What are the current treatment options for adults with scoliosis?

Treatment Options for Adult Scoliosis

The treatment approach for adult scoliosis depends primarily on curve severity and symptoms, with physical therapy and core strengthening recommended for curves 15-50°, while curves >50° require surgical evaluation due to predictable progression of approximately 1° per year in skeletally mature adults. 1

Initial Evaluation and Classification

• Obtain PA and lateral spine radiographs to diagnose, classify severity, and assess progression risk 1
• Measure Cobb angle to determine treatment pathway: curves <15° are mild, 15-50° are moderate, and >50° are severe 1, 2
• Assess for concurrent osteoporosis, particularly in post-menopausal women, as this accelerates curve progression 1, 2

Treatment Algorithm by Curve Severity

Curves <15° (Mild)

• Annual clinical evaluation using Adam's forward bend test 1
• Radiographic monitoring every 12-18 months for stable curves 1
• No active intervention required unless symptoms develop 1

Curves 15-50° (Moderate)

• Physical therapy focusing on core strengthening and postural awareness is the primary treatment 1
• Initial instruction must be provided by a physical therapist, not through unsupervised exercises 1
• More frequent monitoring to detect potential progression 1
• Consider bracing for pain relief: the Peak Scoliosis Brace worn for at least 2 hours daily can reduce worst pain, back pain, and leg pain in adult women with chronic low back pain secondary to scoliosis 3

Curves >50° (Severe)

• Surgical evaluation is recommended due to continued progression risk of approximately 1° per year 1
• Surgery prevents curve progression and offers significant correction of cosmetic deformity 2, 4
• Surgical options include decompression, correction, stabilization, and fusion procedures or combinations thereof 2

Symptom-Specific Management

For Back Pain

• Physical therapy with core strengthening exercises 1
• Bracing for at least 2 hours daily can provide pain relief within 1 month 3
• Avoid spinal manipulation with high-velocity thrusts in patients with spinal fusion or advanced osteoporosis due to fracture risk, spinal cord injury, and paraplegia risk 1

For Spinal Stenosis Symptoms

• Surgical decompression may be required when conservative management fails 2
• Address both the stenosis and underlying deformity in surgical planning 2

Special Considerations

Osteoporosis Management

• Earlier DXA screening is recommended for adult scoliosis patients 1
• Bisphosphonate therapy following general population guidelines for osteoporosis management 1
• Osteoporosis significantly accelerates curve progression, particularly in post-menopausal women 2

Female Patients

• Higher progression risk compared to males 1
• Osteoporosis management is particularly critical in this population 1

Common Pitfalls to Avoid

• Do not overtreat mild curves or delay evaluation of new or worsening symptoms 1
• Avoid excessive radiation exposure by adhering to recommended monitoring intervals rather than more frequent imaging 1
• Do not substitute unsupervised exercises for initial physical therapy instruction 1
• Avoid high-velocity thrust manipulation in patients with fusion or advanced osteoporosis 1

Monitoring Strategy

• For stable curves <50°: radiographs every 12-18 months 1
• For curves approaching surgical threshold: more frequent monitoring to detect progression 1
• Avoid routine scheduled repeat radiographs (e.g., every 2 years) as a standard approach in stable patients on treatment 5