Most parents first notice scoliosis when they see that their child's spine doesn't look straight – one shoulder higher than the other, a rib hump when the child bends forward, or a waist that doesn't look symmetrical. For some, it's a school nurse who picks it up. For a few, it's caught at a routine GP appointment.
What happens next depends on the degree of curvature. Many children with a mild curve will need nothing more than monitoring through the growth spurt. Others will need a brace. A small group will eventually need surgery. The anxiety of a new scoliosis diagnosis is often disproportionate to what turns out to be required, but understanding what the numbers mean and what the process looks like makes it considerably easier to navigate.
Healthbooq (healthbooq.com/apps/healthbooq-kids) covers paediatric orthopaedic conditions and childhood health.
What Scoliosis Is
The spine has natural curves when viewed from the side – a forward curve at the neck and lower back, and a backward curve at the thoracic spine. In scoliosis, the spine also curves sideways when viewed from the front or back, and in most cases it also rotates. That rotation is what produces the characteristic rib hump visible when the child bends forward – the Adams forward bend test, which is the standard screening tool used in schools and clinics.
By definition, scoliosis requires a Cobb angle of 10 degrees or more. The Cobb angle is measured on a standing X-ray of the full spine, drawn between lines parallel to the end vertebrae of the curve. Curves under 10 degrees are not classified as scoliosis.
The most common type, adolescent idiopathic scoliosis (AIS), is called idiopathic because no single cause has been identified. It affects around 2-3% of children, with a female-to-male ratio of around 8:1 for curves significant enough to require treatment. The condition has a clear genetic component: around 30% of people with AIS have a family member who also has it, and research by Carol Wise at the Texas Scottish Rite Hospital for Children has identified several gene variants associated with the condition, though no single gene accounts for most cases.
AIS typically becomes apparent during the adolescent growth spurt – in girls around age 10-12, in boys somewhat later. Growth is what drives progression: a curve that is mild before puberty may worsen significantly during the growth spurt, and then stop progressing once the skeleton is mature.
Other types of scoliosis include congenital scoliosis (structural abnormalities of the vertebrae present from birth), neuromuscular scoliosis (associated with cerebral palsy, muscular dystrophy, or spinal cord conditions), and syndromic scoliosis (associated with Marfan syndrome, neurofibromatosis, or other systemic conditions).
Recognising Scoliosis
The signs that a parent might notice at home include: one shoulder sitting higher than the other; one shoulder blade protruding more than the other; a visible curve when looking at the child's back from behind; a waist that appears uneven, with one side of the waist showing less of a curve; or one hip appearing higher than the other.
The Adams forward bend test confirms the suspicion: the child bends forward at the waist with arms hanging down. In scoliosis with thoracic (mid-back) involvement, the rib cage on one side rises higher than the other. In lumbar scoliosis, the lower back shows asymmetry.
Any child or teenager with these signs should be assessed by their GP, who will examine the spine and, if scoliosis is suspected, arrange a standing full-spine X-ray.
How Severity Is Classified
The Cobb angle determines the approach to management.
Curves under 25 degrees are mild and typically monitored with observation – X-rays every 4-6 months during growth, less frequently once growth has slowed. Most mild curves do not progress significantly. The risk of progression depends on skeletal maturity (how much growth remains) and curve size: a 20-degree curve in a girl who has not yet had her period is at higher risk of progression than the same curve in a girl two years post-menarche.
Curves between 25 and 40 degrees in a child who is still growing are the primary indication for bracing. The BrAIST randomised trial, published in the New England Journal of Medicine in 2013 by Stuart Weinstein and colleagues at the University of Iowa, provided the strongest evidence to date that bracing is effective: 72% of braced patients achieved treatment success (curve remaining under 50 degrees at skeletal maturity) compared with 48% of observed patients. The success rate was dose-dependent – the more hours per day the brace was worn, the better the outcome.
Curves over 45-50 degrees are generally considered for surgery, as curves of this size often continue to progress even after skeletal maturity and can, at very large sizes, affect pulmonary function.
Bracing
A scoliosis brace is a rigid plastic or semi-rigid device worn under clothing. The most commonly used type in the UK is the Boston brace or its variations, which covers the torso from the hips to beneath the arms. For thoracic curves, underarm braces may not achieve adequate correction, and higher braces (TLSO or Milwaukee brace) are used, though the latter is less commonly prescribed because of poor tolerance.
For bracing to work, it needs to be worn consistently – typically 18-23 hours a day, depending on the brace type and the treating team's protocol. Wearing it for fewer hours significantly reduces effectiveness, as the BrAIST trial data showed clearly. The psychological and social challenges of brace-wearing during adolescence are real: teenagers feel self-conscious, the brace affects what they can wear, and it is hot and uncomfortable. Adherence is one of the biggest clinical challenges in scoliosis management, and specialist scoliosis physiotherapists play a key role in helping teenagers manage it.
Specialist physiotherapy approaches, particularly the Schroth method (a scoliosis-specific exercise programme developed in Germany and now practised internationally), have growing evidence for slowing curve progression and improving trunk musculature and posture. It does not replace bracing in curves that require it, but it is used alongside it, and it is appropriate for curves that don't yet meet the threshold for bracing.
Surgery
Posterior spinal fusion is the standard surgical treatment for AIS curves over 45-50 degrees in skeletally immature patients, or curves over 50 degrees in mature patients. The procedure involves placing rods and screws along the spine to correct the curve and fuse the relevant vertebrae together. Results are generally good in specialist centres: curves are typically corrected by 60-70%, correction is maintained long-term, and outcomes in terms of pain, function, and appearance are good.
Recovery from spinal fusion is significant: most teenagers are in hospital for 4-5 days, return to light activity within a few weeks, and to sports over 6-12 months. The decision to proceed with surgery is made jointly by the orthopaedic surgeon, the patient, and the family, with full information about risks (which, in specialist centres, are low) and expected outcomes.
Living with Scoliosis
Most people with treated or monitored scoliosis lead fully normal lives. The condition does not affect life expectancy, does not prevent pregnancy, and for mild to moderate curves does not cause significant pain or limitation in adulthood.
Back pain in adulthood is slightly more common in people with larger untreated curves, but for treated curves, long-term outcomes in terms of pain and function are comparable to the general population. Sport is not contraindicated; most teenagers with braced scoliosis can participate in sport while wearing the brace, and swimming and gymnastics are particularly encouraged for the muscular and postural benefits.
The Scoliosis Association UK (SAUK) provides peer support, information for parents, and a helpline.
Key Takeaways
Scoliosis is a sideways curvature of the spine of 10 degrees or more. Around 2-3% of children have scoliosis, with adolescent idiopathic scoliosis (AIS) being the most common type, affecting primarily girls during the adolescent growth spurt. Most cases are mild and require only monitoring; significant curves require bracing, and a minority require surgery. The Cobb angle, measured on an X-ray, guides management: curves under 25 degrees are observed, 25-40 degrees in a growing child are treated with a brace, and curves over 45-50 degrees are generally considered for surgery. Early identification allows intervention at the most effective point.
