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 Surgeons20
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 Surgeons50–70%
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 SocietySymptoms
- 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.
Specialists Who Treat Scoliosis
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Search spine specialists →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.