Scoliosis and Kyphosis

The spine or "backbone" is a group of bones stacked in a straight line down the middle of the back, held together with muscles and ligaments. Treatment for children's cancer can sometimes result in abnormal curvatures of the spine, known as scoliosis and kyphosis.

Scoliosis is a sideways rotation of the spine. Instead of appearing as a straight line when viewed from the back, the spine appears curved, like the letter "S" or the letter "C". Signs of scoliosis may include:
  • Uneven shoulder blades
  • Uneven hips
  • Uneven waist
  • “Leaning” of the back to one side
  • Head not centered above pelvis
  • One leg longer than the other
Kyphosis is an abnormal rounding of the upper part of the back. When viewed from the side, it may appear as if the person is slouching or has a "hump" on the back.

Causes of Scoliosis

Scoliosis occurs in many young people, especially teenagers, and is most often "idiopathic," meaning that the cause is not known. However, people who have received radiation to the chest, abdomen or spine, especially when combined with surgery, are at increased risk for uneven development of the muscles, bones and soft tissues of the back, resulting in scoliosis.

People at risk include those who have had:
  • Radiation to the trunk (including any area from the shoulders down to the pelvis), especially if:
    • The dose was 20 Gy (2000 cGy/rads) or higher
    • The radiation treatment area was to one half of the chest or abdomen
    • There was also surgery to the chest, abdomen, or spine
  • Orthovoltage type radiation (commonly used before 1970)
  • A tumor in or near the spine
  • A diagnosis of neurofibromatosis

Causes of Kyphosis

Kyphosis sometimes develops from stretching of the spinal ligaments, causing the natural curve of the spine to increase. Kyphosis can also be caused by uneven development of the back muscles and ligaments as a result of radiation.

People at risk include those who have had:
  • Radiation to the chest or thorax (including mantle, mediastinal, whole lung, whole abdomen, or any upper abdominal field), especially in doses of 20 Gy (2000 cGy/rads) or higher
  • Total body irradiation (TBI)
  • Spinal radiation at a dose of 30 Gy (3000 cGy/rads) or higher
  • Orthovoltage type radiation (commonly used before 1970)
  • A tumor in or near the spine
  • A diagnosis of neurofibromatosis

Making a Diagnosis

Signs of scoliosis or kyphosis may be detected on physical examination and confirmed with x-rays. Scoliosis is diagnosed when there is at least a 10-degree lateral (side-to-side) curve on the x-ray. Kyphosis is diagnosed when there is at least a 50-degree curve on the x-ray.


Treatment for scoliosis and kyphosis is usually done in stages. The first stage is usually "observation." During this stage, the curve is closely monitored, especially during periods of rapid growth, such as during puberty. If the curve does not get worse, observation may be all that is necessary.

If the curve progresses, the next step is usually bracing (a plastic body brace worn under the clothing). The goal of bracing is to halt progression or help correct the abnormal spinal curvature.

The final treatment step is surgery. This is done in cases of serious curves that are not manageable with observation or bracing alone.

Monitoring for Scoliosis or Kyphosis

If scoliosis or kyphosis is suspected, an X-ray of the spine should be obtained. If the curve is more than 10 degree for scoliosis or more than 50 degrees for kyphosis, a referral is usually made to an orthopedic (bone) specialist.

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