Scoliosis in Adults: Insights from Spine Specialists

Scoliosis is a disorder that causes the spine to twist or curve to the side. Many grade schools offer basic spine evaluations to check for early signs of this condition. Imaging scans are needed to confirm the diagnosis.

Treating scoliosis before the spine stops growing after puberty may help prevent related back pain and complications. But what happens if scoliosis goes undiagnosed or untreated into adulthood?

What causes scoliosis in children?

“The scoliosis we see in children is typically called idiopathic scoliosis, meaning there isn’t one specific cause,” says Joseph P. Gjolaj, M.D., M.B.A., FACS, FAOA, Chief of Orthopaedic Spine Surgery at the University of Miami Health System. “Although the most common type is idiopathic, there are rarer instances of scoliosis that are related to conditions including neuromuscular problems, congenital malformations in the spine and syndromic scoliosis.”

Although the cause of idiopathic scoliosis is uncertain, there are strong genetic influences. If your family has a history of scoliosis, it’s particularly important for your children to get screened while they’re still growing. 

“Scoliosis can also be associated with other medical conditions, requiring other forms of evaluation, including MRI of the spine, cardiac evaluation and ultrasound,” says Emmanuel Menga, M.D., FACS, FAOA, a scoliosis and spine surgeon at UHealth. “Taking a multidisciplinary approach is important to provide the best medical care for each patient.” 

How is scoliosis treated in children?

Childhood scoliosis may go undetected and isn’t always problematic, Dr. Gjolaj says.

“If a pediatrician notices a small curve in a patient’s spine during a general health screening or from a chest x-ray taken for another reason, that’s considered incidental. That means the scoliosis was identified without symptoms prompting the evaluation. In those cases, a ‘wait and see’ approach with associated surveillance may be appropriate.”

“However, some patients with this condition may require treatment, including bracing,” says Dr. Menga. “For pediatric patients with very large scoliosis curves, surgery might be necessary, despite their young age.”

When is treatment for scoliosis recommended?

“For pediatric patients, treatment for scoliosis is largely based on the age of the patient and the size of the scoliosis curve,” Dr. Menga says.

Dr. Gjolaj adds, “If a child or young adult with scoliosis is feeling back pain; seeing more asymmetry in their body; observing a larger, rapidly changing curve; or has other risk factors for scoliosis progression, that’s a reason to pursue treatment.” 

More advanced symptoms include heart or breathing problems due to a major spine deformity, a shoulder blade that’s more noticeable than the other, or ribs that stick out more than the others. “More significant scoliosis — with larger curves, so to speak — will often result in more problems into adulthood if left untreated,” he says.

Treatments differ between children and adults.

“For our younger patients, we have a variety of treatment options based on the size of their scoliosis curve and their growth potential,” Dr. Menga says.

“There are fewer treatment approaches we can take with scoliosis in adulthood,” adds Dr. Gjolaj.

During childhood and puberty, the spine continues to grow.

“Treatments like casting, bracing and less invasive surgeries and growth-modulating surgeries are aimed at improving the size of the scoliosis curve and guiding the growth of the spine to attempt to correct the scoliosis,” Dr. Menga says. “For some of our younger patients with larger scoliosis curves, bracing and casting are not great options. Surgery in such cases remains a reasonable option, and the decision for treatment is discussed with the patient, taking into account the risk and benefits.”

“In adults, however, we typically don’t recommend bracing long term,” Dr. Gjolaj says, “because it may weaken the core muscles and actually worsen pain when the brace is removed.”

“For our adult patients, treatment is often based on their symptoms,” Dr. Menga says. “Some patients with small and large curves can equally be treated without surgery, while others may need surgery based on their symptoms. In some cases, their symptoms do not always require surgery. Targeted treatment can address their symptoms but not the scoliosis, if it doesn’t cause any significant symptoms.”

“While the spine is no longer growing in adulthood, we can work to strengthen and support the structures around the spine, like the core muscles, to minimize the chances scoliosis will worsen,” Dr. Gjolaj says. “That typically starts with physical therapy. This may also minimize the symptoms associated with scoliosis. The last line of treatments are surgical.”

When childhood scoliosis goes untreated

When childhood scoliosis is diagnosed but left untreated into adulthood, “The problems typically begin with pain, which can progress to more serious issues such as numbness or weakness, as the scoliosis curves move and put pressure on the surrounding nerves,” Dr. Gjolaj says.

Aside from pain, adults may notice the following symptoms “that occur when the shape of the spine deviates from normal,” he says.

• substantial changes in their posture
• difficulty sitting upright
• difficulty standing straight
• difficulty walking
• difficulty with routine exercise

“If an aging person with scoliosis notices that their symptoms are worsening — for example, if they used to have pain rarely and now experience it monthly, weekly, or even daily — that’s a cardinal sign the condition is worsening,” Dr. Gjolaj says.

The prevalence of scoliosis in older adults is much higher than in younger populations.

