Scoliosis is a medical condition defined by an abnormal, sideways curvature and rotation of the spine, most frequently developing during the adolescent growth spurt. The condition involves a three-dimensional change to the vertebral column, often appearing as an S- or C-shape. While it is often discussed in relation to girls, boys absolutely get scoliosis. Although the condition affects both sexes, the likelihood of a boy’s spinal curve progressing to a severe degree differs significantly.
Scoliosis Occurrence in Males
The overall rate of developing adolescent idiopathic scoliosis (AIS)—the most common form with an unknown cause—is nearly equal between boys and girls, affecting approximately 3 to 4% of the teenage population. This means that a diagnosis of a mild curve (10 degrees or more) is not uncommon in young males. The major distinction between the sexes lies in the rate of progression, which is the tendency of the curve to worsen over time.
Girls are far more likely to experience curve progression that requires active intervention like bracing or surgery. For curves severe enough to warrant treatment, the ratio often shifts dramatically, with up to ten girls requiring care for every one boy. Current theories for this difference revolve around the timing and intensity of the pubertal growth spurt. Girls generally experience a more rapid and earlier growth phase, which is thought to make their spines more susceptible to significant curve advancement.
Recognizing the Signs in Boys
Parents and caregivers can look for several subtle physical signs of scoliosis, which are often first noticed during rapid growth. A common sign is an asymmetry in the body’s horizontal alignment, such as one shoulder or one hip appearing higher than the other. You might notice that the boy’s head does not seem perfectly centered over his pelvis, or that his waistline appears uneven when he stands straight.
The most informative visual assessment is the Adam’s Forward Bend Test, which can be performed at home. During this test, the boy bends forward at the waist with straight legs and arms hanging down. If scoliosis is present, the spinal rotation often causes a rib hump or an elevated area on one side of the back. This prominence is caused by the vertebrae twisting and pulling the rib cage out of alignment on the convex side of the curve.
Diagnostic Process and Monitoring
If a parent notices these signs, a physician will conduct a formal physical examination, including the Adam’s Test, often using a tool called a scoliometer to measure the angle of trunk rotation. A reading of five degrees or more on the scoliometer suggests a need for further imaging. A definitive diagnosis of scoliosis requires a standing X-ray of the spine.
The severity of the curve is measured using the Cobb angle, which is determined by drawing lines along the most tilted vertebrae at the top and bottom of the curve on the X-ray. A measurement of ten degrees or greater confirms the diagnosis of scoliosis. For growing boys with mild curves (typically 10 to 25 degrees), the treatment plan involves regular monitoring with repeat physical exams and X-rays. Monitoring is usually performed every four to six months during periods of rapid growth to track any progression.
Treatment Approaches Based on Growth
Treatment for scoliosis in boys is categorized into three paths: observation, bracing, and surgery, with the decision hinging on the curve size and the amount of growth remaining. Because boys typically enter and complete puberty later than girls, the window for curve progression is extended, making the assessment of skeletal maturity critical. Physicians use the Risser sign, a grading system (0 to 5) determined from the X-ray of the pelvis, to estimate how much growth is left.
Bracing is generally recommended for moderate curves, usually between 25 and 45 degrees, but only if the boy is still skeletally immature (low Risser sign). The brace is designed to prevent the curve from worsening as the boy continues to grow, and it is worn until skeletal maturity is reached. If the curve progresses despite bracing, or if the curve is initially severe, measuring 45 to 50 degrees or greater, spinal fusion surgery may be considered. Surgical intervention is timed to achieve maximum correction while minimizing the impact on the final growth spurt.