Scoliosis is a genetic syndrome with a hallmark deformity of the spine, but it’s more than that. One way we identify genetic diseases is to study twin populations. Identical twins have the exact same genome, therefore genetic disease would be shared between the siblings, and that’s exactly what we see in scoliosis. However, these studies also show the severity of the disesse is variable, Twin studies have shown there is no question genetics play a role in developing the conditions, but differences in the direction and severity indicate there is more to it than just genetics. So what makes scoliosis get worse? Epigenetics, or factors beyond the genetics. Things like the environment and the health status of the individual. The environment can further be defined as the internal environment (metabolism) and the external environment (movement and posture). There is strong evidence that posture and movement are major factors influencing scoliosis progression. Newer science also supports hormonal, metabolic and neurological triggers involved in scoliosis progression. Our goal is to identify which trigger in which person may be a contributor to progression in that particular case. As you can imagine this is not easy to do, and requires a thorough history and exam in every case.