One of the most common questions patients and parents ask after a scoliosis diagnosis is whether the condition will worsen over time. The answer isn’t a simple yes or no. Whether scoliosis progresses with age depends on several factors, including the type of scoliosis, the severity of the curve, the patient’s age at diagnosis, and skeletal maturity.
Understanding what influences scoliosis progression can help you make informed decisions about monitoring and treatment. While not all curves worsen significantly, knowing when progression is likely allows for proactive management that can prevent complications down the road.
Scoliosis Progression in Growing Children
For children and adolescents with idiopathic scoliosis (the most common type, with no known cause), the risk of progression is closely tied to growth. During periods of rapid skeletal growth, particularly during puberty, curves have the greatest potential to worsen.
The Growth Factor
Think of scoliosis progression like a race against time. Once a child reaches skeletal maturity (when bones stop growing), the risk of significant curve progression decreases dramatically. However, during active growth phases, curves can progress quickly, sometimes increasing by several degrees in just a few months.
Several factors influence how likely a curve is to worsen during childhood:
Curve Magnitude: Larger curves are more likely to progress than smaller ones. Curves under 20 degrees at diagnosis have a relatively low risk of progression. Curves between 20-40 degrees have a moderate risk, while curves over 40-50 degrees are likely to continue worsening even into adulthood.
Remaining Growth: The younger a child is at diagnosis, the more growth remains, which means more time for the curve to progress. A 10-year-old diagnosed with a 25-degree curve has several years of growth ahead, while a 15-year-old with the same curve has less time for progression.
Gender Differences: Girls with scoliosis are more likely to experience curve progression than boys, particularly once curves reach 25-30 degrees. This difference becomes more pronounced during adolescence.
Curve Location: Thoracic curves (in the upper back) tend to progress more than lumbar curves (in the lower back). Double curves involving both regions require careful monitoring as they can progress in complex patterns.
What Happens After Skeletal Maturity?
Many people assume that once growth stops, scoliosis progression stops too. While it’s true that the rate of progression slows significantly after skeletal maturity, curves don’t always remain stable throughout adulthood.
Small to Moderate Curves: Curves under 30 degrees at skeletal maturity typically remain stable or progress very slowly throughout adult life. These individuals often experience minimal changes and may not require ongoing treatment.
Larger Curves: Curves measuring 50 degrees or more at skeletal maturity are likely to continue progressing into adulthood, even without the influence of growth. The progression is usually slower than during childhood (typically 1-2 degrees per year), but over decades, this can lead to significant changes.
The 40-50 Degree Zone: Curves falling between 40 and 50 degrees exist in a gray area. Some progress slowly over time, while others remain relatively stable. Individual factors like curve pattern, overall spinal balance, and lifestyle influence outcomes.
Adult-Onset (Degenerative) Scoliosis
Not all scoliosis begins in childhood. Many adults develop scoliosis later in life, typically after age 50. This is called degenerative, or de novo scoliosis, and it follows a different progression pattern than adolescent idiopathic scoliosis.
Degenerative scoliosis develops as the spine’s supporting structures weaken with age. Intervertebral discs lose height and hydration, facet joints develop arthritis, and ligaments may weaken. These changes can cause vertebrae to shift and rotate, creating a spinal curve where none existed before.
Unlike adolescent scoliosis, which may not cause pain initially, degenerative scoliosis often presents with back pain, leg pain, numbness, or difficulty walking. The curve tends to be located in the lumbar spine and may be associated with spinal stenosis (narrowing of the spinal canal).
Degenerative scoliosis can progress, though the rate varies widely among individuals. Factors like overall spinal health, activity level, bone density, and body weight all play a role.
Signs Your Scoliosis May Be Progressing
Whether you’re monitoring your child’s curve or managing your own adult scoliosis, certain signs suggest progression:
Visual Changes:
- Increasing asymmetry in shoulder or hip height
- More prominent rib hump
- Clothing fitting differently or hanging unevenly
- Visible lean or shift in trunk position
- Changes in overall posture
Physical Symptoms:
- New or worsening back pain
- Increased fatigue with standing or walking
- Difficulty maintaining upright posture
- Breathing difficulties (in severe thoracic curves)
- Leg pain, numbness, or weakness (in adult degenerative curves)
Functional Limitations:
- Decreased ability to participate in activities
- Reduced exercise tolerance
- Changes in gait or balance
- Difficulty with daily tasks
If you notice any of these changes, it’s time to schedule an evaluation. Documenting progression through physical examination and X-rays allows for timely intervention if needed.
