Pediatric & Adolescent Scoliosis
What Is Adolescent Idiopathic Scoliosis?
Adolescent idiopathic scoliosis (AIS) is the most common form, typically diagnosed between ages 10 and 18. "Idiopathic" means the cause isn't fully understood, though genetics are believed to play a role. AIS is more common in girls and tends to progress fastest 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 requiring only periodic monitoring. The primary concern is whether the curve will progress before skeletal maturity, which depends on curve degree, curve pattern, and remaining growth.
Treatment Based on Curve Severity
Observation (curves under 25°): Mild curves are monitored with clinical exams and X-rays every 4–6 months during active growth. Many children in this range never need bracing or surgery.
Bracing (curves 25°–45°): For skeletally immature patients in this range, bracing is the primary treatment to prevent progression — the goal is holding the curve stable until growth is complete, not correcting it. Patients who wear their brace as prescribed (ideally 13+ hours per day) have significantly better outcomes.
Surgery (curves greater than 45°–50°): Recommended when curves are likely to continue progressing into adulthood, causing pain or affecting function. The primary procedure is posterior spinal fusion with instrumentation — screws and rods correct the curve and hold the spine in a straighter position while the vertebrae fuse. Patients are typically hospitalized 3–5 days and return to school within 3–4 weeks; full return to sports takes about 6 months.
Adult Scoliosis
Types of Adult Scoliosis
Adult idiopathic scoliosis refers to curves that began in adolescence and were either untreated or progressed despite treatment. Adult degenerative (de novo) scoliosis develops in middle-aged and older adults from asymmetric disc degeneration, facet arthritis and vertebral wedging — most commonly in the lumbar spine.
Symptoms
Adults with scoliosis may experience chronic lower back pain, waist or torso asymmetry, difficulty standing upright for extended periods, and leg pain or numbness from nerve compression. In severe cases, a forward lean or lateral list can develop from loss of spinal balance.
Non-Surgical Treatment
Appropriate for most adults with manageable symptoms: physical therapy focused on core strength and flexibility, anti-inflammatory medication, epidural steroid injections for leg pain, and periodic imaging to monitor progression.
Surgical Treatment
Reserved for patients who've failed conservative management and have disabling pain, significant imbalance, or progressive neurological symptoms. Surgery aims to decompress pinched nerves, restore spinal balance, and stabilize the spine through fusion. Complexity varies widely — from single-level decompressions to multi-level reconstructions with osteotomies and long fusion constructs for severe deformity. Dr. Snowden tailors the approach to each patient's anatomy, deformity degree, bone quality and health goals; larger surgeries are sometimes staged over two operations to reduce risk and improve outcomes.
Why Choose Dr. Snowden for Scoliosis Treatment?
Dr. Snowden has been involved in scoliosis research since residency, with published work on outcomes in adolescent scoliosis surgery and presentations at the Scoliosis Research Society annual meeting. He takes an individualized approach to determining the right level of intervention — from active surveillance through complex deformity correction.