What is Scoliosis?

Scoliosis is an abnormal side-to-side curvature of the spine. When viewed from behind, a typical spine appears mostly straight. In scoliosis, the spine may curve in a C-shaped or S-shaped pattern and may also rotate, which can affect posture, shoulder height, rib position, or trunk alignment.

Scoliosis can involve the cervical spine, thoracic spine, lumbar spine, or more than one spinal region. In adults, scoliosis may be a continuation of a curve that began earlier in life, or it may develop from age-related spine changes. This adult form is often called adult degenerative scoliosis or de novo scoliosis.

De Novo Brain & Spine evaluates adult patients with scoliosis when symptoms suggest spinal imbalance, back pain, nerve compression, spinal stenosis, radiculopathy, spinal instability, deformity progression, or another spine-related condition that may require neurosurgical review.

Common Signs and Symptoms

Scoliosis symptoms depend on the size and location of the curve, spinal balance, rotation, age, degenerative changes, and whether nearby nerves or the spinal cord are affected.

Common signs and symptoms may include:

• Uneven shoulders
• Uneven hips or pelvis
• One shoulder blade appearing more prominent than the other
• A visible curve or shift in the spine
• Leaning to one side
• Rib prominence or trunk rotation
• Back pain or stiffness
• Muscle fatigue or spasms
• Reduced ability to stand upright for long periods
• Trouble with posture or spinal balance
• Pain that worsens with standing, walking, lifting, or activity
• Pain that travels into the buttock, hip, thigh, leg, or foot when nerve compression is present
• Numbness or tingling in the leg or foot
• Weakness in the leg, ankle, or foot
• Neurogenic claudication, meaning leg pain, heaviness, cramping, or weakness that worsens with standing or walking
• Difficulty walking normally in more advanced or symptomatic cases

Seek urgent medical evaluation for scoliosis symptoms with progressive weakness, foot drop, worsening numbness, trouble walking, loss of balance, numbness in the groin or saddle area, new bowel or bladder problems, severe pain after trauma, fever, unexplained weight loss, history of cancer, or rapidly worsening neurological symptoms. Seek emergency medical care or call 911 for symptoms concerning for cauda equina syndrome, spinal cord compression, stroke, or another emergency condition.

What Causes This Condition?

Scoliosis can have different causes. In some patients, the cause is not clearly known. In adults, scoliosis may be related to degenerative changes in the discs, joints, and supporting structures of the spine.

Possible causes and related factors may include:

• Idiopathic scoliosis, meaning scoliosis without a clearly known cause
• Adult degenerative scoliosis, caused by age-related changes in spinal discs, facet joints, ligaments, and alignment
• De novo scoliosis, meaning a new scoliosis curve that develops in adulthood
• Congenital scoliosis, related to spinal formation differences present from development
• Neuromuscular scoliosis, related to conditions that affect nerves or muscles
• Degenerative disc disease
• Facet joint disease or spinal arthritis
• Spondylosis, meaning degenerative arthritis of the spine
• Spondylolisthesis, when one vertebra slips in relation to another
• Spinal stenosis, which may develop along with degenerative scoliosis
• Prior spine injury, fracture, or trauma
• Prior spine surgery in selected cases
• Osteoporosis or compression fractures in selected patients
• Spinal tumor, infection, or inflammatory disease in less common cases

These causes and risk factors do not mean every patient with scoliosis will have pain or need surgery. Treatment planning depends on curve type, curve size, spinal balance, symptoms, neurological examination, imaging findings, age, bone health, and overall health.

How It Is Diagnosed?

Scoliosis is diagnosed through medical history, physical examination, neurological examination, and imaging. Imaging helps measure the curve, evaluate spinal alignment, and determine whether nerve compression or spinal instability is present.

