Scoliosis is a sideways curve of the spine combined with rotation of the vertebrae, measuring at least 10 degrees on an X-ray (the Cobb angle). About eight in ten cases are adolescent idiopathic scoliosis, which appears around the growth spurt, has no known single cause and is more likely to progress in girls. Other forms are congenital (malformed vertebrae), neuromuscular (as in cerebral palsy or muscular dystrophy), early-onset in young children, and adult degenerative scoliosis from disc and joint wear.
Small curves are common and mostly harmless. The chance of worsening depends on how much growth remains and how large the curve already is. Bracing during growth can stop many moderate curves from reaching the surgical range, but it does not straighten them. Surgery corrects and holds the curve by fusing part of the spine, at the price of lost movement in that segment.
Symptoms
- Uneven shoulders or one shoulder blade more prominent
- An uneven waist, or one hip appearing higher
- A rib hump visible when bending forwards
- Clothes hanging unevenly or the body leaning to one side
- Usually little or no pain in adolescents
- In adults: back pain, leg pain or heaviness on walking, and gradual loss of height or forward stoop
- Breathlessness only with very large thoracic curves
Causes and risk factors
Adolescent idiopathic scoliosis runs in families and is thought to involve many genes; it is not caused by school bags, posture, sport or mattresses. Congenital scoliosis results from vertebrae that formed incompletely before birth and can be associated with heart and kidney anomalies. Neuromuscular scoliosis arises when muscles cannot support the growing spine. Syndromes such as Marfan syndrome and neurofibromatosis can include scoliosis. In adults, asymmetric disc degeneration or an untreated adolescent curve that slowly increases are the usual explanations.
How it is diagnosed
- Adams forward bend test and scoliometer: A simple screening examination that reveals rib or loin prominence and measures trunk rotation.
- Standing full-spine X-rays: Measure the Cobb angle, sagittal balance and skeletal maturity (Risser or Sanders stage). Low-dose systems reduce radiation for repeated films.
- Neurological examination: Abnormal reflexes or foot shape prompt further tests.
- MRI of the whole spine: For curves with atypical features: left-sided thoracic curve, onset before age 10, rapid progression, significant pain or neurological signs.
- Lung function tests: For large thoracic curves and before major surgery.
- CT scan: To plan surgery for congenital or complex deformity.
Treatment options
- Observation: Curves under about 20 to 25 degrees are reviewed with examination and X-ray every 4 to 6 months while growing.
- Bracing: A rigid thoracolumbar brace for curves of roughly 25 to 40 degrees in a growing child. Effect depends on hours worn, ideally 16 to 18 or more per day.
- Scoliosis-specific exercises: Schroth-type physiotherapy may improve posture and support bracing; evidence that it alone halts progression is limited.
- Posterior spinal fusion: Pedicle screws and rods correct and hold the curve, generally advised for curves above about 45 to 50 degrees in adolescents. Spinal cord monitoring is used throughout.
- Growth-friendly surgery: Growing rods, including magnetically lengthened rods, for young children with progressive curves. Vertebral body tethering is a newer option for selected patients with less long-term data and a notable re-operation rate.
- Adult deformity care: Exercise, pain management and injections first; decompression with or without fusion for disabling nerve compression or imbalance, accepting a higher complication rate.
- Casting: Serial plaster jackets can correct some infantile curves.
When it is urgent
New leg weakness, numbness, loss of bladder or bowel control, or rapidly increasing severe back pain needs urgent local assessment. After spinal surgery, fever, wound discharge, new weakness or breathing difficulty requires immediate medical attention.
Travelling to Türkiye for treatment
A review of X-rays and a second opinion on whether to observe, brace or operate is a reasonable reason to visit, and planned fusion surgery can be done on a trip of roughly 2 to 3 weeks, with about 5 to 7 days in hospital. Most patients are children or teenagers, so both parents should understand the plan, and X-ray follow-up at home must be arranged for the first 1 to 2 years. Bracing and growing-rod programmes need frequent adjustment over years and should be run by a local team. Be cautious about chiropractic or exercise programmes that claim to cure curves.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
Frequently Asked Questions
Did a heavy school bag or bad posture cause this?
No. Neither causes scoliosis.
Can exercise or physiotherapy straighten the curve?
Exercise is good for strength and posture but has not been shown to reverse a structural curve.
Will my child be able to play sport?
Yes. Sport is encouraged with or without a brace. After fusion most non-contact sport resumes at 3 to 6 months and contact sport by about 6 to 12 months, as advised by the surgeon.
Does scoliosis get worse in adulthood?
Curves under 30 degrees at maturity rarely progress. Those over 50 degrees tend to increase by about a degree a year.
Will fusion make my back stiff?
The fused section does not move, but most daily and sporting movement comes from the hips and the unfused spine, so the limitation is often smaller than expected.