Understanding Scoliosis
Learning that your child has scoliosis can feel overwhelming. The diagnosis, the treatment options, and the long-term implications arrive all at once, often during a routine visit when you were not expecting anything significant to come of it. What I want parents to understand from the outset is that scoliosis is a manageable condition, and with early detection, appropriate monitoring, and coordinated care, the vast majority of children with scoliosis live active, healthy lives without meaningful long-term limitation.
THE BASICS
What Scoliosis Is — and How It Is Found
Scoliosis is a sideways curvature of the spine, typically presenting in a C or S shape when viewed from behind. It can affect people at any age, but it is most commonly identified during the adolescent growth spurt — the period when the spine is changing most rapidly and any existing curvature is most likely to progress. Adolescent Idiopathic Scoliosis, the most common form, typically presents between ages 10 and 18, and while it affects both sexes, girls are significantly more likely to develop curves that progress to a degree requiring treatment.
The word idiopathic means the cause is not fully understood, which is honest but sometimes unsatisfying for families looking for an explanation. What we do know is that genetics plays a role, that certain curve patterns are more likely to progress than others, and that the growth remaining in the skeleton at the time of diagnosis is one of the most important variables in determining what treatment, if any, will be needed. Scoliosis is most often identified during routine pediatric examinations or school screening programs, where the forward bend test reveals asymmetry in the rib cage or trunk. The definitive diagnosis is made with standing spinal X-rays, which allow precise measurement of the Cobb angle — the degree of curvature — and provide the baseline against which all future imaging will be compared.
CLINICAL EVIDENCE
How Severity Guides Treatment
Treatment decisions in scoliosis are driven primarily by the magnitude of the curve, the amount of skeletal growth remaining, and the rate of progression observed over time. For curves below 20 degrees in a growing child, observation with periodic clinical and radiographic reassessment is the standard approach — many of these curves do not progress significantly and require no active intervention. For curves between 20 and 45 degrees in a skeletally immature patient, bracing is the evidence-supported treatment to slow or halt progression and reduce the likelihood of surgery. The landmark BrAIST trial demonstrated that bracing is effective when worn consistently, with success rates directly correlated to hours of daily wear — typically 16 to 23 hours is recommended. Curves exceeding 45 to 50 degrees, or those that continue to progress despite bracing, generally warrant surgical evaluation. Spinal fusion remains the most common surgical procedure for severe adolescent scoliosis, using instrumentation to correct and stabilize the curve while the vertebrae fuse into a solid construct. Advances in imaging have improved both surgical planning and the monitoring of non-surgical cases — EOS stereoradiography in particular provides high-quality three-dimensional spinal imaging at significantly reduced radiation exposure compared to conventional X-ray, which matters considerably when a young patient requires repeated imaging over years of follow-up.
THE CARE TEAM
Who Manages Scoliosis — and Why Coordination Matters
Scoliosis is not a condition that any single specialist manages in isolation, and the quality of coordination across the care team has a direct impact on outcomes. Pediatricians play a critical role in initial detection and timely referral. Physiatrists — physicians trained in Physical Medicine and Rehabilitation with expertise in nonoperative spine care — are particularly well-positioned to quarterback the non-surgical management of scoliosis, coordinating between physical therapists, orthotists, and spine surgeons as the clinical picture evolves. Physical therapists trained in the Schroth Method offer a scoliosis-specific rehabilitation approach using individualized exercises designed to address the three-dimensional nature of the spinal deformity, improve postural awareness, and strengthen the supporting musculature in a way that generic core exercise programs do not. Orthotists design and fit the custom braces that are central to moderate curve management, and the quality of the fit and the consistency of wear are both critical determinants of how well bracing works. Spine surgeons specializing in scoliosis — whether orthopedic or neurosurgical in their training — provide the surgical expertise when curves reach the threshold where intervention is necessary, and choosing a surgeon with specific scoliosis experience rather than a general spine surgeon matters meaningfully for outcomes in complex cases.
PATIENT SELECTION
Supporting Your Child Through Treatment
Managing scoliosis in an adolescent involves more than the clinical decisions — it involves supporting a young person through a process that can feel isolating, particularly when bracing requires wearing a visible orthosis through the school day. Brace compliance is the single most modifiable variable in non-surgical scoliosis management, and it is directly tied to how supported and informed the patient feels about why the brace matters. Regular physical activity is encouraged throughout treatment — exercise does not worsen scoliosis, and maintaining strength and cardiovascular fitness supports overall spinal health and quality of life. The specific activities that are safe and appropriate vary by curve severity and should be discussed with the treating physician, but the general principle is that activity is beneficial and restriction should be the exception rather than the rule.
FOR REFERRING CLINICIANS
Pediatricians, family physicians, and school health providers who identify scoliosis on screening or routine examination should refer promptly for specialist evaluation, as the window for non-surgical intervention is defined by skeletal maturity and narrows as growth progresses. I offer comprehensive nonoperative scoliosis evaluation including Cobb angle measurement and progression tracking, Schroth-informed physical therapy coordination, orthotist referral and brace compliance counseling, and surgical coordination when curves reach intervention thresholds. My background in PM&R and nonoperative spine care positions me to manage the full non-surgical arc of adolescent scoliosis and to serve as a consistent point of coordination across the multidisciplinary team. I welcome direct physician-to-physician consultation.
PERSPECTIVE
A Note on Early Intervention and Long-Term Confidence
The families who navigate scoliosis best are the ones who understand what they are managing and why each element of the treatment plan matters. A child who understands why the brace works is more likely to wear it. A parent who understands what the Cobb angle means is better equipped to ask the right questions at each follow-up visit. A family that has a clear point of coordination across the care team is less likely to fall through the gaps between specialties during the years of active monitoring that this condition requires. My role in scoliosis care is to provide that coordination, that clarity, and that continuity — so that the clinical decisions are made at the right time with the right information, and the child and family feel genuinely supported through a process that is rarely quick and is almost always emotionally significant. Scoliosis does not have to define your child's relationship with their body or their capacity for an active life. In the vast majority of cases, with the right care, it simply becomes a part of their history rather than the defining feature of their future.
DISCLOSURE & REFERENCES
This article is for educational purposes and reflects clinical experience and interpretation of published literature. It is not a substitute for individualized medical evaluation. Key references: Weinstein SL et al. 2013 (BrAIST trial, NEJM); Negrini S et al. 2018 (SOSORT guidelines, Scoliosis Spinal Disord); Schreiber S et al. 2016 (Schroth Method RCT, JAMA Pediatrics); Lonstein JE 2006 (adolescent idiopathic scoliosis natural history, Spine); Dubousset J et al. 2005 (EOS imaging system, IRBM).
ABOUT THE AUTHOR
Dr. Mahajer is a double board-certified physiatrist and sports medicine physician, fellowship-trained in Interventional Spine & Sports Medicine at the Icahn School of Medicine at Mount Sinai. He is an Assistant Professor of Neuroscience at FIU Herbert Wertheim College of Medicine. He is the Immediate Past President of the American Osteopathic College of Physical Medicine and Rehabilitation (AOCPMR), holds medical licenses in Florida, New York, and California, and has been recognized as a Top Physiatrist and Top Doctor in both Florida and New York.
