Scoliosis (Spinal Curvature)

Sideways curvature of the spine

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Dr. Özgür Akşan

Brain & Nerve Surgery

1Overview

Quick and clear information for patients

What is this Condition?

Scoliosis is not simply a sideways bend of the spine; it is a three-dimensional deformity in which the spine also rotates. Adolescent idiopathic scoliosis is the most common form, but congenital, neuromuscular, syndromic and adult degenerative types also exist. The degree of the curve, the patient's age, remaining growth potential and any associated balance problem directly shape the treatment plan. In mild curves, observation may be enough; in curves at risk of progression, bracing is considered, and in selected severe deformities surgical correction may be needed. The goal is not only to reduce the angle on the X-ray, but to preserve spinal balance, prevent progression, ease cosmetic concerns and, in the long term, keep the risks of pain, breathing problems and loss of function under control.

Symptoms

Noticeable difference in shoulder height

One shoulder blade appearing more prominent

Asymmetry of the waistline or hip level

A rib hump or rotational difference visible when bending forward

Back and low back pain and early fatigue, especially in adults

In advanced curves, postural deformity, loss of balance and, rarely, reduced breathing capacity

Diagnosis Methods

The first step is a detailed physical examination. Shoulder and shoulder-blade level, trunk balance, pelvic level and rotational prominence are assessed, including the Adams forward bend test. For a definitive assessment, standing full-spine scoliosis X-rays are taken and the Cobb angle is measured. In children and adolescents who are still growing, the Risser grade, menarche status and growth velocity help estimate the risk of progression. Depending on the curve pattern, spinal MRI may be used to look for spinal cord anomalies, associated congenital problems or neurological causes. When surgery is planned, balance analysis, flexibility (bending) X-rays and, in some patients, three-dimensional planning are helpful.

Treatment Methods

Treatment is tailored to the size of the curve and its risk of progression. Mild, stable curves may only need regular follow-up. In selected patients who are still growing and whose curves are at risk of progression, a brace is used to slow the rate of progression. Exercise and physiotherapy support posture awareness, muscle balance and overall function; however, in advanced curves they do not correct the structural deformity on their own. Surgery is usually considered for progressive curves, large-angle deformities, and curves that cause marked cosmetic imbalance, pain or loss of function. The aim is to bring the spine into the most balanced position possible, stop the deformity from progressing and protect long-term quality of life.

Regular Clinical and Radiological Follow-up

Brace Treatment

Scoliosis-Specific Exercise and Physiotherapy

Posterior Correction and Fusion Surgery

Advanced Deformity Surgery and Stabilization in Selected Cases

Frequently Asked Questions About Scoliosis (Spinal Curvature)

Q1.Does every scoliosis patient need surgery?▼

No. Surgery is needed only in a specific group of patients. The size of the curve, how fast it is progressing, remaining growth, cosmetic imbalance and functional impact are assessed together. For many patients, follow-up or bracing is enough.

Q2.Can scoliosis be fully corrected with exercise?▼

Exercise helps with posture control, muscle balance and function, but on its own it does not correct the degree of structural scoliosis in every patient. It should be seen as a supportive part of follow-up or brace treatment in suitable cases.

Q3.When is a brace considered?▼

A brace is mainly considered for children and adolescents who are still growing and whose curves have the potential to progress. The aim is not to make the existing curve disappear, but to slow its progression and reduce the likelihood of surgery.

Q4.Can scoliosis progress in adulthood?▼

Yes. Especially in degenerative scoliosis, or in curves present since childhood, pain, balance problems and increasing deformity can occur in adulthood. Regular assessment is therefore important for adults as well, not only for children.

Q5.How is the decision for surgery made?▼

The decision is not based on the Cobb angle alone. Curve flexibility, trunk balance, the patient's age, pain level, neurological status, effect on breathing and day-to-day quality of life are evaluated together. Surgical planning is individual to each patient.

References

Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. New York: Thieme; 2023. Chapter 79: Spine Measurements, pp. 1312–1318; Chapter 80: Idiopathic Scoliosis, pp. 1319–1326.
Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. New York: Thieme; 2023. Chapter 82: Adult Spinal Deformity and Degenerative Scoliosis, pp. 1352–1361.
Kesler K, Cychosz C, Holt J, Weinstein SL. Late-Onset Idiopathic Scoliosis. In: Steinmetz MP, Benzel EC, eds. Benzel's Spine Surgery: Techniques, Complication Avoidance and Management. 5th ed. Philadelphia: Elsevier; 2022. Chapter 21, pp. 200–205.
Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018;13:3. doi:10.1186/s13013-017-0145-8 (PMID 29435499). Physiotherapeutic scoliosis-specific exercises: Tables 11–12.

This content is based on academic sources and is for general information only; individual assessment requires a medical examination.

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Scoliosis (Spinal Curvature)

1Overview

What is this Condition?

Symptoms

Diagnosis Methods

Treatment Methods

Frequently Asked Questions About Scoliosis (Spinal Curvature)

References

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