Scoliosis

What is this condition?

Scoliosis is a three-dimensional spinal curve, not simply poor posture. It may be idiopathic in adolescents, congenital, neuromuscular, degenerative in adults or secondary to another condition. The curve angle, remaining growth, progression, balance, pain and neurological findings guide treatment.

What symptoms can it cause?

• Uneven shoulders, waist or hips
• Rib prominence on forward bending
• Adult pain, fatigue or imbalance
• Severe curves may affect breathing or cause nerve compression

How is it assessed and diagnosed?

Standing full-length X-rays measure the Cobb angle and balance; growth status is assessed in children. MRI is selected for unusual curves, pain, neurological signs or preoperative planning. Pulmonary tests, CT and bone-health evaluation may be needed for large or complex deformity.

Treatment without surgery

Observation suits small stable curves. Bracing can reduce progression in selected growing adolescents but does not make every curve perfectly straight. Physiotherapy improves strength, conditioning and pain control; it cannot reliably correct a large structural curve alone. Adult treatment also addresses osteoporosis, weight and other pain generators.

When is surgery or a procedure considered?

Surgery is considered for documented progression, large deformity, imbalance, neurological compression, uncontrolled disability or threatened cardiopulmonary function. Modern correction uses screws/rods and fusion, often with neurological monitoring. The aim is a safe balanced correction, not a radiographically perfect straight spine at any cost.

Treatment and procedure options

• Observation with growth and X-ray review
• Bracing for selected growing children
• Conditioning and scoliosis-specific rehabilitation
• Posterior or combined deformity correction and fusion
• Decompression with limited or larger reconstruction in selected adults

Risks from the disease and from treatment

Progressive severe curves can worsen balance, pain, nerve function and rarely breathing. Major deformity surgery carries significant risks including blood loss, infection, neurological injury, non-union, implant failure and adjacent-segment problems; careful optimisation is essential. No procedure is risk-free. General risks include anaesthetic problems, bleeding, infection, blood clots and delayed healing. Neurological risks depend strongly on the exact structure being treated and may include new weakness, numbness, speech or vision change, seizure, cerebrospinal-fluid leakage, need for another procedure or failure to obtain the hoped-for relief. The surgeon should discuss the risks that apply to the individual case.

Recovery and follow-up

Recovery is longer than routine disc surgery. Patients need pain control, early safe mobilisation, nutrition, bone health and staged return to school/work. Fusion takes months to mature, and appearance, function and expectations should be discussed before surgery. Recovery is not judged only by the first few days. Pain control, wound care, nutrition, safe mobilisation, physiotherapy and planned follow-up all matter. Some symptoms improve quickly after pressure is relieved; others recover gradually over weeks or months, and permanent nerve injury may not fully reverse.

Preparing for your consultation

Bring the original MRI/CT images or digital files, written reports, previous prescriptions, a current medicine list, and any operative or pathology records. For sudden warning symptoms, use the nearest emergency department rather than waiting for a routine appointment.

Authoritative patient-information sources

• AANS — Scoliosis: https://www.aans.org/patients/conditions-treatments/scoliosis/