Scoliosis

Understanding the type of scoliosis you have is important to plan the right treatment. The main types include:

Idiopathic scoliosis – the most common type, accounting for around 80% of cases, in which no underlying cause is identified. It is further classified by age of onset:

• infantile idiopathic scoliosis – developing in children under 3 years

• juvenile idiopathic scoliosis – developing between ages 4 and 9; this type carries a higher risk of progression and often requires earlier intervention

• adolescent idiopathic scoliosis (AIS) – developing between ages 10 and 18; the most prevalent subtype, and the most frequently seen in clinical practice

Congenital scoliosis – present from birth, caused by abnormal development of the vertebrae during fetal growth.

Neuromuscular scoliosis – associated with conditions affecting the muscles or nervous system, such as cerebral palsy, muscular dystrophy, or spina bifida.

Degenerative scoliosis (de novo scoliosis) – develops in adults, typically in the lumbar spine, as a result of age-related disc and joint degeneration; distinct from adult progression of childhood scoliosis.

Scoliosis, particularly in children and teenagers, is often painless in its early stages. It may first be noticed through changes in appearance rather than discomfort.

Postural and visible signs include:

• uneven shoulders, with one sitting higher than the other

• one shoulder blade appearing more prominent

• an uneven waistline, or one hip appearing raised

• a visible curve or twist in the spine when standing

• leaning to one side

• clothes hanging unevenly or not fitting symmetrically

Physical symptoms, more common in adults or with larger curves:

• back pain or stiffness, particularly in the lower back

• muscle fatigue, especially after prolonged standing or activity

• reduced flexibility or range of motion in the spine

• in severe cases, shortness of breath due to restriction of the chest cavity

Because scoliosis in children is so often symptom-free, it’s important to seek an assessment if any postural changes are noticed, even in the absence of pain. Early detection significantly improves the range of management options available.

In the majority of cases, particularly in children and adolescents, the exact cause of scoliosis is unknown. This is referred to as idiopathic scoliosis.

Where a cause can be identified, it typically relates to one of the following:

• spinal development anomalies present from birth (congenital scoliosis)

• neurological or muscular conditions such as cerebral palsy or muscular dystrophy (neuromuscular scoliosis)

• degenerative disc and joint changes in the adult spine (de novo degenerative scoliosis)

• connective tissue disorders such as Marfan syndrome or Ehlers-Danlos syndrome, which are associated with an increased risk of scoliosis

Risk factors for curve progression include:

• age and skeletal maturity – curves in skeletally immature children and teenagers are at greater risk of progressing; the Risser sign and bone age help assess this

• sex – while adolescent idiopathic scoliosis occurs in both sexes, females are significantly more likely to experience curve progression requiring treatment, at an approximate ratio of 8:1 for curves exceeding 30°

• family history – scoliosis has a recognised hereditary component

• underlying medical conditions – particularly those affecting the neuromuscular system

If you or your child has signs of scoliosis, early assessment by a specialist is important. At Welbeck, your consultant will carry out a thorough and structured evaluation.

Clinical assessment

Your appointment will begin with a detailed history, including any family history of scoliosis, the age at which changes were first noticed, and any associated symptoms. Your consultant will then perform a physical examination, including:

• assessment of posture and spinal alignment

• the Adam's forward bend test, in which the patient bends forward at the waist – this is one of the most reliable clinical tests for detecting spinal rotation and asymmetry

• evaluation of shoulder, waist, and hip symmetry

• assessment of leg length and neurological function, where indicated

Measuring the curve: the Cobb angle

The severity of scoliosis is measured using the Cobb angle – the standard international measure of spinal curvature, determined from spinal X-rays.

A curve is generally considered:

• less than 10° – within normal variation, not classified as scoliosis

• 10 to 24° – mild scoliosis; typically monitored

• 25 to 44° – moderate scoliosis; bracing often recommended in growing patients

• 45° or above – severe scoliosis; surgical referral may be considered

Understanding your Cobb angle helps your consultant make informed, evidence-based decisions about the most appropriate management pathway.

Imaging

Depending on your clinical assessment, further investigations may include:

• standing spinal X-rays – to measure the Cobb angle and assess spinal balance

• MRI scan – to evaluate the spinal cord and nerve roots, particularly in atypical presentations, congenital scoliosis, or where surgery is being considered

• CT scan – used selectively for detailed bony assessment, particularly in congenital cases

In children and teenagers, your consultant will also monitor skeletal maturity to assess progression risk, as curves are most likely to worsen during active growth phases.

Scoliosis, particularly idiopathic scoliosis, cannot be prevented, as its cause is not fully understood. No evidence supports the idea that posture habits, carrying heavy bags, or participation in sports causes scoliosis to develop.

However, early detection is important and can meaningfully influence outcomes by expanding the range of treatment options available before a curve progresses.

