How serious is scoliosis?
6/30/2025 by Todd Milbrandt, M.D.
Scoliosis is a sideways curve of the spine with rotation. It most often develops during the growth spurt just before puberty. If the spinal curve is small — less than approximately 15 degrees — then having it checked periodically at follow-up appointments may be the only treatment needed. Most of the time, these small curves don't get worse over time.
However, when the curve is in the 20- to 40-degree range and a child has at least two years of growth remaining, a brace is typically the best treatment choice. Wearing a brace doesn't cure scoliosis or reverse the curve, but it usually prevents the curve from worsening.
The most common type of brace is made of plastic and is contoured to a child's body. It fits under the arms and around the rib cage, lower back and hips. The brace must be worn day and night to be most effective. Children who wear braces for scoliosis can usually participate in most activities and have few restrictions. If necessary, kids can take off the brace to participate in sports or other physical activities. A child stops wearing the brace once their bones stop growing. A brace won't help older teens and young adults diagnosed with scoliosis after they have stopped growing.
In general, surgery is also the first step in treatment for large curves, usually greater than 50 degrees. The standard surgery for scoliosis is spinal fusion. This procedure corrects the spine curve by connecting two or more spinal vertebrae. Metal screws and rods are used to hold the vertebrae together so that they can heal into one solid unit.
A newer surgical option is anterior vertebral body tethering. It involves inserting screws into the vertebrae affected by scoliosis. The surgeon attaches a cord to each of the screws and then pulls and secures the cord, so the vertebrae are cinched together on one side and splayed open on the other, correcting the curve. This technique aligns the spine and gives the vertebrae space to grow properly. This surgery is used mainly in cases of significant scoliosis in a child with growth remaining. Mayo Clinic is one of only a handful of centers where this surgery is performed.
If moderate to severe scoliosis is not treated, it usually progresses at an average of 2 to 3 degrees a year. By the time a person reaches middle age, that could result in a curve of 100 to 115 degrees. Such a significant spinal deformity leads to noticeable changes in appearance, such as shoulders that are not level, ribs on one side of the body that stick out farther than on the other side, uneven hips, and a shift of the waist and trunk to the side. It can also cause increased back pain, and the rib cage may press against the lungs and heart, making it more difficult to breathe and harder for the heart to pump.
If you notice that your child's spine seems to be curved, or if you spot other signs and symptoms of scoliosis — such as uneven shoulders or an uneven waist, one hip higher than the other, or one shoulder blade that seems more prominent than the other — make an appointment to have it evaluated as soon as possible.
Todd Milbrandt, M.D., is a physician in the Division of Pediatric Orthopedic Surgery at Mayo Clinic in Rochester. He specializes in the care of children with spine disorders, including scoliosis.