Scoliosis is a three-dimensional deformity in which the spine curves sideways while the vertebrae also rotate. It is diagnosed when the curve measures more than ten degrees on a standing full-spine X-ray. The most common form is adolescent idiopathic scoliosis, which appears during the growth spurt without a single identifiable cause. Other forms are congenital, related to neuromuscular disease, or degenerative curves that develop in adults as discs and facet joints wear down. Treatment is not one procedure but a pathway chosen according to the size of the curve, how much growth remains, how quickly the curve is progressing, and whether there is pain or any neurological finding. Small curves are monitored with periodic examination and imaging. Moderate curves in a still-growing child may be managed with a custom-moulded brace worn for a prescribed number of hours a day, combined with scoliosis-specific physiotherapy that works on trunk balance, posture, breathing and muscular endurance. Large or progressive curves are discussed for surgical correction using screws and rods, with fusion of the corrected levels. The limits of each option matter. A brace is a tool for preventing a curve from worsening while the skeleton is still growing; it is not a way to straighten a spine that has already curved, and it has no role once growth is complete. Exercise, swimming, massage and manual therapy improve fitness, pain and posture, but they do not correct a structural deformity in the shape of the vertebrae, and no medication straightens a spine. One widespread myth deserves correcting: carrying a school bag or sitting poorly does not cause idiopathic scoliosis, although either can aggravate muscular complaints. Adolescent scoliosis is also usually painless, so severe or night-time pain, weakness, numbness or unsteadiness are signals that call for wider imaging to look for another cause behind the curve rather than simply tracking the angle. Which pathway suits you is determined by clinical examination, curve measurement and an estimate of remaining growth, not by reading a page or comparing photographs, and it is revisited regularly because scoliosis changes over time.
Procedure steps
- 1
Clinical examination and asymmetry assessment
The doctor examines the back standing and then in forward bend, assessing rib prominence, shoulder height, pelvic tilt and trunk balance, uses a scoliometer, performs a neurological check of power, sensation and reflexes, and asks about growth acceleration and family history.
- 2
Radiographs and curve measurement
A standing full-spine X-ray is taken to measure the angle and define the level and pattern of the curve, and remaining growth is estimated from skeletal maturity markers. MRI is requested when there is atypical pain, a neurological sign, or an early-onset or unusual curve.
- 3
Choosing the treatment track
Periodic observation for small curves, a custom brace with scoliosis-specific physiotherapy for moderate curves during growth, or surgical referral for large curves or curves progressing despite bracing. The decision rests on angle, remaining growth and symptoms together, never on one number alone.
- 4
Surgical correction when indicated
Under general anaesthesia the surgeon reaches the involved vertebrae, places screws and rods that gradually correct the curve and rotation, and adds bone graft to fuse the corrected levels. Nerve function is monitored electrically throughout to reduce the risk of neurological injury during correction.
- 5
Follow-up and rehabilitation
After surgery, standing and walking begin on the first or second day, with activity progressing over months and imaging repeated at set intervals. On the non-surgical track, X-rays are repeated every four to six months through the growth spurt so any progression is caught early and the plan adjusted.
Before the procedure
Bring every previous X-ray and report arranged by date, because comparing the curve over time is the single most useful piece of information. Wear light clothing that allows the whole back to be exposed. Tell the doctor how fast height has increased over the last two years, the age of puberty or first period for girls, any family history of scoliosis, and any neurological, muscular, cardiac or respiratory condition. List all medicines and supplements, especially blood thinners if surgery is being considered, and never stop a medicine on your own. If surgery is planned, stop smoking early because it impairs bone healing, complete the requested blood tests and heart and lung assessment, and follow fasting instructions before anaesthesia. Write your questions down, and if the patient is a child bring them along to share in the decision.
After the procedure
After surgery, get up and walk early as your team directs, sleep on your back or side with a supportive pillow, and avoid bending, twisting and lifting for as long as your surgeon specifies. Keep the wound clean and dry, take pain medicine as prescribed, increase your walking distance daily, and postpone contact sports until you are cleared. With a brace, wear it for the prescribed number of hours, inspect the skin daily for rubbing or breakdown, and keep doing core-strengthening exercises, because a brace does not replace them. **Go to the emergency department immediately if you develop progressive weakness in the legs or feet, numbness between the thighs and around the anus, retention of urine, or leakage of urine or stool — these are signs of pressure on the cauda equina nerve bundle and are treated as an emergency, not as an appointment.** Contact your doctor promptly for fever or chills, redness, swelling, fluid or pus from the wound, chest pain, shortness of breath, a painful swollen calf, or pain that unexpectedly worsens after an initial improvement.
Expected duration
An assessment and measurement visit usually takes 30 to 45 minutes; corrective surgery usually takes 3 to 6 hours with a hospital stay of about 3 to 5 days.
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