Treatment for Mild Scoliosis
For mild scoliosis (curves <20°), observation and regular monitoring are the recommended treatments, with scoliosis-specific exercises considered for curves between 15-20° to prevent progression. 1, 2
Assessment and Classification
- Mild scoliosis is defined as a spinal curvature with a Cobb angle of 10-20° 3, 4
- Initial evaluation should include PA and lateral spine radiographs to diagnose and classify the deformity, evaluate severity, and assess risk for progression 5
- Scoliosis can be categorized as idiopathic (most common, 70% of cases), congenital, neuromuscular, or secondary to other conditions 3, 6
Treatment Algorithm Based on Curve Severity
For Curves <15°:
- Regular observation with radiographic monitoring every 12-18 months for stable curves 1, 2
- Annual clinical evaluation using Adam's forward bend test 5
- Referral to orthopedics if there is concern about progression 5
For Curves 15-20°:
- Scoliosis-specific corrective exercises are recommended in many European countries (France, Germany, Italy, Poland) rather than passive observation 7
- Physical therapy focusing on core strengthening and postural awareness can help manage symptoms 2
- More frequent monitoring (every 6 months) to detect potential progression 5, 2
Red Flags Requiring More Aggressive Management
- Development of new neurological symptoms 2
- Rapid curve progression despite skeletal maturity 2
- Pain not responding to conservative measures 2
- Curves approaching or exceeding 20° in patients under 10 years of age 3
Special Considerations
- Skeletally immature patients have higher risk of progression and require more vigilant monitoring 2, 3
- Female patients have higher risk of progression (female-to-male ratio of 10:1 for larger curves) 2
- Avoid excessive radiation exposure by following recommended monitoring intervals 2
When to Refer to a Specialist
- Curves greater than 20° in patients 10 years or older 3
- Curves greater than 10° in patients younger than 10 years 3
- Presence of atypical features, back pain, or neurological abnormalities 3
- Evidence of rapid progression 2, 3
Common Pitfalls
- Assuming no progression due to absence of symptoms - curves can progress silently 2
- Delaying evaluation of new or worsening symptoms 2
- Overtreatment of mild curves - surgical intervention is not indicated for mild scoliosis 1, 2
- Neglecting the psychological impact of the condition, especially in adolescents 6
Remember that surgical intervention is typically only considered for curves greater than 50° in young adults due to risk of continued progression into adulthood 1, 2.