As we age, various joints of the spine degenerate or develop arthritis. This can disrupt the ligaments surrounding the joints around the spine, leading to scoliosis and nerve compression that can cause leg pain and weakness. This nerve pain and weakness is often the primary reason adults visit their doctor or see an orthopedic specialist, unaware that scoliosis may be the underlying cause.

“Sometimes, adults come into our office for a concern other than scoliosis. Maybe they’re experiencing a sciatica flare-up or what they describe as back muscle pain. When we do basic imaging studies, such as X-rays, we can clearly see that scoliosis is present,” says Dr. Gjolaj.

Many other adults have scoliosis curvatures without any symptoms. These patients do not require any immediate treatment, but their curves should be monitored to determine how quickly they’re increasing in size. It’s unknown if exercise or physical therapy can help prevent these curvatures from increasing in size.

In adults, scoliosis may have gone undetected during childhood and adolescence. Or, it may have developed later in life. Some adults develop scoliosis as a result of a neurologic ailment that affects the spinal cord, such as a spinal tumor or spinal trauma.

Aside from pain, adult patients may complain of changes in their posture.

“For example, finding it more difficult to stand upright for as long as you used to, or noticing a tilt toward one side,” says Dr. Gjolaj. “Your ribcage may protrude more on one side, or you may develop a hump in your back that wasn’t there, or wasn’t as noticeable, before.

“You may notice changes in how your clothes fit. Things like the hem of your pants or skirt suddenly sit differently on one side. Or, your shirt slides off one shoulder but not the other, and that didn’t used to happen. These are signs that your shoulders may be becoming asymmetric, possibly due to a worsening spinal curve,” he says. “You may notice that your pants sit differently on your waist, or your waistline appears tilted. Those are signs of potential changes in the lower spine.”

Degenerative scoliosis can develop in older adults.

“The cause is typically a combination of degenerative changes in the spine and conditions such as osteopenia or osteoporosis, which involve a loss of bone density,” he says.

“Some adult patients also have a leg length discrepancy, which can tilt the pelvis and lead the spine to curve to accommodate for that discrepancy. Combine that with degenerative changes and bone density issues — and the spine can start to curve pretty rapidly.”

Treatments for degenerative scoliosis

For adults with these conditions, the initial treatment recommendation is the same: core muscle strengthening with physical therapy. If that’s ineffective at reducing symptoms and slowing the progressive curving of the spine, then healthcare providers can recommend other options.

Some treatments focus on managing symptoms.

If the pain is in the spine, anti-inflammatory medications (over-the-counter or prescription) can help reduce inflammation and relieve pain. “We may consider steroid injections to minimize inflammation directly where the problem exists,” Dr. Gjolaj says. “If pain radiates into the extremities, like in sciatica, prescription nerve medications may help. Ultimately, the definitive treatment is surgery.”

Cutting-edge surgical options for scoliosis

If you have back pain caused by scoliosis or think you may have undiagnosed scoliosis, see an orthopaedic specialist. A national leader in orthopedic services for more than 35 years, UHealth’s orthopaedic team is highly experienced and trained in diagnosing and treating a variety of back and spine conditions. Services include advanced diagnostics (X-rays, CT scans, and MRIs), innovative treatment options, minimally invasive procedures, and traditional, open surgeries.

In addition to prescription medications, steroid injections, and physical therapy, UHealth offers the following scoliosis treatments, when appropriate, for children, adolescents, adults and geriatric patients.

Bracing: Your orthopaedic specialist may recommend wearing a brace to help slow the progression of your scoliosis.

Vertebral Body Tethering: The orthopaedic surgeon applies implants to the spine, connected with a flexible “ tether” or rope with the appropriate tension to correct the spinal curvature while maintaining flexibility.

Spine Reconstruction (incorporates spinal fusion): Spinal reconstruction can be achieved through various advanced techniques, including minimally invasive surgery. For patients who aren’t candidates for less invasive approaches, robotic, navigation, and open surgery are other options. The orthopaedic surgeon may loosen the spinal curvature by removing parts of the bones. Then, they attach spinal implants, such as screws and rods, to the curved part of the spine to straighten it. Next, a bone graft is applied, allowing the spine to heal permanently in the corrected position.

To make an appointment, call 305-243-3000 or request an appointment online.

Written by Dana Kantrowitz for UHealth.

Reviewed in May 2025 by:

Joseph P. Gjolaj, M.D., M.B.A., FACS, FAOA, Chief of Orthopedic Spine Surgery at UHealth

Emmanuel Menga, M.D., FACS, FAOA, a scoliosis and spine surgeon at UHealth

Nathan H. Lebwohl, M.D., Chief of Spinal Deformity Surgery at UHealth

Tags: Dr. Emmanuel Menga, Dr. Joseph Gjolaj, Dr. Nathan Lebwohl, Postural imbalance, Spinal alignment, Spinal curvature progression