What is scoliosis?
Scoliosis is a sideways curve of the spine. Viewed from behind, the backbone bends into a ‘C’ or ‘S’ shape rather than running straight, and it may also rotate slightly. A curve is generally called scoliosis once it measures more than 10 degrees on an X-ray - a figure known as the Cobb angle.
It can appear at any age, and the two most common patterns are quite different. In children and teenagers, most cases are adolescent idiopathic scoliosis - ‘idiopathic’ simply meaning the cause is not known. In adults, the more common form is adult degenerative scoliosis (also called de novo scoliosis), where the curve develops later in life as the discs and joints of the spine gradually wear.
The reassuring part: many curves are mild, cause few problems, and simply need monitoring over time. Where treatment is needed, most people can be managed without surgery. Our role is to confirm what is actually driving your symptoms and guide you to the least invasive option that gives a durable result.
Symptoms to look for
Scoliosis can look and feel very different from one person to the next:
- A visible curve or uneven posture - one shoulder, shoulder blade, or hip sitting higher than the other, or a waistline that looks uneven.
- Back pain or stiffness - common in adult scoliosis, often across the lower back, and sometimes worse after standing or walking for a while.
- Aching and fatigue - the back tiring easily, or a feeling of leaning to one side.
- Leg pain, numbness, or tingling - in adult degenerative scoliosis the curve can narrow the space around a nerve, causing symptoms that travel into the leg.
- Clothes hanging unevenly - a hemline or shirt that no longer sits level can be an early clue.
In children, a curve is often painless and is noticed by a parent, teacher, or during a routine check rather than because of discomfort.
NOTE
Most scoliosis develops gradually. Arrange a review sooner rather than later if a curve appears to be worsening quickly, if you notice new or worsening leg weakness, numbness, or bladder or bowel changes, or if a large curve is affecting your breathing.
What causes scoliosis?
The cause depends on the type. In adolescent idiopathic scoliosis - the most common form in young people - no single cause is identified, though it can run in families. In adults, degenerative scoliosis develops from years of wear on the discs and facet joints, sometimes alongside arthritis or a loss of bone density (osteoporosis) that lets the spine tilt as it settles.
Less commonly, scoliosis is congenital (the spine forms unevenly before birth) or neuromuscular (linked to conditions such as cerebral palsy or muscular dystrophy that affect the muscles supporting the spine). Risk factors that make progression more likely include increasing age, a larger existing curve, and reduced bone strength.
How we diagnose it
Diagnosis begins with your history and a physical examination. This includes checking the symmetry of your shoulders, waist, and hips, a forward-bend test, and a focused neurological examination if you have any leg symptoms. Standing X-rays are the key test - they let us measure the Cobb angle and track whether a curve is changing over time. An MRI may be added when nerve symptoms are present, and bone-density testing is arranged where fragile bone may be a factor.
Just as important, we match the imaging to how you actually feel. Some sizeable curves cause few symptoms, while smaller ones can be troublesome, so we treat the person, not the picture. Your assessment is led by a US board-certified neurosurgeon.
Treatment - least invasive first
We follow a measured, surgery-last approach, and the right path depends on your age, the size of the curve, whether it is progressing, and how much it affects you.
- Monitoring (for many mild curves). Small, stable curves often need nothing more than periodic review with an examination and X-ray to make sure they are not progressing.
- Conservative care (first line for most symptomatic adults). Staying active, physiotherapy to strengthen and support the spine, and simple pain relief can ease discomfort and maintain mobility. This does not straighten the curve, but for many people it keeps symptoms manageable.
- Bracing (for growing children and teenagers). In a young person whose spine is still growing, a brace may be used for a moderate curve to reduce the chance of it worsening before growth is complete.
- Deformity correction or fusion (reserved for progressive or disabling curves). When a curve is large, clearly progressing, or causing pain or nerve compression that has not responded to non-surgical care, scoliosis and deformity correction or spinal fusion can realign and stabilize the spine. These are major procedures, considered only when the benefits clearly outweigh the alternatives.
If you have already been told you need surgery, we are glad to give an honest second opinion on whether a less invasive path could work for you.
What to expect
For most people, scoliosis is a condition to manage rather than cure. With monitoring and conservative care, the aim is to keep you comfortable and active, with regular checks to catch any change early - improvement in symptoms is usually gradual rather than immediate. If surgery is genuinely needed, it is a bigger undertaking, and recovery typically unfolds over several months with a guided return to activity. Your surgeon will explain the likely timeline for your specific case, and the plan is built around you with clear explanations at every step.
Common questions
Can scoliosis be corrected without surgery in adults?
For most adults, scoliosis can be managed well without an operation. Physiotherapy, targeted exercise, activity changes, and - where needed - pain relief or an injection often keep symptoms under control. Non-surgical care does not straighten the curve, but it can ease pain and maintain mobility. Surgery is usually reserved for curves that are progressing or causing disabling symptoms.
Does scoliosis get worse with age?
It can. Small curves often stay stable, but some progress slowly over years, particularly the degenerative scoliosis that develops in later life as discs and joints wear. Larger curves tend to carry a higher risk of progression. Regular monitoring with X-rays lets your specialist measure any change and step in early if the curve or your symptoms are worsening.
What is the Cobb angle?
The Cobb angle is the measurement, taken from a standing X-ray, that describes how far the spine curves sideways. A curve is generally called scoliosis once it measures more than 10 degrees. The angle helps guide treatment: smaller curves are usually monitored, moderate curves may be braced in growing children, and larger curves are watched more closely.
Can exercise or physiotherapy fix scoliosis?
Exercise and physiotherapy do not straighten an established curve, but they play an important role. A structured program can strengthen the muscles that support the spine, improve flexibility and posture, and reduce pain and fatigue. For many people this is enough to stay active and comfortable without further treatment. Your physiotherapist can tailor a plan to your curve and symptoms.
When does scoliosis need surgery?
Surgery is considered for a minority of people - typically when a curve is large or clearly progressing, when pain or nerve compression is disabling and has not settled with non-surgical care, or when the curve affects balance or, rarely, breathing. If an operation has been recommended to you, an independent second opinion can confirm whether it is the right step or whether less invasive care may help first.
Is scoliosis painful?
It varies. In children and teenagers a curve is often painless and noticed by its appearance. In adults, scoliosis is more likely to cause back pain, stiffness, or fatigue, and if the curve narrows the space around a nerve it can also cause leg pain, numbness, or tingling. A careful assessment helps identify what is actually driving your discomfort.