Types of Scoliosis We Treat
| Type | Who it affects | Key features |
| Adolescent Idiopathic | Ages 10–18 | Most common; cause unknown; often detected at school screenings |
| Adult Degenerative | Adults 50+ | Caused by disc and joint wear; can cause back pain and leg symptoms |
| Congenital | Birth to childhood | Caused by vertebral malformations; may require early intervention |
| Neuromuscular | Any age | Associated with cerebral palsy, muscular dystrophy, or spinal cord conditions |
| Kyphosis / Sagittal Deformity | Any age | Abnormal forward rounding; Scheuermann’s, post-surgical, or degenerative |
Symptoms
- Visible shoulder, waist, or hip asymmetry when standing
- One shoulder blade more prominent than the other
- Back pain, stiffness, or fatigue with activity
- In severe cases: leg pain, numbness, or reduced lung capacity
| Many cases are painless early on Adolescent idiopathic scoliosis often develops silently during growth. The American Academy of Orthopedic Surgeons recommends monitoring by a specialist if a curve is detected at a school screening or pediatric exam. |
Diagnosis & Measurement
Diagnosis begins with a standing full-spine X-ray. The Cobb angle — measured from the most tilted vertebrae above and below the curve — determines severity and guides treatment decisions. We also assess spinal balance in three planes (coronal, sagittal, and axial), particularly for adult deformity and complex reconstruction cases.
| Ready to stop the pain? Most patients are seen within the same week — most insurance accepted. Call (516) 743-9450 |
Treatment — The Full Spectrum
Observation (mild curves <25°)
Most small curves are monitored with periodic X-rays during growth. Many never progress. We use a low-radiation protocol with EOS imaging where available.
Physical therapy & Schroth method
Scoliosis-specific physical therapy, including the Schroth method, teaches patients corrective posture and breathing patterns that can reduce curve progression and improve function.
Bracing (25–45° in growing patients)
For curves in the 25–45° range in skeletally immature patients, a custom brace worn 16–23 hours daily is the standard of care. Consistent brace wear significantly reduces the likelihood of surgical intervention.
Surgical correction (curves >45–50°, progressive, or symptomatic)
For curves that progress beyond 45–50°, cause neurological symptoms, or significantly affect quality of life, surgical correction uses posterior spinal instrumentation with pedicle screws, computerized spinal navigation, and — in complex cases — three-column osteotomies to restore spinal balance. As a UCSF Complex Spine & Deformity fellowship graduate, Dr. Grewal performs these reconstructions with a level of subspecialty training most surgeons do not have.
| Why the fellowship matters Most orthopedic spine surgeons do not complete a deformity fellowship. Dr. Grewal’s training at UCSF — one of the nation’s top deformity programs — means patients with complex scoliosis and spinal deformity have access to subspecialty-level care without traveling to a major academic center. |
CLINICAL REFERENCES
- Weinstein SL et al. Health and function of patients with untreated idiopathic scoliosis. JAMA. 2003;289(5):559-67. PubMed 12578508
- Weinstein SL et al. Effects of bracing in adolescents with idiopathic scoliosis (BRAIST trial). New England Journal of Medicine. 2013;369(16):1512-21. (72% success rate with bracing.) PubMed 24047455
- Negrini S et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis and Spinal Disorders. 2018;13:3. PubMed 29435499
- Scoliosis Research Society (SRS). Patient Information: Adolescent Idiopathic Scoliosis. srs.org. 2024. Available at: srs.org
Common Questions
Do I need surgery for scoliosis?
Most people don’t. Surgery is considered for curves over 45–50° that are progressing, or when symptoms significantly affect function. The large majority of scoliosis patients are managed with monitoring, PT, or bracing.
What is the UCSF Complex Spine & Deformity Fellowship?
It’s a subspecialty surgical fellowship at the University of California, San Francisco, focused on complex scoliosis and spinal deformity reconstruction — one of the most prestigious programs in the world for spine surgery.
Does scoliosis get worse with age?
It can. Curves under 25° in adults typically remain stable. Curves over 30° in skeletally mature patients have a higher likelihood of slow progression over decades. Degenerative scoliosis, which develops in adulthood, can progress with continued disc degeneration.
Can adults be treated for scoliosis?
Yes. Adult scoliosis — whether idiopathic that was never treated or degenerative that developed in adulthood — can cause pain and functional limitations. Non-surgical and surgical options both apply, guided by symptoms and curve severity.
At what age is scoliosis usually detected?
Adolescent idiopathic scoliosis is most commonly detected between ages 10–15, often at a school screening or routine pediatric exam. Adult degenerative scoliosis develops later in life as discs and facet joints wear asymmetrically.
What is a Cobb angle?
The Cobb angle is the standard measurement of scoliosis severity: the angle between the most tilted vertebrae above and below the curve, measured on a standing full-spine X-ray. Curves under 10° are not classified as scoliosis; treatment decisions are guided by the Cobb angle.
Will my child with scoliosis need surgery?
Most children do not. Only curves that progress beyond 40–50° or cause functional problems typically require surgery. The BRAIST trial (NEJM 2013) showed bracing is highly effective at preventing curve progression in adolescents who wear the brace as prescribed.
