Scoliosis: Understanding Spinal Curvature in Adults and Children

What Is Scoliosis?

Scoliosis is a sideways (lateral) curvature of the spine, typically forming an S- or C-shape when viewed from behind. A normal spine is straight when viewed from the back; a spine with scoliosis curves to one side.

The severity of scoliosis is measured by the Cobb angle — the angle formed between the tilted vertebrae at the top and bottom of the curve. Curves are generally classified as:

Mild: Less than 20°
Moderate: 20–40°
Severe: Greater than 40°

Types of Scoliosis

Idiopathic scoliosis (80%): The most common type — the cause is unknown. Subtypes include:

Adolescent idiopathic scoliosis (AIS): Most common; occurs in patients 10–18 years old; girls more commonly progress to treatment-level curves
Juvenile idiopathic scoliosis: Ages 3–10
Infantile idiopathic scoliosis: Birth to age 3

Degenerative (adult) scoliosis: Develops in adulthood due to age-related disc and joint degeneration causing asymmetric collapse of the spine

Neuromuscular scoliosis: Associated with conditions like cerebral palsy, muscular dystrophy, or spina bifida; often more severe

Congenital scoliosis: Caused by abnormal vertebral formation in utero

Causes and Risk Factors

For idiopathic scoliosis:

Genetics play a significant role — scoliosis runs in families
Female sex (adolescent girls have 10x higher risk of curve progression requiring treatment)
Growth spurts (curves most commonly progress during puberty)

For adult degenerative scoliosis:

Age-related asymmetric disc and facet joint degeneration
Prior history of idiopathic scoliosis

Symptoms

Adolescent Idiopathic Scoliosis

Often asymptomatic — discovered during school screenings or routine physical exams. Visible findings include:

One shoulder higher than the other
One shoulder blade more prominent
Uneven waistline or hips
Rib hump visible when bending forward (Adam's forward bend test)
Clothes not fitting symmetrically

Adult Degenerative Scoliosis

Adults typically present with symptoms:

Chronic lower back pain, often worse with prolonged standing or walking
Pain and leg symptoms from associated nerve compression (similar to stenosis)
Visible trunk shift or leaning to one side
Fatigue from muscles working to compensate

Diagnosis

X-rays (standing full-length spine films): The primary diagnostic tool; Cobb angle is measured
MRI: Assesses nerve compression and disc degeneration in symptomatic adults
CT scan: Evaluates bony anatomy in surgical planning

Treatment

Observation

For curves less than 20° in growing children: periodic monitoring with spinal X-rays every 6 months.

Bracing (Adolescents)

For curves 20–40° in skeletally immature patients: bracing (Boston, Milwaukee, or custom TLSO braces) can prevent curve progression during growth. Full-time brace wear (16–22 hours/day) is most effective.

Physical Therapy

Scoliosis-specific exercise programs (Schroth method, SEAS) can help manage symptoms and may reduce curve progression in motivated adolescent patients.

Surgery

Surgical intervention is considered when:

Curve exceeds 40–50° in growing children (high risk of continued progression)
Curve exceeds 50° in adults with significant symptoms
Progressive neurological deficits in adults

Spinal fusion with instrumentation is the standard procedure — implanting rods, screws, and hooks to straighten the spine and fuse the vertebrae.

Recovery Timeline

Post-surgical recovery for scoliosis correction is significant:

Hospital stay: 3–5 days
Return to school/sedentary activity: 3–4 weeks
Light activity: 6–8 weeks
Full recovery (return to sports): 6–12 months