New leg weakness, bladder problems, or breathlessness at rest needs urgent assessment. Also seek prompt assessment for a curve that is visibly worsening quickly, or back pain waking a child at night.
A sideways curvature of the spine, usually with rotation. In adolescents it is largely about whether the curve will progress during growth; in adults it is about pain, imbalance and nerve compression.
For a growing child, this is a race against the remaining growth. Bracing works — but only while the skeleton is still immature, which is why timing matters more here than in almost any other orthopaedic condition.
Scoliosis is a lateral curvature of the spine, measured in degrees by the Cobb angle on a standing X-ray, almost always with a rotational component that produces the rib hump seen when bending forward.
Adolescent idiopathic scoliosis is by far the commonest form, appearing around the growth spurt, more often in girls, with no identifiable cause. Its behaviour is governed by two things: how large the curve is and how much growth remains. A curve in a child with substantial growth left is far more likely to progress than the same curve in one who has finished growing.
Skeletal maturity is assessed by the Risser sign on X-ray and by menarche in girls. This matters because bracing can prevent progression in a growing child but does nothing once growth is complete — so the window for non-surgical treatment closes permanently, and children who present late have lost an option they cannot get back.
Adult deformity is different. It arises either from an untreated adolescent curve that has progressed, or from degeneration causing collapse and imbalance. Here the problem is usually pain, nerve compression and the inability to stand upright rather than the cosmetic appearance, and surgery is correspondingly bigger and riskier.
Scoliosis in an infant, or with neurological signs, or with a painful curve, is not idiopathic and requires MRI to look for an underlying cause such as a tethered cord or syrinx.
Bracing can halt progression in adolescent scoliosis, and there is good evidence it reduces the proportion of curves reaching a surgical threshold. But it works only while the skeleton is still growing — once growth is complete, a brace achieves nothing. This means a child with a moderate curve and substantial growth remaining has an option that will disappear within a year or two, and the delay caused by waiting to see, or by travelling for opinions, can cost that option permanently. If your child has been found to have a curve, get a standing X-ray with a Cobb angle measurement and an assessment of skeletal maturity now, rather than at the next school year.
A standing X-ray with two measurements answers most of the question.
Two numbers from a single standing X-ray determine most of the plan: the Cobb angle, which measures the curve, and the Risser grade, which indicates how much growth remains. Add the child's age, height, and in girls whether periods have started. Send any earlier X-rays too — how fast the curve has changed is as informative as its current size. Photographs from the front, back and bending forward are also genuinely useful.
For children, the plan follows the curve size and the growth remaining.
Curves below around twenty-five degrees in a growing child are monitored with X-rays every four to six months. Many never progress to a treatment threshold. Observation is active management rather than doing nothing, and missing the review interval is how curves slip past the point where bracing would have worked.
A custom brace worn for a prescribed number of hours daily halts progression in a substantial proportion of growing children. It does not straighten the spine — it prevents worsening. Compliance is genuinely difficult for adolescents, and honest discussion about that is more useful than assuming it will happen.
Screws placed along the curve, connected to rods that correct and hold the alignment, with bone graft to fuse the levels. Intraoperative neuromonitoring is essential. Most adolescents are walking within days and back to school within six to eight weeks, with sport resumed at six months to a year.
Adult deformity surgery addresses pain, nerve compression and forward imbalance rather than appearance. It frequently involves several levels, sometimes with osteotomies to restore balance, and it carries substantially higher risk than adolescent surgery. Bone density must be assessed first.
Risser grade and menarche. This determines whether bracing is still an option or whether that window has closed.
The current Cobb angle and how fast it has changed over previous films, which matters as much as the number itself.
Onset under ten, left-sided thoracic curves, pain or neurological signs all require MRI to exclude an underlying cause.
If your child's curve is under twenty-five degrees and growth is nearly complete, we will tell you that observation is enough. Many curves at that stage never need anything.
Scoliosis with neurological symptoms, or in a very young child, is not routine idiopathic scoliosis and needs an MRI before any treatment plan is made.
Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.
No — a brace prevents the curve from worsening rather than correcting it. That is still a substantial benefit, because it can keep a curve below the threshold where surgery becomes necessary. It works only while the child is still growing, which is why timing matters so much and why delay can permanently remove the option.
Two factors: the size of the curve now, and how much growth remains. A thirty-degree curve in a child at the start of the growth spurt is far more likely to progress than the same curve in one who has finished growing. The Risser grade on the X-ray and, in girls, whether periods have started, tell us where they are.
In adolescents, roughly forty-five to fifty degrees is the usual threshold, though it depends on the curve pattern, the remaining growth and the rate of progression. Curves beyond fifty degrees tend to continue progressing slowly even into adulthood, which is why they are corrected rather than observed.
Yes, in most cases. Most adolescents return to school within six to eight weeks and to non-contact sport at around six months, with contact sport usually permitted at a year. The fused segment does not move, but the remaining spine compensates well and most young people function normally.
In adolescents, usually not — idiopathic scoliosis is typically painless, which is why a painful curve in a child should prompt an MRI to look for another cause. In adults, pain is often the main problem, arising from degeneration, muscular fatigue from imbalance, and nerve compression.
It depends on symptoms rather than the angle. Adults are operated on for pain, nerve compression and inability to stand upright, not for appearance. Adult deformity surgery is major, with a meaningful complication rate, so the burden of symptoms must genuinely justify it. Many adults are better served by targeted decompression than by full correction.
Send a standing full-length X-ray with the Cobb angle and Risser grade, plus your child's age and whether periods have started. Those decide whether bracing is still possible.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
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