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What is Rotoscoliosis and How Can It Be Treated?


Rotoscoliosis is a specific type of scoliosis that involves a significant rotational component in addition to the typical lateral curvature of the spine. Scoliosis generally entails a side-to-side deviation of the spine, but when this curvature is accompanied by pronounced twisting of the vertebrae, it is classified as rotoscoliosis. This twisting becomes particularly prominent when the spinal curve exceeds 30 degrees, creating more complex structural challenges and often necessitating specialized diagnostic and treatment approaches.

Diagnosis of Rotoscoliosis

Diagnosing rotoscoliosis involves more than just identifying a lateral curve. The degree of rotation is a critical factor. For mild scoliosis, with curves less than 20 degrees, there is some rotation, but it is usually minimal. However, as the curve progresses beyond 30 degrees, the rotational component becomes more significant. Advanced imaging techniques, such as a 3D CT scan, can provide detailed insights into the extent of spinal twisting, especially when preparing for surgical intervention. This level of imaging, however, involves high radiation exposure and is typically reserved for surgical planning.

Measurement Techniques: Cobb vs. Ferguson

The Cobb method is the standard approach for measuring the severity of scoliosis. However, in cases of severe rotoscoliosis where curves exceed 50 degrees, this method may not adequately capture the rotational aspect. Instead, the Ferguson method can be employed to provide a more accurate assessment of the spine’s condition. This method takes into account both the lateral curvature and the rotational displacement, offering a comprehensive view necessary for effective treatment planning.

Implications of Rotational Elements

The rotational component in rotoscoliosis significantly impacts the spine’s structure and function. As the spine twists, the intervertebral discs experience torsion, which can lead to displacement or deformation. Terms like disc bulge, disc herniation, disc protrusion, and in severe cases, disc extrusion, describe varying degrees of disc displacement. A disc extrusion, where a fragment of the disc breaks off and moves into the spinal canal, can cause severe symptoms and often necessitates surgical intervention.

Symptoms Requiring Surgical Intervention

In severe cases of rotoscoliosis, symptoms may include intractable pain, loss of bowel or bladder control, or muscle atrophy, such as significant withering of a leg. These symptoms indicate severe nerve compression or spinal cord involvement. For example, a disc herniation pressing on a nerve can cause pain that radiates down the leg or affects bladder function. When conservative treatments fail to alleviate such severe symptoms, surgery becomes a necessary option to prevent further neurological damage and to relieve debilitating pain.

Types of Scoliosis: Functional vs. Structural

Scoliosis can be categorized into two main types: functional and structural. Functional scoliosis does not involve any rotational component and is usually a result of external factors such as muscle spasms or leg length discrepancy. Structural scoliosis, on the other hand, always includes a rotational element and is often idiopathic, meaning its cause is unknown. Structural scoliosis can also arise from congenital anomalies or other underlying conditions.

Conservative Treatment Options

While surgery is reserved for the most severe cases of rotoscoliosis, the majority of cases can be managed successfully through conservative methods. These methods focus on strengthening the core muscles, improving spinal alignment, and enhancing postural stability. Conservative treatment plans typically include:

  • Exercise Programs: Tailored exercise regimens designed to strengthen the muscles supporting the spine, improve flexibility, and reduce spinal curvature.
  • Lifestyle Advice: Recommendations for daily activities and ergonomic adjustments to minimize strain on the spine.
  • Bracing: Bracing has been validated as an effective treatment for both children and adults with scoliosis. Various types of braces are used depending on the individual’s specific needs.

The Strauss Method

The Strauss method integrates a combination of exercises, lifestyle modifications, targeted stretching routines, and bracing to treat rotoscoliosis. This comprehensive approach aims to correct spinal alignment, enhance mobility, and retrain the postural mechanisms. Each patient receives a customized treatment plan that includes:

  • In-Office Therapies: A variety of therapies targeting specific aspects of scoliosis to improve alignment and mobility.
  • Home Exercises: Exercises to be performed at home to maintain and enhance the progress achieved during in-office treatments.
  • Bracing: In specific cases, patients are fitted with braces to support spinal correction and prevent further progression.

Visual Evidence of Treatment Success

Before-and-after X-rays of patients treated for rotoscoliosis often show significant improvements. These images typically reveal a reduction in spinal curvature and rotation, demonstrating the effectiveness of conservative treatments. Patients may also experience an increase in height as the spine becomes more aligned and the postural collapse is corrected.

Identifying Rotoscoliosis

Rotoscoliosis has distinct physical manifestations. Observing a patient from behind, one may notice asymmetrical waists, with one side appearing more indented and the other flat. When the patient bends forward, one shoulder blade may protrude more prominently than the other. Other signs include a tilted head and uneven hand placement due to unlevel shoulders.

Postural Collapse

Postural collapse is a common phenomenon in patients with severe rotoscoliosis, leading to a noticeable loss of height. This collapse occurs as the spine’s curvature and rotation cause the body to compress. Patients often report significant height loss, which can be distressing. Addressing postural collapse through conservative treatment can help restore some of the lost height and improve overall posture.


Rotoscoliosis is a complex form of scoliosis characterized by significant spinal rotation. While severe cases may require surgical intervention, most can be effectively managed through conservative treatments. A comprehensive approach that includes exercise, lifestyle modifications, and bracing can significantly improve spinal alignment and reduce symptoms. Early diagnosis and personalized treatment plans are crucial for managing rotoscoliosis and enhancing the quality of life for affected individuals.

Also read: Scoliosis X-ray in 6 Year Old: 34° Curve Reduced to 9° with Strauss Method


Dr. Strauss is the director of the Hudson Valley Scoliosis Correction Center in New York. He has been actively engaged in scoliosis treatment for the past 30 years and has authored two books on the subject, Your Child Has Scoliosis and The Truth About Adult Scoliosis

He is Vice President of the CLEAR Scoliosis Institute and a lecturer for their introductory and advanced workshops.  He is certified in scoliosis bracing and in the use of  scoliosis specific exercises.  Dr. Strauss is a graduate of the ISICO World Masters of Scoliosis.His postgraduate studies also include a Masters Degree in Acupuncture as well as training in Grostic, Pettibon, CBP, Clinical Nutrition, Chinese Herbal Medicine, Manipulation under Anesthesia, and Electrodiagnosis.

His scoliosis practice has treated patients from 25 states and 32 other foreign countries.If you have questions about childhood and adult scoliosis and how it can be successfully treated without surgery subscribe to our channel!