Scoliosis in Adolescents: How Is a Curved Spine Found and Treated?

Scoliosis in adolescents is a sideways curve of the spine that is often found during a school screening or a routine checkup, when a clinician has the teen bend forward and looks for asymmetry. An X-ray confirms and measures the curve. Many curves are mild and are simply watched, while larger ones in a growing teen may need a brace or, less often, surgery. This article covers how scoliosis is found, how it is treated, and which symptoms need prompt care.

How scoliosis in adolescents is found

Most teens with scoliosis have no pain and feel well. The curve is often noticed by a parent, a school nurse, a coach, or a pediatrician. According to MedlinePlus (NIH), scoliosis is a sideways curve of the spine, and most cases appear during the growth spurt just before puberty. In many adolescents no single cause is identified, and this pattern is called adolescent idiopathic scoliosis.

Signs a family may notice include:

• One shoulder that looks higher than the other
• One shoulder blade that sticks out more
• An uneven waistline, or one hip that looks higher
• Clothes that hang unevenly, or a hem that never seems to sit straight
• A rib prominence on one side when the teen bends forward

Because these changes appear gradually, they are easy to miss. A teen who is growing quickly can change noticeably between visits.

The forward bend test and school screening

The usual first check is the forward bend test. The teen stands with feet together and bends at the waist with arms hanging down, while the examiner looks along the back from behind. A rib hump or a lower back bulge on one side can suggest the spine is rotating as well as curving. Many clinicians add a scoliometer, a small handheld tool that estimates trunk rotation.

School screening programs have used this approach for decades. A review of age- and sex-specific prevalence of scoliosis and the value of school screening programs looked at how often curves are found at different ages and in boys and girls, and at how useful screening is. Screening practices differ between regions, and a published guideline for adolescent scoliosis screening in China is one international example of how a health system can organize it. In the United States, school screening varies and professional groups differ on routine screening of teens without symptoms, so a parent who has a concern can raise it at a pediatric visit.

A positive screen is a reason for a closer look, not a diagnosis. Some teens with a positive screen turn out to have only mild asymmetry that needs no treatment.

How the curve is confirmed and measured

Clinicians combine the history, a physical examination, and imaging. A standing X-ray of the spine is the usual way to confirm scoliosis. The doctor measures the curve using the Cobb angle, which compares the tilt of the most tilted vertebrae at the top and bottom of the curve. A larger angle indicates a more pronounced curve. Orthopedic teams often use angle ranges as a rough guide, together with remaining growth, and can explain which range applies to your teen.

The X-ray also helps estimate how much growing the teen has left. This matters because curves are more likely to progress while a child is still growing. Clinicians often look at signs of skeletal maturity, the stage of puberty, and, for girls, whether periods have started. The location and pattern of the curve are noted too.

When an MRI or other tests may be added

Most teens with typical idiopathic scoliosis do not need further imaging. A clinician may consider an MRI or other evaluation when the picture looks different from the usual pattern. Examples include significant pain, pain that wakes a teen at night, abnormal findings on a neurologic exam, an unusually young age at onset, or a curve that progresses quickly. These features can sometimes be linked to a different underlying problem in the spine or nervous system, which is much less common than idiopathic scoliosis. One feature alone does not establish such a condition, and in many cases the evaluation is reassuring.

What may cause the curve

The cause of adolescent idiopathic scoliosis is not fully understood. Several factors are thought to contribute, and family history appears to play a role, since scoliosis often runs in families. Scoliosis can also develop because of other conditions, such as those affecting nerves and muscles. MedlinePlus lists, for example, spinal muscular atrophy among conditions that can involve spine curvature. A curve can also be present from birth. These forms are evaluated differently from the idiopathic type.

Backpacks, posture, sports, and sleeping position are commonly blamed, but they are not established causes of idiopathic scoliosis. Families can reasonably let go of guilt about habits.

Treatment: observation, bracing, and surgery

Treatment is based on the size of the curve, the teen's remaining growth, and how fast the curve is changing. In general, the options are observation, bracing, and surgery, and the right choice varies from teen to teen. The orthopedic team can explain how its own approach applies to your teen.

