Scoliosis: Symptoms, Diagnosis, Treatment and When Surgery Is Needed

What Is Scoliosis?

Scoliosis is a condition in which the spine curves sideways and may also rotate.

Instead of appearing straight when viewed from behind, the spine may form a “C” or “S” shape.

A spinal curve measuring more than 10 degrees on an X-ray is generally considered scoliosis.

The condition can affect children, teenagers and adults, but the most common form is adolescent idiopathic scoliosis, which usually develops during periods of rapid growth.

What Causes Scoliosis?

In most children and teenagers, the exact cause is unknown. This is called idiopathic scoliosis.

Other forms can be associated with:

• Abnormal development of the spine before birth
• Neurological conditions
• Muscular disorders
• Certain genetic conditions
• Previous spinal injury or disease

In adults, scoliosis may be a continuation of a curve that began earlier in life or may develop because of age-related changes in the spine.

Poor posture, carrying a heavy backpack or sleeping in a particular position does not cause scoliosis.

What Are the Signs of Scoliosis?

Scoliosis may initially be noticed because of changes in body symmetry rather than pain.

Possible signs include:

• One shoulder higher than the other
• One shoulder blade appearing more prominent
• Uneven hips
• The head appearing slightly off-center
• One side of the waist looking different from the other
• Leaning to one side
• A rib prominence or “rib hump” when bending forward
• Clothes hanging unevenly

Many adolescents with scoliosis have little or no pain.

Very large curves may eventually affect posture, cause discomfort or, in severe cases, influence breathing.

How Is Scoliosis Diagnosed?

Diagnosis usually begins with a physical examination.

The doctor examines the patient's posture, shoulders, hips and spine while standing and may ask the patient to bend forward. This is commonly known as the Adams forward-bend test.

A device called a scoliometer may be used to estimate trunk rotation.

If scoliosis is suspected, standing X-rays of the spine are usually taken.

Doctors then measure the curve using the Cobb angle.

The angle helps determine the severity of scoliosis and guides decisions about follow-up and treatment.

Does Every Patient Need Treatment?

No.

Many mild scoliosis curves never progress enough to require active treatment.

Management depends on factors such as:

• Size of the curve
• Patient's age
• Remaining growth
• Whether the curve is getting worse
• Location and shape of the curve
• Symptoms
• Overall health

Treatment may range from simple observation to bracing or surgery.

Observation

For smaller curves, especially those below approximately 25 to 30 degrees, doctors often recommend monitoring rather than immediate treatment.

Children and teenagers who are still growing may have periodic examinations and X-rays to determine whether the curve is progressing.

If the curve remains stable, no additional treatment may be needed.

Bracing

A brace may be recommended for a growing child or teenager whose curve has reached a range where progression is a concern.

Bracing does not usually make an existing curve completely straight.

Its main purpose is to reduce the chance that the curve will become significantly worse while the child continues growing.

The type of brace and the number of hours it should be worn depend on the individual case.

Can Exercise or Physiotherapy Help?

Physical activity is generally encouraged for people with scoliosis.

Exercises and physiotherapy may help improve strength, flexibility, posture and symptoms such as back discomfort.

However, exercise alone cannot reliably correct every structural spinal curve.

Specialized scoliosis exercise programs may be recommended as part of treatment in selected patients, but they do not replace appropriate monitoring, bracing or surgery when those treatments are medically necessary.

When Is Surgery Considered?

Surgery is generally considered for larger curves that are continuing to progress or are likely to cause significant problems.

In adolescents, curves around 45 to 50 degrees or greater are often evaluated for surgical treatment.

The most common operation is spinal fusion.

During spinal fusion, implants such as screws and rods are used to correct and stabilize the spine while selected vertebrae gradually fuse together.

The goal is not necessarily to make the spine perfectly straight, but to safely reduce the deformity and prevent further progression.

What Is Recovery Like After Surgery?

Recovery depends on the type and extent of surgery.

Patients usually begin walking during the early recovery period and gradually return to school, work and daily activities.

Sports and strenuous activities are restricted for a period while the spine heals.

Follow-up appointments and imaging help the surgical team monitor healing and spinal alignment.

Living With Scoliosis

Most people with mild scoliosis can remain active and participate in normal daily activities and sports.

Regular monitoring is particularly important during periods of rapid growth because some curves can progress quickly.

A scoliosis diagnosis does not automatically mean that a patient will need a brace or surgery.

The best treatment plan is based on the individual curve, the patient's age and growth potential, symptoms and whether the condition is progressing.

Evaluation by an orthopedic or spine specialist can help determine whether observation, bracing, rehabilitation or surgical treatment is appropriate.