Scoliosis is a three-dimensional deformity of the spine in which the lateral curvature measures more than 10 degrees. When the curvature of the spine appears under the age of 10 it is referred to as an early onset scoliosis and when the diagnosis is made after the age of 10 it is referred to as a late onset scoliosis. This rotation of the spine causes asymmetry of the posterior chest wall, shoulders, flanks and hips. The prevalence of curves of more than 10 degrees  in the general population varies between 1-3 %. However, only 0.25% progress to the point where treatment is required. The female to male ratio of curves more than 20 degress  is 5.4 to1.

Scoliosis is often first noticed by parents, friends, teachers, or health professionals during everyday activities or routine school screening programs. It may be noticed when:

• One shoulder appears higher than the other
• The waist looks uneven
• One shoulder blade is more prominent
• The rib cage appears asymmetrical when bending forward

A simple clinical test called the Adam’s forward bend test is commonly used to assess for scoliosis. When the patient bends forward, any rib or lumbar prominence may become more visible.

If scoliosis is suspected, the diagnosis is confirmed with standing spinal X-rays. These allow measurement of the spinal curve using the Cobb angle, which determines the severity of the scoliosis and guides management.

Pain is not typically associated with mild to moderate scoliosis in a paediatric patient. Pain is more common in adult scoliosis due to the degenerative changes that may be associated with it.

Pain is uncommon in children but can be a feature in adults, particularly with degenerative scoliosis.

Treatment for scoliosis depends on:

• The patient’s age
• Skeletal maturity (how much growth remains)
• The size of the curve (measured in degrees)
• Evidence of curve progression

1. Observation

Small curves in growing children are usually monitored with regular clinical reviews and X-rays.

If the curve is mild and not progressing, no active treatment may be required other than careful follow-up during growth.

2. Bracing

If a curve in a growing child shows progression, bracing may be recommended.

Bracing can be used to modulate growth and reduce the size of the scoliosis. It can help prevent further progression while the child is still growing. Bracing is typically used for moderate curves in skeletally immature patients.

3. Surgery

If a curve continues to progress despite bracing and reaches a moderate to severe size (generally 45–50 degrees or greater), surgery may be recommended.

The aim of surgery is to:

• Correct the spinal deformity
• Prevent further progression
• Restore spinal balance

In summary, treatment is carefully tailored to the individual. Smaller curves are observed, progressing curves in growing children are braced, and larger or progressive curves may require surgery to correct the curvature and prevent ongoing progression.

A scoliosis brace is a custom-made, firm plastic jacket that is worn around the torso (chest and lower back). It is designed specifically for each child’s body and curve pattern.

The brace fits under clothing and gently applies pressure to certain areas of the spine while leaving space in others. This helps guide the spine as the child grows.

It is mainly used in children who are skeletally immature and still growing.

A brace serves several important purposes:

• To guide growth during the teenage growth spurt — In some cases, a brace can help partially correct or reduce the curve while the spine is still developing.
• To prevent progression — The primary goal of bracing is to stop the curve from worsening as the child grows taller.
• To delay or avoid surgery — In certain cases, successful bracing can control the curve long enough to delay, or potentially avoid, the need for spinal fusion surgery.

Bracing works best in patients who are still growing and have moderate-sized curves. Its effectiveness depends on growth remaining, curve size, and brace compliance.

Regular follow-up is essential to monitor the patient’s response and adjust treatment as needed.

No. Surgery is not always required for scoliosis.

The need for surgery depends mainly on:

• The size of the curve (measured in degrees)
• The child’s skeletal maturity (how much growth remains)
• Whether the curve is progressing

In growing children (skeletally immature)

If a child still has significant growth remaining and the curve measures 45 degrees or more, particularly in children over the age of 10, surgery may be recommended earlier,  especially if the curve continues to progress despite bracing.

In skeletally mature patients

Once growth has finished, surgery is generally considered for curves measuring more than 50 degrees, particularly for those curves located in the thoracic spine.

Curves of this size carry a higher risk of progression over time, even into adulthood.

Special circumstances

Surgery may sometimes be recommended for smaller curve when:

• The curve involves the thoracolumbar spine, and
• There is significant coronal (side-to-side) trunk imbalance

Every patient is different. A detailed discussion with your treating spine surgeon is essential if:

• The curve progresses beyond 45 degrees despite bracing, or
• The curve measures more than 50 degrees in a skeletally mature child

The decision to proceed with surgery is always made carefully, considering growth, curve behaviour, balance, symptoms, and long-term outlook.

