Adult and Pediatric Scoliosis

Scoliosis is an abnormal lateral curvature of the spine, often accompanied by rotation of the vertebrae. It can affect children and adolescents during periods of rapid growth, as well as adults through the natural degenerative process of aging. While many people with scoliosis live without significant symptoms, others experience progressive spinal deformity, chronic pain, limited mobility, and in severe cases, cardiopulmonary compromise.

Dr. Ryan Snowden is one of Nashville's few spine surgeons with subspecialty training and active research experience in both pediatric and adult spinal deformity. He completed his spine fellowship at the Indiana Spine Group focusing on complex deformity correction and has presented research on adolescent idiopathic scoliosis at national meetings. He practices at Tennessee Orthopedic Alliance, serving patients throughout Middle Tennessee.

What Is Adolescent Idiopathic Scoliosis?

Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis, typically diagnosed in children between ages 10 and 18. The term "idiopathic" means the cause is not fully understood, though genetic factors are believed to play a role. AIS is more common in girls and tends to progress most rapidly during growth spurts. Curves are measured in degrees using the Cobb angle on a standing full-length X-ray — a curve greater than 10 degrees is considered scoliosis.

Most children with AIS have mild curves that require only periodic monitoring. The primary concern is whether the curve will progress before skeletal maturity, which depends on the degree of the curve, the pattern of the curve, and how much growing the child has left to do.

Treatment Based on Curve Severity

Observation (curves under 25°):

Mild curves are monitored with clinical exams and X-rays every 4–6 months during periods of active growth. Many children with curves in this range will never require bracing or surgery.

Bracing (curves 25°–45°):

For skeletally immature patients with curves in this range, bracing is the primary treatment to prevent progression. The goal is not to correct the curve but to hold it stable until growth is complete. Research shows that patients who wear their brace as prescribed — ideally 13 or more hours per day — have significantly better outcomes. Dr. Snowden works closely with orthotists to ensure proper brace fit and compliance.

Surgery (curves greater than 45°–50°):

Surgical treatment is recommended when curves are large enough that they are likely to continue progressing into adulthood, causing pain or affecting function. The primary surgical procedure for AIS is posterior spinal fusion with instrumentation — metal screws and rods are used to correct the curvature and hold the spine in a straighter position while the vertebrae fuse. Patients are typically hospitalized for 3–5 days and return to school within 3–4 weeks. Full return to sports and high-impact activity takes approximately 6 months.

Types of Adult Scoliosis

Adult scoliosis falls into two main categories. Adult idiopathic scoliosis refers to curves that began in adolescence and were either untreated or progressed despite treatment. Adult degenerative scoliosis (also called de novo scoliosis) develops in middle-aged and older adults as a result of asymmetric disc degeneration, facet arthritis, and vertebral wedging — most commonly in the lumbar spine.

Symptoms

Adults with scoliosis may experience chronic lower back pain, asymmetry of the waist or torso, difficulty standing upright for prolonged periods, and leg pain or numbness caused by nerve compression from the curved and degenerated spine. In severe cases, patients may develop a forward lean or list to one side due to loss of sagittal and coronal balance.

Non-Surgical Treatment

Non-surgical management is appropriate for most adults with degenerative scoliosis who have manageable symptoms. Treatment includes physical therapy focused on core strengthening and flexibility, over-the-counter and prescription anti-inflammatory medications, epidural steroid injections for leg pain from nerve compression, and periodic observation with imaging to monitor curve progression.

Surgical Treatment

Surgery for adult scoliosis is reserved for patients who have failed conservative management and have disabling pain, significant spinal imbalance, or progressive neurological symptoms. The goals of surgery are to decompress pinched nerves, restore spinal balance, and stabilize the spine in a corrected position through fusion. The complexity of adult scoliosis surgery varies widely — from single-level decompressions for mild stenosis to multi-level reconstructions involving osteotomies and long fusion constructs for severe deformity.

Dr. Snowden has specific training and research experience in adult spinal deformity surgery. He tailors the surgical approach to each patient's anatomy, degree of deformity, bone quality, and overall health goals. When larger surgeries are required, staging the procedure over two separate operations may reduce risk and improve outcomes.

Dr. Snowden has been involved in scoliosis research since his residency training, with published work on outcomes in adolescent scoliosis surgery and presentations at the Scoliosis Research Society annual meeting. He offers robotic-assisted surgical technology for enhanced screw placement accuracy, and takes a thoughtful, individualized approach to determining the right level of intervention for each patient — from active surveillance through complex deformity correction.