You can support early identification by:

• checking for postural asymmetry in children and teenagers, particularly during growth spurts

• attending routine health or school screening checks where available

• seeking specialist assessment promptly if uneven shoulders, hips, or a visible spinal curve are noticed

In adults, maintaining general spinal and bone health — through regular activity, muscle strengthening, and appropriate management of bone density — may help to reduce the impact of degenerative changes, though it will not prevent de novo scoliosis from developing.

The majority of people with scoliosis have mild curves that remain stable and do not lead to serious complications. However, more significant or progressive curves — particularly if untreated — can cause difficulties over time.

Potential complications include:

• chronic back pain – particularly in adults with degenerative or progressive curves

• reduced mobility and flexibility – affecting daily activity and quality of life

• psychological impact – visible postural changes can affect body image and confidence, particularly in adolescents

• respiratory compromise – in severe thoracic scoliosis (typically curves above 70 to 80°), chest cavity restriction can impair lung function

• curve progression – in skeletally immature patients, untreated curves may worsen significantly during growth

With appropriate monitoring and timely treatment, serious complications are uncommon. The goal of management is to prevent progression and preserve quality of life.

Treatment is tailored to each patient based on their age, skeletal maturity, the type and cause of scoliosis, the Cobb angle, and any symptoms present.

At Welbeck, your consultant will develop a personalised management plan and will explain all options clearly.

Observation and monitoring

For mild curves (typically below 20 to 25°), regular monitoring with clinical review and serial X-rays is often all that is required. The frequency of monitoring depends on the patient's age and growth stage.

Schroth physiotherapy and exercise

Physiotherapy plays an important role in scoliosis management. At Welbeck, we recommend Schroth-based physiotherapy, an internationally recognised, scoliosis-specific exercise programme developed to improve posture, spinal alignment, muscle balance, and breathing patterns. The SEAS (Scientific Exercise Approach to Scoliosis) method is a related evidence-based approach.

Physiotherapy does not correct an established curve, but it can reduce progression risk, improve function, and is frequently used alongside bracing or following surgery.

Bracing

Bracing is the primary non-surgical intervention for moderate curves in skeletally immature patients, typically recommended when:

• The Cobb angle is between approximately 20 to 45°

• The patient has significant remaining skeletal growth

The aim of bracing is to prevent curve progression rather than to correct an existing curve. For it to be effective, compliance is essential – most programmes require the brace to be worn for 16 to 23 hours per day. Modern low-profile braces, including the Boston brace and Rigo Chêneau brace, are well tolerated by most patients.

Bracing is not typically used for adult or degenerative scoliosis, where the goal of management shifts to symptom control.

Pain management and spinal injections

For adults with symptomatic scoliosis, pain management strategies may include:

• anti-inflammatory medication and physiotherapy

• epidural steroid injections or facet joint injections to manage localised nerve or joint pain in degenerative scoliosis

• activity modification and lifestyle support

Injections are a tool for managing symptoms in adult scoliosis and are not a treatment for curve correction.

Surgery

Surgical intervention is considered for curves that are severe, progressive, or causing significant functional impairment, and where non-surgical management has not been sufficient. The decision to proceed with surgery is made collaboratively, with a thorough discussion of risks, benefits, and expected outcomes.

Surgical options include:

• posterior spinal fusion with instrumentation – the standard surgical treatment for adolescent idiopathic scoliosis with curves typically above 45 to 50°. Spinal rods, screws, and bone grafts are used to correct and fuse the affected spinal segments

• growing rod constructs, including MAGEC rods – used in younger, skeletally immature children where fusion would prematurely restrict spinal growth. MAGEC (MAGnetic Expansion Control) rods can be lengthened non-invasively using an external magnet, avoiding repeated open surgery

• anterior or combined approaches – used selectively depending on curve pattern and anatomy

Surgery for scoliosis is highly specialised. Your consultant will explain the most appropriate technique for your individual situation and ensure you have a full understanding of what to expect before, during, and after your procedure.

At Welbeck, our orthopaedic consultants are specialists in spinal and paediatric orthopaedic conditions, with extensive experience in managing scoliosis across all age groups, from young children to adults.

With access to colleagues across other specialties, our consultants are also able to refer within the Welbeck ecosystem if required to ensure you receive the treatment you need as quickly as possible, all under one roof.  

All appointments, testing, treatment, and follow-up appointments take place within our state-of-the-art facilities, enabling us to deliver accurate diagnostics and advanced treatments.

If you’re concerned about scoliosis,  in yourself or your child,  we encourage you to seek an early assessment. The sooner a curve is identified, the wider the range of management options available to you.

Our consultants are recognised by the major health insurance companies. If you have private health insurance, your treatment at Welbeck can begin once you have obtained authorisation. We also provide care to self-paying patients.