A curved spine always needs treatment
A 14-year-old and her very anxious parents sat across from me after an X-ray showed a 22-degree curve. They'd been told she had scoliosis. They'd spent the week researching surgery. I had to slow everything down.
What Patients SayMy GP mentioned I have a mild curve in my spine on the X-ray. Does this mean I have scoliosis? Will I need surgery? I'm worried it will keep getting worse.
Where Did This Come From?
The word "scoliosis" carries enormous weight. People hear it and immediately think of the dramatic presentations they've read about — severe curves, back braces, major surgery, restricted lives. But scoliosis is a spectrum, and the majority of people on that spectrum have mild curves that will never cause significant problems and never require treatment.
The increasing availability of spinal imaging means more mild curves are being discovered incidentally — on scans done for other reasons. This creates a cohort of people who have a finding that wouldn't have been discovered a generation ago and now need to be told about it without causing unnecessary alarm.
What the Science Actually Says
Scoliosis is defined as a lateral spinal curve measuring more than 10 degrees (Cobb angle) on standing X-ray. The vast majority of people with scoliosis — roughly 80–85% — have what's called adolescent idiopathic scoliosis (curve developed in teenage years, no known cause) with mild to moderate curves.
For curves under 25 degrees, the standard approach is observation — monitoring to make sure the curve isn't progressing. Most don't progress significantly, especially in adults whose spines have finished growing. Bracing is considered for growing adolescents with curves in the 25–45 degree range. Surgery is typically only considered for curves above 45– 50 degrees that are causing symptoms or progressing — a small minority of the total scoliosis population.
Adults with scoliosis: mild to moderate curves rarely cause symptoms beyond some back pain, and that pain responds to the same approaches as non-scoliotic back pain. Severe adult scoliosis (above 70–80 degrees) can affect lung function and cause significant pain — but again, this is the severe end of a wide spectrum. A mild curve is not a progressive, worsening condition in the majority of adult cases. It is not a sentence to surgery.
The Verdict
Scoliosis exists on a huge spectrum. Mild curves (under 25 degrees) typically need only monitoring. Treatment — let alone surgery — is reserved for significant, progressive, or symptomatic curves.
What To Do Instead
- Get your Cobb angle measured by a specialist — you need to know the degree of your curve
- Ask specifically: "Is this curve likely to progress, and what would trigger a change in management?"
- For adolescents with curves of 20–45 degrees who are still growing: ask specifically about Schroth-method physiotherapy (PSSE — Physiotherapeutic Scoliosis-Specific Exercises). These are now endorsed by international scoliosis guidelines as an evidence-based way to reduce progression risk, and can be used alongside bracing
- Stay active — core strengthening and overall fitness help manage scoliosis-related back pain
- For adolescents with growing spines: regular monitoring is important as this is the period when progression is most likely
Yellow Flags — Worth Monitoring
- A curve that was previously measured and appears to have progressed on a new scan — needs specialist review
- Scoliosis with significant back or leg pain — the curve may need to be considered in your pain management
- Adolescents with curves approaching 25 degrees who are still growing — brace therapy discussion with a specialist is timely
Red Flags — Get Checked Immediately
- Rapid apparent progression of a scoliotic curve in an adult — consider whether this could indicate a pathological cause (tumour, infection)
- Scoliosis with new neurological symptoms — requires urgent specialist evaluation
- Weinstein SL et al., "Adolescent idiopathic scoliosis," Lancet, 2008;371(9623):1527-37. Bunnell WP, "The natural history of idiopathic scoliosis," Clinical Orthopaedics and Related Research, 1988;(229):20-25. Negrini S et al., "2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth," Scoliosis and Spinal Disorders, 2018;13:3. [SOSORT guidelines endorsing PSSE-Schroth exercises as evidence-based treatment for curves 20-45° in skeletally immature patients.] PAR T FIVE Treatment & Surgery What surgery can and can't do — and why the fear of the operating table might be holding you back. MYTHS 20–25