At a glance
What it is
An abnormal sideways (S- or C-shaped) curve of the spine, usually of unknown cause and noticed during adolescent growth.
Typical signs
Uneven shoulders, one shoulder blade more prominent, uneven waist, one hip higher, a rib hump on forward bend.
How we treat it
Observation for mild curves, bracing for moderate progressing curves in growing spines, surgery for severe or rapidly progressing curves.
What scoliosis is
Scoliosis is a lateral (sideways) curvature of the spine that measures more than 10° on a specific X-ray measurement (the Cobb angle). Small curves are extremely common and often clinically silent; the ones that need active management are the ones that grow.
In most cases (~80%) the cause is unknown — adolescent idiopathic scoliosis. In others, scoliosis is a feature of a syndrome, neuromuscular disease, or a congenital vertebral anomaly. The distinction changes the workup and the risk of progression.
Adolescent vs adult scoliosis
Two very different clinical problems share the same name. Deciding which one you have is the first job at the consultation.
Type A
Adolescent idiopathic scoliosis
- Discovered during growth (10–18 years old).
- Risk factor is remaining growth — hence bracing while the skeleton is still immature.
- Cosmetic and postural concerns dominate; pain is unusual until the curve is severe.
Type B
Adult / degenerative scoliosis
- Develops later from degenerative disc and facet changes.
- Pain, radiculopathy, and stenosis dominate; the curve is often incidental.
- Treatment targets the symptoms, not the curve number.
What we see in clinic
80%
Of adolescent scoliosis is idiopathic (no identifiable cause)
10°
Cobb angle threshold — below this is not called scoliosis
45–50°
Typical threshold for surgical discussion in adolescents
Key facts
How it is treated
Care is matched to the curve severity, skeletal maturity, and the pattern of progression. Most curves land in observation.
Observation
Mild curves
- X-ray every 6–12 months during growth
- Adam's test at each visit
- Escalate only if the curve progresses
Bracing
Moderate curves, growing skeleton
- Rigid custom brace (TLSO, Boston, Milwaukee)
- Worn 16–23 hours per day while skeletally immature
- Purpose: prevent progression, not correct the curve
Physiotherapy
Adjunctive at every stage
- Postural training
- Core and paraspinal strengthening
- Schroth-method exercises where available
Surgery
Severe or progressive curves
- Posterior spinal fusion with instrumentation
- Anterior spinal fusion in selected curves
- Growing rod systems for very young patients
- Vertebral body tethering for suitable adolescents
Progression is judged by comparing X-rays over time, not by a single snapshot. Skipping the follow-up is what turns a small curve into a large one.
Related reading
Back pain
Most back pain is mechanical and settles in weeks. The first visit identifies the few cases that need imaging, injections or surgery, without over-treating.
Herniated disc
The soft centre of a spinal disc bulges through a tear and presses on a nerve. Most heal without surgery; the task is spotting the ones that don't.
Book a consultation
The secretary schedules first appointments during clinic hours; please have prior imaging, operative notes and a current medication list available at the time of the call.
This page provides general information about scoliosis and is not a substitute for individual medical assessment. If your symptoms are severe or worsening, contact a clinician promptly.