bend
- Shoulder asymmetryVisibly higher shoulder on one side
- Waist asymmetryUneven waistline
- Usually painlessUsually painless in adolescence; consider other cause if painful
How it is examined
- Adams forward bendRib hump visible at 90° forward bend
- ScoliometerMeasures axial rotation (>7° → get X-ray)
- Shoulder/pelvis levelAssess shoulder and pelvic levelness
- Neurologic examDeficit suggests secondary scoliosis
Imaging
Standing full-spine AP/lateral X-ray — Cobb angle measurement.
- Cobb >10° = scoliosis
- Vertebral rotation (Nash-Moe)
- Apex vertebra location
- Compensatory curves
MRI for early-onset, atypical curves, or neurologic signs.
- Syringomyelia
- Chiari malformation
- Tethered cord
- Exclude structural pathology
Non-surgical care
- Observation (Cobb 10–25°)X-ray follow-up every 4–6 months
- Boston/Milwaukee braceCobb 25–40° with remaining growth; 20 hr/day
- Schroth method PT3D postural correction exercises
- Regular monitoringSerial X-ray until skeletal maturity
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Cobb >45–50°, progressive curve, pulmonary risk
Procedures that may be discussed
- Posterior instrumented fusion
- Anterior fusion (selective)
Outlook
Cobb <30° rarely progresses post-maturity; early detection is key.