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Scoliosis

An abnormal sideways curvature of the spine affecting children and adults

ICD-10: M41.9 · thoracic condition

Scoliosis is a condition in which the spine curves sideways, often with a rotation component, forming an S- or C-shape when viewed from behind. It is most commonly diagnosed in adolescents (adolescent idiopathic scoliosis), but can also develop in adults as a result of spinal degeneration (de novo degenerative scoliosis) or progression of a childhood curve. The degree of curvature — measured by the Cobb angle — guides treatment decisions.

2–4%

Adolescent idiopathic scoliosis affects 2–4% of children between ages 10 and 16, with girls being 8 times more likely than boys to progress to a curve requiring treatment.

American Academy of Orthopaedic Surgeons

20

Curves under 20 degrees rarely progress to the point of requiring treatment; curves between 25–40 degrees in growing children typically require bracing.

American Academy of Orthopaedic Surgeons

50–70%

Spinal fusion surgery for severe scoliosis achieves an average curve correction of 50–70% and has a 90%+ patient satisfaction rate at 10-year follow-up.

Scoliosis Research Society

Symptoms

  • Visible asymmetry: one shoulder, shoulder blade, or hip higher than the other
  • Prominent rib hump on one side when bending forward
  • Uneven waistline or clothing fitting asymmetrically
  • Back pain (more common in adults; less so in adolescents)
  • Fatigue after prolonged standing or activity
  • In severe cases: breathing difficulty from chest wall restriction

Causes & Risk Factors

  • Idiopathic (unknown) — accounts for ~80% of adolescent cases
  • Congenital — abnormal vertebral formation during fetal development
  • Neuromuscular — conditions like cerebral palsy, muscular dystrophy, or spina bifida
  • Degenerative — disc and joint breakdown in adults over 40
  • Syndromic — associated with Marfan syndrome, neurofibromatosis, or Ehlers-Danlos

Treatment Options

Conservative

  • Observation (monitoring curves <25°) with serial X-rays every 6–12 months
  • Bracing (25–45° in skeletally immature patients) to slow curve progression
  • Physical therapy and scoliosis-specific exercises (Schroth method)
  • Pain management for adults with degenerative scoliosis
  • Activity as tolerated — scoliosis does not generally require restriction

Surgical

  • Posterior spinal fusion and instrumentation for curves >45–50° in adolescents
  • Adult deformity correction with pedicle screw instrumentation and fusion
  • Vertebral body tethering (VBT) — a motion-preserving option for selected adolescents
  • Minimally invasive approaches for selected adult degenerative cases

When to see a spine specialist

Children with a noticeable postural asymmetry should see a physician for scoliosis screening. Adults with progressive back pain, new asymmetry, or previously diagnosed scoliosis with worsening symptoms should be evaluated by a spine specialist.

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Frequently Asked Questions

Does scoliosis always need surgery?

No. The majority of scoliosis patients — especially those with mild adolescent idiopathic scoliosis (curves under 25°) — never need surgery. Curves between 25° and 45° in growing adolescents are managed with bracing. Surgery is generally reserved for curves exceeding 45–50° in adolescents, or significant pain or functional limitation in adults.

Does scoliosis get worse with age?

In adolescents, curves progress most rapidly during growth spurts. After skeletal maturity, small curves (<30°) are unlikely to worsen significantly. Larger curves (>50°) tend to progress slowly in adulthood. In adults, degenerative scoliosis can worsen gradually as disc and joint degeneration progresses.

Can exercise treat scoliosis?

Exercise does not straighten a scoliotic curve, but scoliosis-specific exercises — particularly the Schroth method, which is supported by clinical evidence — can reduce progression in adolescents, improve posture, and decrease pain. Physical therapy is a valuable part of non-surgical management for both adolescents and adults.

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