Home / Conditions / Scoliosis
A sideways curve of the spine, usually with a twist. In a teenager the question is whether it will grow; in an adult, what it is pressing on.
Seen from behind, a healthy spine runs straight down. In scoliosis it bends to one side in a C or S shape, and the vertebrae also rotate — which is why one side of the ribcage or the lower back can stand out more than the other. A forward rounding seen from the side is a different condition, kyphosis.
The size of the curve is measured on an X-ray as the Cobb angle. A curve of 10 degrees or more counts as scoliosis. Most people who have one have a small curve that never causes trouble.
The first spine is straight. The others show the usual patterns: a curve in the upper back, the commonest in teenagers; a curve in the lower back, typical of adult degenerative scoliosis; and a double curve, where one bend balances the other.
What a drawing cannot show is the twist. In real scoliosis the vertebrae also rotate, which is what raises one side of the ribcage into a rib hump.
X-ray reports may call a curve dextroscoliosis or levoscoliosis. These describe direction only: the curve bulges to the right or to the left. There is more on a left-sided lower back curve under lumbar levoscoliosis.
It is not caused by poor posture, heavy school bags or sport. Parents often worry that they missed something or caused it. For the commonest type, neither is the case — the cause is unknown.
Teenage and adult scoliosis share a name and an X-ray appearance. Almost everything else about them differs, including what treatment is trying to achieve.
| Adolescent idiopathic | Adult degenerative | |
|---|---|---|
| Who | Children and teenagers, starting around puberty. Larger curves are far more common in girls | Adults, usually over 50 |
| Where | Usually the upper back, often S-shaped | Usually the lower back |
| Cause | Unknown | Uneven wear of the discs and small joints of the spine |
| Pain | Usually little. Significant or night pain is a reason to look for another cause | Common: back pain, and leg pain from nerves squeezed where the spine has narrowed |
| What decides treatment | The size of the curve, and how much growing is left | Pain, nerve symptoms and balance — not the angle alone |
| The main concern | The curve getting bigger during growth | Nerve compression, and the trunk tipping forward or sideways |
Some adults have a curve that began in adolescence and has carried on; once it causes symptoms it is managed much like an adult curve. The less common types below are managed differently again.
Not every curve is structural. A leg-length difference, or muscle spasm from back pain, can make the spine lean without any change in the bones. This functional curve usually disappears when the person bends forward or lies down, and goes once its cause is dealt with.
A check you can do at home. With the child bending forward from the waist, arms hanging, look along the back from behind. If one side sits clearly higher, have it assessed. It is a screening check, not a diagnosis.
Scoliosis usually changes slowly. These suggest something more is happening:
Call us on +65 8849 0677. We will see you the same day and arrange imaging where it is needed.
If we are closed, go to an emergency department — we are shut on Sundays and after 1pm on Saturdays. For the last symptom on that list, do not wait for us to open.
Call +65 8849 0677A few degrees is not progression. Cobb angle measurements can differ by around 5 degrees between X-rays and between the people reading them. A change smaller than that does not, on its own, mean the curve is growing.
Which kind of scoliosis it is decides the approach. For a teenager, treatment is about the curve and the growth left; for an adult, about the symptoms.
Most curves only need watching. In a growing child, that means repeat X-rays every several months until growth ends, because that is when curves are most likely to increase. Adults with a curve that causes no trouble need no treatment.
For a growing child with a curve of roughly 20 to 40 degrees. A brace does not straighten the spine; it aims to stop the curve reaching the size where surgery is advised. It works better the more hours a day it is worn, and stops being useful once growth has finished — judged on X-ray, not by age.
For adults, strengthening, flexibility and balance work to ease pain and help stay upright. In teenagers, scoliosis-specific exercise can be used alongside monitoring or bracing, but not in place of a brace where one is advised.
For adults: medication, and for leg pain from nerves squeezed by narrowing, an image-guided epidural or nerve root injection. These treat the symptoms rather than the curve.
In teenagers, surgery is usually advised once a curve passes about 45 to 50 degrees, because curves that large tend to keep increasing after growth has finished.
In adults, it is considered for leg pain or weakness from nerve compression that has not settled, for a trunk that is tipping forward or sideways and cannot be held upright, or for a curve that is clearly getting worse.
These are major operations. Fusion removes movement at the levels treated, so the size and flexibility of the curve, the number of levels and the person’s overall health are all weighed before it is recommended.
A curve is a structural problem, and structure is the orthopaedic side. In adults, though, much of the pain comes from nerves squeezed where the curve has narrowed the spine — and that is where the neurosurgical side comes in.
How large it is, whether it is growing, the balance of the trunk, bracing, and correction.
An orthopaedic spine surgeon trains on the musculoskeletal system first. Spinal deformity correction is a particular interest of Dr Lim Heng Hing.
Leg pain, numbness or weakness on walking from stenosis in a curved lower spine.
A neurosurgeon trains on the nervous system first. Dr Mathew Tung performs lumbar foraminotomy, and decompression with fusion.
For a curve on its own, the orthopaedic side is the natural start. For an adult with leg symptoms, either is a sound first appointment. Having both surgeons in one clinic means the answer is not shaped by whichever one you happened to book.
More on how the two differ: neuro spine and orthopaedic spine surgery.
No. The commonest type has no known cause, and it is not brought on by posture, bags or sport. Poor posture can make someone lean, but that is not structural scoliosis.
It depends mainly on the size of the curve and how much growing is left. Curves are most likely to increase during the growth spurt, which is why they are checked regularly until growth ends.
A structural curve in a teenager does not straighten on its own. Some curves that appear in infancy do resolve, and a functional curve goes once its cause is dealt with.
Yes. Degenerative scoliosis develops in later life as discs and joints wear unevenly, usually in the lower back. Some adults also have a curve that began in adolescence.
They describe direction only. Dextroscoliosis is a curve that bulges to the right, levoscoliosis one that bulges to the left. Neither term says anything about how serious the curve is.
No. Bring any spine X-rays you have. Earlier ones are especially useful, because comparing them shows whether the curve is changing.
Kyphosis · Lumbar levoscoliosis · Spinal stenosis · Back pain · Lower back pain · Spondylolisthesis · Neurofibromatosis
If you have earlier X-rays of the spine, bring them. Comparing the curve over time says more than any single picture.
