Congenital scoliosis.Care & specialists in South Africa

Scoliosis is not curable in the sense that the underlying tendency to curve is structural, but it is highly controllable. Most curves never progress and need no treatment beyond observation. Bracing during growth prevents most moderate curves from reaching surgical threshold, and posterior spinal fusion permanently corrects severe curves with 50-70% reduction and 90-95% patient-reported satisfaction in adolescent series.

Scoliosis is diagnosed by a standing full-length posteroanterior spine radiograph showing a Cobb angle of 10 degrees or more. The Adams forward-bend test and a handheld scoliometer screen for the rib or lumbar prominence that prompts imaging — a reading of 7 degrees or more typically triggers X-rays. MRI is added when the presentation is atypical (early onset, left thoracic curve, painful, abnormal neurology).

The Cobb angle is the standard measurement of scoliosis curve severity, taken on a standing PA radiograph. Lines are drawn along the superior endplate of the most tilted upper vertebra and the inferior endplate of the most tilted lower vertebra; the angle between perpendiculars to these lines is the Cobb angle. 10 degrees confirms scoliosis; 25-45 is moderate; over 45 is severe.

About 80% of pediatric scoliosis is idiopathic — no single identifiable cause, with a strong genetic component (heritability around 70-90%) interacting with growth and neurohormonal factors. The remainder is congenital (malformed vertebrae), neuromuscular (cerebral palsy, muscular dystrophy), syndromic (Marfan, Ehlers-Danlos, neurofibromatosis), or adult degenerative from asymmetric disc and facet wear after age 50.

Yes. Adolescent idiopathic scoliosis has a strong familial pattern, with heritability estimates from twin studies of roughly 70-90%. Having a first-degree relative with scoliosis raises personal risk 3-7 fold. Siblings and children of someone with scoliosis should be examined during their adolescent growth spurt to catch curves while they are still small enough to brace.

Adolescent idiopathic scoliosis is most often detected between ages 10 and 16, with peak progression around the adolescent growth spurt — typically age 11-13 in girls and 13-15 in boys. Congenital scoliosis is usually identified before age 5. Adult degenerative scoliosis is a separate entity, developing after age 50 from disc and facet wear and rising in prevalence with each decade.

Girls and boys develop small scoliosis curves at roughly similar rates, but girls are 5-10x more likely to progress to curves over 30 degrees that need treatment. The reason is not fully understood; current evidence implicates the timing of the adolescent growth spurt, hormonal patterns, and sex-linked genetic factors. Boys with progressive curves often have larger curves at presentation and need careful follow-up.

Adolescent idiopathic scoliosis is usually painless. Significant pain in a child with scoliosis is a red flag and warrants imaging to exclude tumor, infection, syrinx, or spondylolysis. In adult untreated scoliosis, back pain becomes common with age — roughly 60-80% of adults with persistent AIS report some back pain by age 50, usually mild and manageable with conservative care. Adult degenerative scoliosis is typically painful from the outset.

Yes, when worn as prescribed in a growing patient with a moderate curve. The BrAIST trial (Weinstein, NEJM 2013) showed that bracing prevented progression to the 50-degree surgical threshold in 72% of treated adolescents versus 48% of those observed, with a clear dose-response by hours of wear per day. Bracing is most effective for curves 25-45 degrees in skeletally immature patients.

Standard prescription is 16-23 hours per day until skeletal maturity. The BrAIST trial showed that patients who wore the brace at least 13 hours daily had the lowest progression rates, with benefit increasing for each additional hour. Nighttime-only braces (Providence, Charleston) are an alternative for single thoracolumbar or lumbar curves worn 8-10 hours overnight.

Mild curves under 25 degrees rarely need treatment and are simply observed. Moderate curves 25-45 degrees in growing patients are usually managed with bracing, which prevents progression to surgical threshold in most patients. Established curves over 50 degrees do not reverse without surgery — bracing and physiotherapy do not straighten a structural curve, they only slow or stop further growth.

Surgery is generally recommended for adolescent curves over 45-50 degrees while still growing, curves over 50-55 degrees at skeletal maturity, curves that progress despite proper bracing, neuromuscular curves over 50 degrees that impair sitting, and adult deformity with severe pain, neurologic symptoms, or progressive sagittal imbalance unresponsive to 3-6 months of conservative care.

The standard operation is posterior spinal fusion. Pedicle screws are placed at multiple levels under image guidance, two titanium rods are contoured to the correction, the curve is corrected by rotation and translation, and bone graft is added so the fused segments unite over 6-12 months. Surgery takes 4-8 hours under general anesthesia with continuous intraoperative neurologic monitoring.

Most adolescent patients walk with assistance within 1-2 days, leave hospital in 3-5 days, return to school in 4-6 weeks, resume non-contact sport at 3-6 months, and return to contact sport at 9-12 months. Adult deformity surgery recovery is slower — most patients return to non-physical work at 6-12 weeks and reach maximal functional improvement by 12-18 months.

Severe thoracic curves above 70-80 degrees can compromise lung volumes and produce restrictive lung disease, exercise intolerance, and in untreated early-onset cases, right heart strain. Most curves treated under 50 degrees do not affect breathing. In neuromuscular scoliosis and Duchenne muscular dystrophy, pulmonary function is a major driver of surgical timing.

Yes. Adult de novo (degenerative) scoliosis develops after age 50 from asymmetric disc and facet wear, almost always in the lumbar spine. Imaging surveys find lumbar curves over 10 degrees in 30-60% of adults over 60. Symptoms are dominated by back pain, radicular leg pain, and neurogenic claudication rather than visible deformity, and most patients respond to structured non-operative care.

The US Preventive Services Task Force concluded in 2018 that current evidence is insufficient to recommend for or against routine school screening (I statement). The Scoliosis Research Society, American Academy of Pediatrics, and American Academy of Orthopaedic Surgeons continue to recommend screening at adolescent well-child visits using the Adams forward-bend test and a scoliometer.

No. Heavy backpacks, slouching, and uneven posture do not cause structural scoliosis. They can produce postural asymmetry that disappears on the forward-bend test or with a lumbar support, but they do not create the vertebral rotation and Cobb angle that define true scoliosis. Sleeping position and sitting habits are similarly not causal.

Yes. Children and adolescents with scoliosis, including those in braces, should continue full participation in sports, dance, and physical education unless a surgeon has placed an individual restriction. Exercise restriction is not evidence-based and worsens self-image during a vulnerable period. After spinal fusion, most surgeons clear non-contact sport at 3-6 months and contact sport at 9-12 months.

Yes. Most women with curves below 40 degrees have uncomplicated pregnancies and vaginal deliveries. Spinal anesthesia and epidurals are usually feasible but may take longer to site. Pregnancy does not cause meaningful curve progression in stable adult scoliosis. Women with prior spinal fusion should share their operative imaging with the anesthesia team for planning.

Bracing in the US typically costs USD 5,000-10,000 including the custom orthosis and follow-up visits, with insurance usually covering most of it. Posterior spinal fusion list prices range from USD 75,000 to USD 150,000 with insurance covering most for medically necessary cases. In India and many emerging markets the total package for AIS fusion is USD 5,000-12,000. Conservative care for adult scoliosis is comparatively low-cost.

Schroth physiotherapy is a structured 3D corrective exercise method that the international SOSORT 2016 guidelines conditionally recommend as an adjunct to observation or bracing. Randomized trials show small but reproducible advantages over generic exercise in Cobb angle progression and quality-of-life scores, on the order of 2-4 degrees. It does not replace bracing for moderate curves or surgery for severe curves.