Yes, scoliosis can worsen over time, and the risk of progression depends largely on the size of the curve and whether growth has finished.

During growth

Scoliosis is most likely to progress during adolescence, particularly during rapid growth. This is why children and teenagers with scoliosis are monitored closely.

After skeletal maturity

Once growth has finished (usually around 16–18 years of age), the behaviour of the curve depends mainly on its size:

• Curves less than 30 degrees at skeletal maturity are unlikely to progress significantly in adulthood.
• Curves between 30–50 degrees may progress slowly over time.
• Thoracic curves greater than 50 degrees at skeletal maturity are known to continue progressing, on average by approximately 1 degree per year.

This progression is based on long-term natural history studies of untreated adolescent idiopathic scoliosis. Syndromic and congenital scoliosis may behave differently.

Over decades, larger curves may become more noticeable and, in some cases, may contribute to back pain, cosmetic concerns, or in very large thoracic curves (Curves >80 Degrees) may reduce lung function.

The key message

Most mild curves do not worsen significantly after growth has finished. However, larger curves particularly thoracic curves greater than 50 degrees have a predictable tendency to progress slowly over adulthood.

Regular follow-up allows for appropriate monitoring and timely discussion of treatment options as required.

Scoliosis can arise from different causes and at different stages of life. Understanding the type of scoliosis is important and helps to guide appropriate monitoring and treatment decisions.

1. Idiopathic scoliosis (the most common form)

“Idiopathic” means the exact cause is unknown. Idiopathic scoliosis is further categorised based on when it first appears:

Early-onset idiopathic scoliosis (EOS)

• Develops before the age of 10
• Includes curvature that begins in infancy and early childhood
• Requires careful monitoring because the spine has a long time to grow and curves can progress more rapidly

Late-onset idiopathic scoliosis

• Develops at age 10 or older
• Most common form seen in adolescents
• Curves are monitored until skeletal maturity to decide whether observation, bracing, or surgery is needed

This classification reflects current clinical use and replaces older terms like “infantile,” “juvenile,” and “adolescent” idiopathic scoliosis.

2. Congenital scoliosis

This type of scoliosis is present at birth. It develops when some vertebrae do not form normally before birth. These structural differences can affect how the spine grows and may lead to progression as the child grows.

3. Neuromuscular scoliosis

This occurs when there is an underlying neurological or muscular condition that prevents normal muscular support of the spine. It is seen in conditions such as cerebral palsy, muscular dystrophy, spinal cord injury, or spina bifida. These curves can be more severe and more likely to progress.

4. Degenerative (adult) scoliosis

This type develops in adulthood, usually due to age-related changes in the spine such as disc degeneration and joint wear causing an asymmetrical curve. It may be associated with back pain and changes in posture.

Other less common forms

There are rare forms of scoliosis associated with specific syndromes or medical conditions, as well as temporary or flexible curves due to factors like differences in leg length, sometimes called functional or non-structural scoliosis.

Mild Curves

In most cases, mild scoliosis does not significantly affect daily life.

Long-term natural history studies of adolescent idiopathic scoliosis show that most individuals with small to moderate curves grow up to live normal, active lives including working, playing sport, having families, and remaining physically active.

Mild to moderate curves

Most people with curves less than 40–50 degrees at skeletal maturity:

• Have normal life expectancy
• Have normal ability to work and exercise
• Do not develop severe disability

Some individuals may experience intermittent back pain, but this is often similar to what is seen in the general population.

Larger curves

Larger curves particularly thoracic curves greater than 50 degrees may gradually progress over adulthood. Over many years, this can sometimes lead to:

• Increasing spinal asymmetry
• Back discomfort or pain
• Cosmetic concerns
• In very large untreated thoracic curves (greater than 80 degrees), lung capacity may be reduced.

Severe functional limitation is uncommon and usually only occurs only with very large curves.

The key message

For most people, scoliosis does not prevent a normal, productive, and active life. The impact of scoliosis largely depends on the size of the curve and how it behaves over time.

Regular follow-up allows appropriate monitoring and early discussion of treatment options if needed.

Call Harbour Spine Doctors on (02) 9057 2450 to schedule a consultation with a scoliosis specialist.