By Mr Ahmed-Ramadan Sadek, Neurosurgeon · Last reviewed October 2026 · 7 min read

What is scoliosis?

Seen from behind, a healthy spine runs in a fairly straight line from the neck to the pelvis. In scoliosis the spine bends to one side, and often twists slightly as well, so it may look like a gentle ‘C’ or ‘S’. The size of a curve is measured on a standing X-ray as the Cobb angle, the angle between the most tilted vertebrae at each end of the bend.

There are two quite different situations, which we consider separately below: scoliosis that starts in childhood or adolescence, and scoliosis that develops in older adults.

Scoliosis in children and teenagers

Most scoliosis is first noticed during childhood, frequently during the growth spurt of the early teenage years. Parents may spot one shoulder sitting higher, a shoulder blade that sticks out, an uneven waist, or a rib hump when the child bends forward.

The commonest form is idiopathic scoliosis, which means no underlying medical cause is found. the British Association of Spine Surgeons (BASS) patient information notes that current research points mainly to a genetic basis. It is not caused by posture, heavy school bags or sport. Importantly, it does not mean the spine is weak, and it is not usually painful; for many young people the main concern is how their back looks.

A smaller group have scoliosis linked to another condition, for example one affecting muscle strength or balance. When scoliosis appears before the age of six it is called early onset, and in very young children it can sometimes progress and need specialist care.

How is it treated in young people?

Treatment depends on the size of the curve, how much growing the child still has to do and how the young person feels about it. Broadly, options include:

• Observation: regular check-ups and X-rays during growth to see whether the curve is changing.
• Bracing: a fitted brace worn for many hours a day during growth, intended to limit progression of moderate curves rather than straighten them.
• Surgery: for larger or progressive curves, an operation to straighten and stabilise the spine with screws, rods and bone graft (a spinal fusion) may be recommended by a specialist scoliosis team.

Exercise and sport are generally encouraged. Treatment approaches vary between countries and surgeons, so it is reasonable to ask your team to explain the options in detail.

Degenerative (adult) scoliosis

Scoliosis that first appears in later life, sometimes called de novo or adult-onset scoliosis, results from ageing of the spine. Everyone’s discs and facet joints wear with time (see our guide to degenerative disc disease). If this happens faster, or more on one side, the joints can slip and the spine gradually tilts over. BASS patient information states that degenerative scoliosis is diagnosed once the sideways curve reaches at least 10 degrees on full-length standing X-rays.

Symptoms

• Back pain and stiffness, often coming and going, and muscle tightness
• Pain in the buttocks or thighs
• Leg pain, tingling or numbness (sciatica) if the curve narrows the spinal canal or stretches a nerve, typically worse when standing or walking and eased by sitting or bending forward, as in spinal stenosis
• In severe curves, a stooped posture, problems with balance and, very occasionally, breathing difficulty. BASS notes this mainly with curves of 90 degrees or more

Non-surgical treatment

Most adults with degenerative scoliosis are managed without an operation. Physiotherapy and exercise, pain medication, manual therapy and lifestyle changes all play a part. Losing excess weight reduces the load on the spine. Injections, such as nerve root injections or facet joint injections, can calm painful nerves or joints.

Surgery for adult scoliosis

Surgery is only considered once non-surgical measures have stopped helping, and your overall health must be weighed very carefully. Age alone is not a barrier; BASS notes that most people with troublesome degenerative scoliosis are 60 or older. For frailer patients, a smaller operation to relieve pressure on the nerves may be the safer choice.

• Decompression: removing bone and thickened tissue (a laminectomy or laminotomy), sometimes through a narrow tube, to free trapped nerves. See our guide to lumbar decompression.
• Correction and fusion: screws and rods hold the spine in a better position while bone graft knits the vertebrae together over about 6 to 12 months. Screws may extend into the pelvis for extra anchorage.
• Interbody fusion: a worn disc is replaced with a cage and bone graft, approached from the back, side or front of the body, to restore disc height and alignment. Reaching the upper spine may require opening the chest (a thoracotomy).

These operations are often carried out in two stages, sometimes weeks apart. According to BASS patient information, roughly 7 in 10 people get good relief of leg symptoms, often building over several months. Back pain is much less predictable, partly because some of it comes from muscle spasm.

Risks of adult scoliosis surgery

BASS describes surgery for degenerative scoliosis as carrying the highest potential risks of any routine spinal operation. It quotes published figures suggesting that about 8 in 10 patients have some complication, around 3 in 10 a major one, and that 13 in 100 need further surgery within one year (25 in 100 within three years). The table below lists further BASS figures.

Risk	Approximate frequency (BASS)
Delirium (temporary confusion)	13 in 100
Urine infection	Around 10 in 100
Tear in the nerve lining (dura)	Fewer than 10 in 100
Pneumonia	8 in 100
Deep wound infection	7 in 100
Ongoing nerve pain	7 in 100
Bone not fusing (non-union)	Up to 5 in 100
Worsening of spinal cord or nerve function	3 in 100
Nerve root injury (first operation)	Less than 2 in 100
Misplaced screws	2 in 100
Blood loss over two litres	2 in 100
Cage or implant movement	Up to 2 in 100; about 1 in 100 need re-operation
Blood clot in the leg or lung	Fewer than 1 in 700
Death from major vessel or organ injury	2 in 10,000
Fatal anaesthetic complication	2 in 250,000

Approach-specific risks also apply. BASS reports major blood vessel injury in up to 15 in 100 front or oblique approaches, temporary bowel paralysis (ileus) in 11 in 100, and retrograde ejaculation in men in fewer than 1 in 100. After opening the chest, long-term wound pain is reported in about 1 in 10.

Outlook

Most young people with idiopathic scoliosis lead full, active lives, whether or not they need treatment. For adults, the majority manage well with non-surgical care. Where surgery is advised, a frank conversation with your surgeon about expected benefits and risks is essential.

• BASS patient information: Scoliosis
• BASS patient booklet: Degenerative Scoliosis
• NHS: Scoliosis
• British Scoliosis Society
• Scoliosis Association UK (SAUK)

This guide is general information and is not a substitute for advice about your own situation. Please speak to your GP or specialist.