Scoliosis is a sideways curvature of the spine that also involves rotation of the vertebrae. Rather than running straight down your back when viewed from behind, the spine curves into a C or S shape. It’s measured in degrees using the Cobb angle on X-rays. Scoliosis most commonly develops during adolescence (idiopathic scoliosis), though it can occur in younger children or adults. Adult scoliosis may be a progression of adolescent curves or develop due to degenerative changes. Small curves often cause no problems, whilst larger curves can lead to visible asymmetry, back pain, and in severe cases, breathing difficulties.

Not necessarily. Small curves in adolescents who have finished growing rarely progress. However, curves in growing children can worsen, particularly during growth spurts, which is why monitoring is crucial during adolescence. The larger the curve when growth completes, the higher the risk of adult progression. Curves over 50 degrees tend to progress slowly throughout life. Adult degenerative scoliosis can worsen over time as discs and joints deteriorate. Risk factors for progression include curve size, skeletal immaturity, and in girls, curves detected before the first menstrual period. Regular monitoring with examinations and X-rays helps identify curves that need intervention.

Surgery is the only way to permanently straighten a scoliotic curve. However, most scoliosis doesn’t require surgery. Observation with regular monitoring is appropriate for small curves. Bracing in growing adolescents can prevent curve progression but doesn’t correct existing curvature. Once worn properly during growth, bracing can be quite effective at stopping worsening. Physiotherapy and exercises, whilst beneficial for strength and flexibility, don’t reduce curve magnitude either, though they help with symptoms and function. The goal of non-surgical treatment is preventing progression rather than correction. Surgery is reserved for large curves, progressive curves despite bracing, or curves causing significant symptoms or functional problems.

In adolescents, curves exceeding 25 to 30 degrees that are still progressing during growth usually require bracing. Curves over 45 to 50 degrees, particularly if still progressing, may need surgery. Visible deformity causing significant distress can be an indication for treatment. In adults, treatment is considered when scoliosis causes disabling pain unresponsive to conservative measures, or when neurological symptoms develop from nerve compression. Rapidly progressive curves or those causing breathing difficulties due to chest cavity restriction also warrant intervention. Treatment decisions are individualised, considering curve severity, symptoms, age, and functional impact rather than just curve magnitude alone.

Scoliosis itself, particularly in adolescents, doesn’t always cause significant pain. Many teenagers with scoliosis have minimal discomfort. However, adult scoliosis more commonly causes pain, often from muscle fatigue due to altered mechanics, degenerative changes in the curved portion of the spine, or nerve compression. Severe curves can lead to muscle imbalance and strain. That said, not all back pain in someone with scoliosis is necessarily from the scoliosis, as other spinal problems can coexist. If you have scoliosis and new or worsening pain, proper assessment is important to identify the cause and guide appropriate treatment, which often includes physiotherapy, pain management, and addressing any specific problems like nerve compression.