Common diagnostic steps may include:

• Medical history and symptom review to understand posture changes, back pain, leg pain, numbness, tingling, weakness, walking tolerance, prior scoliosis history, prior treatment, and red-flag symptoms
• Physical examination to evaluate posture, shoulder height, pelvic alignment, rib prominence, trunk shift, spinal flexibility, gait, and painful movement
• Forward bend test to assess rib prominence or rotational deformity
• Neurological examination to assess strength, sensation, reflexes, coordination, gait, balance, and signs of nerve root or spinal cord involvement
• Standing spine X-rays to measure the spinal curve and overall alignment
• Cobb angle measurement to quantify the degree of scoliosis curvature
• Standing scoliosis or full-spine X-rays to evaluate coronal balance, sagittal balance, pelvic parameters, and overall spinal alignment
• Flexion-extension X-rays in selected cases when abnormal motion or spinal instability is suspected
• Side-bending X-rays in selected cases to assess curve flexibility for treatment planning
• MRI of the cervical, thoracic, or lumbar spine when nerve compression, spinal stenosis, spinal cord compression, disc disease, tumor, infection, or neurological symptoms are suspected
• CT scan when bone detail, rotation, fusion status, fracture, deformity, or surgical planning requires further evaluation
• CT myelogram in selected cases when MRI is not possible or when additional detail around the spinal canal and nerve roots is needed
• Bone density testing in selected adults when osteoporosis or fracture risk may affect treatment planning
• Electromyography and nerve conduction studies, also called EMG/NCS, when symptoms may overlap with radiculopathy, peripheral neuropathy, or another nerve disorder

The goal of diagnosis is to determine the scoliosis type, curve size, spinal balance, nerve involvement, and whether conservative care, injections, monitoring, or surgical evaluation may be appropriate.

Treatment Options

Scoliosis treatment depends on the curve type, curve size, symptoms, spinal balance, neurological examination, imaging findings, bone health, prior treatment, activity limitations, and overall health. Not every patient with scoliosis needs surgery.

Treatment options may include:

• Observation with repeat imaging for selected mild, stable, or minimally symptomatic curves
• Activity modification to reduce positions, lifting, or activities that worsen symptoms
• Physical therapy to improve posture, core strength, flexibility, spinal support, balance, and walking mechanics
• Scoliosis-specific exercises in selected cases when recommended by an appropriate clinician or therapist
• Home exercise and stretching when recommended by a clinician or therapist
• Heat, ice, or other comfort measures for short-term symptom relief
• Anti-inflammatory medication, acetaminophen, muscle relaxants, or nerve pain medication when medically appropriate
• Bracing in selected cases, more commonly to support posture or reduce pain in adults rather than to fully correct the curve
• Treatment of osteoporosis or bone health concerns when relevant to fractures, deformity, or surgical planning
• Epidural steroid injection in selected cases involving nerve root inflammation, radiculopathy, or sciatica
• Selective nerve root block in selected cases when diagnostic or therapeutic nerve-targeted injection is appropriate
• Facet joint injection, medial branch block, or radiofrequency ablation in selected cases when facet joint pain contributes to symptoms
• Sacroiliac joint evaluation or injection in selected cases when SI joint pain overlaps with scoliosis-related symptoms
• Lumbar decompression in selected cases when spinal stenosis or nerve compression is a major source of symptoms
• Spinal fusion or deformity correction in selected cases involving significant spinal imbalance, progressive deformity, disabling symptoms, nerve compression, instability, or failure of appropriate non-surgical care
• Interbody fusion procedures, such as lateral interbody fusion, transforaminal lumbar interbody fusion, or anterior lumbar interbody fusion, in selected cases depending on anatomy and surgical goals
• Revision spine surgery in selected patients with prior surgery, adjacent segment disease, pseudoarthrosis, hardware-related concerns, or recurrent deformity
• Rehabilitation and follow-up care to monitor pain, posture, strength, walking, alignment, function, and neurological status

Surgery is not appropriate for every patient with scoliosis. Neurosurgical treatment may be considered when scoliosis causes significant nerve compression, spinal stenosis, spinal instability, progressive deformity, severe imbalance, progressive weakness, or symptoms that do not improve with appropriate non-surgical care.