Scoliosis: Diagnosis & Treatment

Doctors diagnose scoliosis by combining medical history, a physical examination, and a standing spinal X-ray.

Medical History

The doctor asks when the curve or any symptoms were first noticed, how the person has grown and developed, and about previous health problems. Family history matters because genetic factors are involved. Roughly 85% of scoliosis is idiopathic, meaning no underlying cause is identified.

Onset & Trigger

The doctor may ask when a change in spinal alignment or any symptom was first noticed, and whether an injury, activity or other event came before it.

Aggravating & Relieving Factors

The doctor may ask what makes the symptoms better or worse, such as activity, prolonged sitting or standing, bending, or lying down. Pain is not always present in people with scoliosis.

Prior Episodes & Treatment Tried

The doctor may ask about previous episodes, earlier X-rays, and treatments you have tried, including how well they worked. This helps the doctor understand how the scoliosis has changed over time.

Red-Flag Screening

Severe pain, weakness, numbness, changes in reflexes, or rapid change in the curve can point to another cause and prompt further tests.

The examination usually starts with posture and alignment, including whether the shoulders, waist or hips look uneven. Spinal movement may also be assessed. A neurological check of strength, reflexes and sensation is added when symptoms or findings suggest nerve involvement.

The forward bend test can flag a possible curve, but only a standing spinal X-ray confirms scoliosis. To measure the Cobb angle, the doctor finds the vertebrae at the top and bottom of the curve that tilt the most, draws a line along the endplate of each, and measures the angle between them. A Cobb angle of at least 10 degrees is needed for a scoliosis diagnosis. The measurement is made by hand or with software and can vary between observers, so small differences between two X-rays are interpreted with care. Together with age, symptoms and the amount of growth remaining, the Cobb angle guides whether a curve is monitored, braced or referred for surgical assessment. Further imaging, such as MRI, is reserved for particular situations.

X-ray vs MRI

X-ray

• Main purpose: confirms scoliosis and measures the curve.
• What it shows: the bones of the spine, the curve's shape and location, and signs of how much growth remains.
• Role in measuring the curve: standing images are used to calculate the Cobb angle and to compare the curve over time.

MRI

• Main purpose: looks at the spinal cord, nerves and soft tissues. It does not replace the X-ray for measuring the curve.
• When it may be considered: not routinely for everyone, it may be used when there are neurological symptoms or findings, severe or unusual pain, or atypical features such as very early onset. It is also often discussed before surgery.

Treatment depends on age, curve size, symptoms, how much growth remains and whether the curve is progressing. Not every curve needs treatment:

Non-Surgical Treatment

General Options

Non-surgical care usually begins with an assessment by a doctor experienced in spinal conditions. Depending on the type and severity of scoliosis, some people may simply need regular monitoring, with periodic examinations and repeat X-rays when needed.

Other non-surgical options may include:

• Physiotherapy and prescribed exercises: These may be recommended to improve strength, mobility, posture, and function. In growing adolescents, the treatment plan may also aim to limit curve progression. Scoliosis can sometimes affect the way the chest moves during breathing, particularly when the spinal curve is more pronounced. Breathing exercises may therefore be included as part of a personalised scoliosis rehabilitation programme.A physiotherapist may teach deep breathing and directed breathing techniques to encourage better expansion of areas of the chest that have restricted movement. These exercises may help improve breathing patterns, chest mobility and exercise capacity.
• Activity Modification: Children with scoliosis generally do not need to stop normal physical activity or sports. Staying active can help maintain muscle strength, flexibility and overall fitness. However, some activities may need to be modified depending on the child's symptoms and treatment. If a child experiences pain, unusual fatigue or difficulty with a particular movement, the activity may need to be reduced, adapted or temporarily avoided while the underlying problem is assessed.
• Pain-relief medicines: These can help manage pain when present but do not correct the spinal curve.
• Spinal injections: In adults with degenerative scoliosis and nerve-related leg pain, injections may provide temporary pain relief. However, their effect can wear off over time, and they do not correct the curve.

Mild curves are often monitored rather than actively treated. Curves measuring less than about 30° at the end of growth are generally less likely to progress significantly.

For adolescents who are still growing and have curves at risk of progression, bracing may be recommended.

In a study of adolescents aged 10–15 years with spinal curves of 20°–40° and ongoing growth, wearing braces for at least 18 hours daily led to a treatment success rate of 72%, compared to 48% among those who were merely observed. Increased brace usage correlated with better outcomes.

Surgery When Indicated

Surgery is considered for selected patients, after a set period of non-surgical treatment. In adolescents, surgery is usually discussed for large curves, often above about 50 degrees at the end of growth, or above about 40 degrees in a young person with growth remaining. Curves of 50 to 75 degrees at skeletal maturity progressed the most in long-term follow-up. Pain, effects on daily function and appearance, and, rarely, breathing problems in very severe curves also influence the decision. A spinal cord or nerve problem, if found, may need treatment before scoliosis surgery.

At QI Spine, we manage scoliosis with a personalised medical rehabilitation programme that aims to reduce pain, improve spinal flexibility, strengthen supporting muscles, improve postural control and restore functional movement. Our treatment plan is backed by medical outcomes that are published in 18 medical journals. Our team of non-surgical orthopaedic care experts and spine specialists builds a personalised recovery programme based on your condition and recovery goals, which includes:

An orthopaedic doctor leads a detailed assessment to understand the nature and severity of your scoliosis and its effect on function. Advanced technology such as Digital Spine Analysis may also be used to assess spinal alignment and design a personalised plan.

The in-clinic programme may include pain management, specific exercises and movement-based rehabilitation to improve mobility, strength and function. Depending on your symptoms and clinical needs, treatment may also include medicines, supplements or injections, and, when appropriate, postural support aids.

Your treatment plan may include a structured programme to follow at home. This can include prescribed exercises or movements, pain-relief medicines or supplements when advised, posture and activity modifications, and other lifestyle measures suited to your condition.

Scoliosis may require ongoing monitoring, particularly when the spinal curve has the potential to change over time. Your long-term care programme is designed to monitor your condition, maintain improvements in movement and function, address symptoms if they recur and slow down the progression.

At QI Spine, surgery is considered only when it is clinically necessary.