Scoliosis
Scoliosis is an abnormal sideways curvature of the spine that can affect children, adolescents, and adults. Treatment depends on age, growth remaining, curve severity, symptoms, and whether the curve is progressing.
Quick Answer
Scoliosis is a sideways curvature of the spine that can occur in children, adolescents, or adults. In growing patients, treatment focuses on monitoring the curve and preventing progression, with bracing when appropriate. In adults, scoliosis may develop or worsen as the spine degenerates and can cause back pain, leg pain, numbness, or difficulty standing and walking. Surgery is generally considered for severe or progressive curves, significant imbalance, or symptoms that do not improve with nonsurgical care.
Key Takeaways
- Scoliosis is an abnormal sideways curve of the spine.
- In growing children and adolescents, treatment may include monitoring or bracing to help prevent curve progression.
- Adult scoliosis frequently relates to degeneration and can cause pain and nerve symptoms.
- Bracing helps control curves during growth; it does not straighten an existing curve.
- Surgery is reserved for severe, progressive, or symptomatic curves.
At a Glance
| What it is | Sideways curvature of the spine |
|---|---|
| Common types | Adolescent idiopathic, congenital, neuromuscular, and adult degenerative scoliosis |
| Typical signs | Uneven shoulders or hips, asymmetry, a visible curved back, or leg symptoms in adults |
| Monitoring | Periodic examinations and X-rays to track curve size and progression |
| Non-surgical care | Observation, bracing in growing patients, physical therapy, and symptom management |
| Surgical option | Spinal correction and stabilization for severe, progressive, or symptomatic curves |
Symptoms
Scoliosis can look and feel different depending on age, curve severity, and the underlying cause. In children and adolescents, scoliosis is often painless and may first be noticed because of changes in posture or body symmetry. Adults are more likely to experience symptoms related to spinal degeneration or imbalance.
What Families May Notice
- Uneven shoulders, waist, or hips
- A visible curve or rib prominence when bending forward
- Clothes that hang unevenly
- One shoulder blade appearing more prominent
- A curve that appears to be increasing during growth
Common Symptoms
- Back pain and stiffness
- Difficulty standing upright
- Fatigue with prolonged standing or walking
- Leg pain, numbness, or weakness when nerves are compressed
- Progressive imbalance or loss of function
Scoliosis in Children and Adolescents
Adolescent idiopathic scoliosis is the most common form in otherwise healthy children and teenagers. Because curves can progress during periods of rapid growth, the amount of growth remaining is an important part of deciding whether a child needs observation, bracing, or surgery.
Diagnosis
Scoliosis is evaluated with a physical examination, including the forward-bend (Adams) test, which highlights the curve and any rib prominence. Standing X-rays measure the curve in degrees, called the Cobb angle, and help determine progression.
Evaluating Growth and Progression
In children and adolescents, skeletal maturity and growth remaining are important because curves are more likely to progress during rapid growth.
When MRI or CT May Be Needed
MRI or CT may be used when symptoms are atypical, neurological findings are present, or additional detail is needed for surgical planning. In adults, imaging also evaluates degeneration, nerve compression, and spinal stenosis.
Treatment
Treatment is individualized based on age, curve size and location, growth remaining, symptoms, progression, and overall spinal balance.
Monitoring & Bracing
Smaller curves are often monitored with periodic examinations and X-rays. For growing children with moderate curves, bracing may help prevent the curve from worsening. Bracing does not straighten an existing curve.
Symptom-Focused Care
Treatment often begins with nonsurgical care aimed at relieving pain and maintaining function, including physical therapy, medications, injections, and other treatments when appropriate.
Scoliosis Surgery
When surgery is necessary, treatment is planned to restore spinal balance, relieve nerve compression when present, stabilize the spine, and improve function while avoiding unnecessary intervention.
Surgery may be considered for severe curves, curves that continue to progress, significant imbalance, neurological symptoms, or functional limitations that do not respond to conservative care.
When to Seek Evaluation
- A spinal curve that appears to be increasing
- Rapid changes in shoulder, waist, or hip symmetry during growth
- Persistent or worsening back pain
- New leg pain, numbness, or weakness
- Increasing difficulty standing or walking
- New bowel or bladder dysfunction
The Diagnosis-to-Treatment Pathway
1. Clinical Evaluation
Spinal alignment, posture, symptoms, neurological function, and visible signs of scoliosis are assessed.
2. Standing X-Rays
X-rays are used to measure the spinal curve and evaluate overall alignment.
3. Growth & Progression Assessment
For children and adolescents, remaining growth and changes in the curve help determine the risk of progression.
4. Treatment Planning
Treatment is individualized based on age, curve severity, progression, symptoms, spinal balance, and neurological findings.
5. Nonsurgical Treatment
Observation, physical therapy, symptom management, or bracing during growth may be recommended when appropriate.
6. Surgical Evaluation
Surgery may be considered for severe or progressive curves, significant spinal imbalance, neurological symptoms, or persistent functional limitations.
7. Follow-Up
Spinal alignment, symptoms, function, and—in growing patients—curve progression are monitored over time.
Frequently Asked Questions
Scoliosis has several causes. Adolescent idiopathic scoliosis has no single known cause. Other forms can be congenital, neuromuscular, or related to age-related spinal degeneration.
Common signs include uneven shoulders or hips, a prominent shoulder blade or ribs, clothes that hang unevenly, and a visible curve of the spine.
No. In growing children with appropriate curves, bracing is used primarily to reduce the risk that the curve will worsen during growth.
Some curves remain stable while others progress. The risk depends on factors such as curve size, age, growth remaining, underlying cause, and—in adults—degenerative changes.
Surgery may be considered for severe or progressive curves, significant spinal imbalance, neurological symptoms, or functional limitations that do not improve with nonsurgical care.
Yes. Adults may have a curve that began earlier in life or develop degenerative scoliosis as discs and joints wear unevenly over time.
Scoliosis may be treated by spine specialists with expertise in pediatric or adult spinal deformity, including orthopedic spine surgeons and neurosurgeons.
Scoliosis surgery is complex and carries risks, but modern imaging, navigation, neuromonitoring, and surgical planning are used to improve precision and safety. Individual risk depends on the curve and the patient’s overall health.
Specialists Who Treat Scoliosis
Our care is provided by Atlantic Brain and Spine specialists, including fellowship-trained neurosurgeons and orthopedic spine surgeons.
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