An abnormal, S-shaped, lateral curvature or deviation of the spine occurring in the normally straight vertical line of the spine in the thoracic, lumbar, or thoracolumbar sections. The dorsal spine includes twelve dorsal or thoracic vertebrae (T1 to T12) that extend from the cervical vertebrae. In addition to the curvature, the vertebral bodies are often rotated.

In general, the cause of scoliosis is unknown. However, many cases are traceable to genetic factors. In the idiopathic variety the deformity begins gradually and is not associated with pain. Therefore, significant curvature can develop without a person's being aware of the deformity.

There are two forms of scoliosis: postural and structural.

• Postural is due to poor posture from muscular weakness, a discrepancy in leg length, or secondary to a herniated disc with nerve root irritation causing a list.

• Structural can result from congenital abnormality of the vertebrae; neurological conditions, such as poliomyelitis and cerebral palsy; and other unknown causes. Idiopathic scoliosis is the most common type of structural scoliosis.

Indications of the condition are rarely presented until it is well established. Symptoms of scoliosis may include fatigue in the lumbar region after prolonged sitting or standing, muscular backaches in areas of strain, such as the lumbosacral area, or there may be no pain. One shoulder may appear higher than the other or one hip may be more prominent than the other. A severe curve can reduce the person's height and cause interference with lung efficiency.

Diagnosis requires a thorough medical history to determine if any other problems may be the cause of the spinal curvature. A visual examination is usually sufficient to identify the condition. The back is examined for discrepancies in shoulder, elbow, or height of the iliac crest. An x-ray, (anteroposterior radiograph) of the spine may be done to determine the extent of the curvature.

Some variables affecting the treatment goal are age of onset, and angle and mobility of the curve. Referral to an orthopedist may be indicated. Treatment includes: a conservative approach (preventing further deformity, e.g., with a cast or Milwaukee brace and exercise program); or an operative approach (correcting the deformity with the use of grafts and devices to stabilize the spine).

Complications and residuals are related to the type of curvature, the extent of the curvature, and the type of treatment required. Spinal fusions, major surgical procedures associated with the condition, can result in complications, including

• wound infection,

• pneumonia, and

• neurological deficits.

In addition to the curvature, rotation of the spine can contribute to diminished lung capacity and the development of restrictive lung disease. Despite therapy, there may be varying degrees of impaired physical mobility, and limited activities of daily living (ADL). Cosmetic concerns are significant to many patients.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• Evaluate under the General Rating Formula for Diseases and Injuries of the Spine for diagnostic codes 5235 to 5243 unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes.

• Congenital or developmental defects refer to normally static, structural or inherent body abnormalities which are typically present at birth and are generally incapable of improvement or deterioration.  These include but are not limited to vertebral anomalies. Congenital or developmental defects are not diseases or injuries within the meaning of applicable legislation as outlined in 38 CFR 3.303(c) and 38 CFR 4.9. The M21-1 includes a section devoted entirely to this subject (Service Connection (SC) for Congenital, Developmental, or Hereditary Disorders). Diseases of congenital, developmental, or familial, hereditary origin may be subject to SC if they first manifest in service, pre-exist service but progress at a high rate during service, are presumptively related to service, or for disabilities resulting from an overlying injury or disease of a congenital defect.

• Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.

• For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees (see forward flexion-cervical spine), extension is zero to 45 degrees (see extension-cervical spine), left and right lateral flexion are zero to 45 degrees (see lateral flexion-cervical spine), and left and right lateral rotation are zero to 80 degrees (see lateral rotation-cervical spine). Normal forward flexion of the thoracolumbar spine is zero to 90 degrees , extension is zero to 30 degrees (see forward flexion-thoracolumbar), left and right lateral flexion are zero to 30 degrees (see lateral flexion-thoracolumbar), and left and right lateral rotation are zero to 30 degrees (see lateral rotation-thoracolumbar spine.) The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion.

• In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted.

• Round each range of motion measurement to the nearest five degrees.

• For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.

• Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability.

• See Plate V found in 38 CFR 4.71a under The Spine section.