Observation for smaller curves

For a mild curve, the usual plan is regular checkups with repeat measurements. Many mild curves stay stable, though some can progress during growth. A teen who is nearly done growing is generally less likely to see a large change.

Bracing for growing teens with moderate curves

Orthopedic teams generally consider a brace when a growing teen has a moderate curve, or a smaller curve that is clearly progressing. The goal of bracing is to reduce the chance that the curve gets worse while the teen grows. It is not designed to straighten the spine permanently. Outcomes vary, and bracing works best when it is worn as the orthopedic team prescribes. Teens often find a brace hard to accept, so open conversation about comfort, clothing, sports, and school can help. Tell the clinician if the brace causes skin irritation, pain, or trouble breathing so they can adjust it.

Surgery for larger curves

Surgery is usually reserved for large or fast-progressing curves, or curves that continue to worsen despite bracing. The most common operation is spinal fusion, in which surgeons straighten part of the spine and join vertebrae so the correction holds. Surgeons discuss the benefits and risks, which include infection, bleeding, and a longer recovery. Whether and when to operate is a decision made with a pediatric spine specialist, based on the individual teen.

Exercise and physical therapy

Exercise is a common question. A systematic review with Bayesian network meta-analysis of exercise therapies in adolescent idiopathic scoliosis compared different approaches and suggests that some scoliosis-specific exercise programs may help reduce curve measurements in some teens. The quality of studies varies, and exercise is generally considered an addition to, not a replacement for, the plan from the orthopedic team. A physical therapist trained in scoliosis-specific methods can guide a program that fits the teen.

Regular sports and activity are generally encouraged. Ask the treating team whether any activity should be adjusted, especially while in a brace or after surgery.

Alternative approaches

Families sometimes ask about acupuncture, chiropractic care, or supplements. For acupuncture, a protocol for a systematic review exists, which describes how the evidence would be gathered, but a protocol is a plan and does not itself show that a treatment works. Before starting any alternative approach, tell the orthopedic clinician, so a curve that needs bracing or monitoring is not left unwatched.

Living with scoliosis as a teen

Scoliosis can affect more than the spine. A qualitative evidence synthesis on living with adolescent idiopathic scoliosis found themes such as concern about appearance, the burden of bracing, and the need for support from family and peers. Some teens feel self-conscious about their body or worry about being different. Listening without minimizing, and asking whether they would like to talk with a counselor or a peer support group, can help. A teen who seems persistently sad, withdrawn, or hopeless should be seen by a clinician. If a teen mentions thoughts of self-harm, call or text the 988 Suicide and Crisis Lifeline at 988, or call 911 if there is immediate danger.

Back pain and scoliosis

Many teens with idiopathic scoliosis have little or no back pain. When pain is present, it can have ordinary causes such as muscle strain. Pain that is severe, persistent, or that wakes a teen at night deserves prompt evaluation, since it can sometimes point to a cause other than idiopathic scoliosis. New or worsening numbness, tingling, or weakness in the legs, or a change in how your teen walks, needs a same-day medical evaluation. Go to the emergency room if these symptoms are worsening quickly or come with changes in bladder or bowel control. Both tiers are listed in the emergency section below.

What to ask at the visit

Helpful topics to bring up with the clinician include the size of the curve, how much growth remains, how often to repeat X-rays, and what signs would change the plan. Families can also ask how bracing would fit into school and sports, and whether physical therapy is appropriate. Keeping photos of the teen's back over time and noting when periods started or growth spurts happened can help the clinician judge how quickly things are changing.

Key takeaways

• Scoliosis in adolescents is often found on a forward bend exam and confirmed with a standing X-ray.
• Many curves are mild and are monitored. Some growing teens benefit from a brace, and surgery is considered for larger or progressing curves.
• Scoliosis-specific exercise may help some teens as part of a plan, and outcomes vary.
• New weakness, numbness, severe pain, or changes in bladder or bowel control need urgent evaluation.

When to Seek Medical Care