Scoliosis & Spinal Deformity

Scoliosis is a side-to-side curve of the spine. Spinal deformity is the broader term for any abnormal spinal alignment — including scoliosis, kyphosis (an excessive forward rounding), and adult degenerative deformities that develop with age. Treatment depends heavily on the type, the size of the curve, the patient’s age, and how much it limits daily life.

What’s happening

Viewed from behind, a healthy spine is straight. In scoliosis, the spine curves to the side — often in an “S” or “C” shape — and frequently twists at the same time. The severity is measured on an X-ray with the Cobb angle: curves under 10° are normal variation; 10–25° is mild; 25–45° is moderate; and curves above 45–50° are large and may worsen over time.

Common symptoms

• Uneven shoulders, hips, or waistline
• One shoulder blade that sticks out more than the other
• A noticeable curve in the back, especially when bending forward
• Back pain — more common in adult and degenerative scoliosis than in adolescents
• In severe curves: trouble standing upright, leg pain, or, rarely, shortness of breath

Causes & risk factors

The most common type — adolescent idiopathic scoliosis — appears during the growth years and has no single known cause, though genetics play a role. Adult scoliosis is the form Dr. Kwan most commonly treats. It usually develops in one of two ways: an untreated curve from adolescence that has grown over time, or a new curve that develops in adulthood as discs and joints wear, often called degenerative scoliosis. Other less common causes include neuromuscular conditions, prior spine surgery, and congenital differences in spine development.

How it’s diagnosed

The diagnosis starts with a physical exam, including the forward bend test, which makes a curve easier to see. Standing X-rays of the full spine are the standard imaging test and let your provider measure the Cobb angle and check alignment. MRI is used when there is leg pain, nerve symptoms, or when a curve is unusual or progressing rapidly. CT may be used to plan surgery.

Treatment options

Most curves do not need surgery. Treatment depends on the patient’s age and the size and behavior of the curve:

• Observation for small, stable curves — repeat exams and X-rays every 6–12 months
• Bracing in growing adolescents with moderate curves to help prevent worsening
• Physical therapy focused on posture, core strength, and walking endurance — particularly helpful for adults with degenerative scoliosis
• Pain control — anti-inflammatory medication, targeted injections, and activity modification

Surgery is considered when a curve is severe and worsening, when an adult curve is causing significant back or leg pain that conservative care has not relieved, when there is nerve compression, or when the deformity is significantly affecting balance and quality of life. The most common operation is a spinal fusion, in which the curved segments are realigned and joined together with rods and screws so they heal as one solid piece. Modern techniques include minimally invasive approaches in selected patients and the use of navigation and robotics for greater precision.

When to see a specialist

Schedule an evaluation if you notice a new or worsening curve, asymmetry of the shoulders or waist, back pain that is changing, leg pain or numbness with a known curve, or trouble standing upright. Adults with a curve identified earlier in life should be re-examined periodically, even if previously stable.