Monitoring Scoliosis Over Time
Regular monitoring is essential for understanding whether scoliosis is progressing and determining when treatment might be necessary.
For Growing Children: Children with diagnosed scoliosis typically require check-ups every 4-6 months during periods of rapid growth. These visits include physical examination and often X-rays to measure the Cobb angle and track changes. More frequent monitoring may be needed for curves approaching treatment thresholds or during peak growth periods.
For Adults with Stable Curves: Adults whose curves were stable at skeletal maturity may only need periodic check-ups every few years, or whenever symptoms develop. However, adults with larger curves or those experiencing symptoms should maintain regular follow-up.
For Adult Degenerative Scoliosis: Monitoring frequency depends on symptoms and curve severity. Some patients need annual evaluations, while others with symptomatic curves require more frequent assessment.
Preventing Progression: Treatment Options
While we cannot always prevent scoliosis from worsening, several treatment approaches can slow or halt progression depending on the patient’s age and curve characteristics.
Bracing for Growing Children
For curves between 25 and 40 degrees in children who are still growing, bracing is often recommended. Modern braces work by applying corrective forces to the spine, preventing progression during the crucial growth years. Success depends on wearing the brace as prescribed, typically 18-23 hours daily.
Bracing doesn’t “fix” scoliosis, but it can prevent curves from reaching levels that require surgery. Studies show that compliant brace wear significantly reduces the risk of curve progression.
Physical Therapy and Exercise
While exercise alone won’t correct scoliosis, specialized programs can support spinal health. Core strengthening, flexibility exercises, and activities that promote good posture may help maintain function and potentially slow progression in some cases.
For adults with degenerative scoliosis, physical therapy focused on strengthening, flexibility, and pain management can improve quality of life and function.
Surgical Intervention
Surgery becomes appropriate when:
- Curves exceed 45-50 degrees in adolescents
- Curves continue progressing despite bracing
- Adult curves cause significant pain or functional limitations
- Progression threatens organ function or quality of life
Modern surgical techniques focus on correcting the curve, stabilizing the spine, and preventing further progression. Dr. Siambanes utilizes advanced instrumentation systems, including the Daytona Deformity System, to achieve optimal correction of complex spinal deformities.
Spinal fusion surgery involves straightening the curved portion of the spine using rods, screws, and hooks, then encouraging the vertebrae to fuse together. This prevents progression in the fused segment while maintaining mobility in other areas of the spine.
Living with Progressive Scoliosis
If your scoliosis is progressing or has the potential to worsen, proactive management is key. This includes:
- Maintaining regular follow-up appointments with a spine specialist
- Staying physically active within your abilities
- Maintaining a healthy weight to reduce spinal stress
- Practicing good posture habits
- Addressing pain or symptoms promptly
- Following treatment recommendations consistently
For parents of children with scoliosis, compliance with monitoring schedules and treatment plans (like brace wear) significantly impacts outcomes. Open communication with your child about their condition and the importance of treatment helps ensure better results.
Why Specialized Expertise Matters
Scoliosis progression is complex and highly individual. What happens with one person’s curve may differ completely from another’s, even with similar initial measurements. This is why specialized care from an experienced spine surgeon is essential.
Dr. Siambanes has extensive experience evaluating and treating scoliosis at all stages and ages. As the director of the scoliosis center at St. Joseph’s Children’s Hospital and founder of Scoliosis Care, he understands the nuances of curve progression and how to develop personalized treatment plans that address each patient’s unique situation.
Whether you’re concerned about your child’s growing curve or managing your own adult scoliosis, having a specialist who can accurately assess progression risk and recommend appropriate interventions provides peace of mind and better outcomes.
Expert Scoliosis Care in Tampa Bay
If you’re concerned about scoliosis progression, don’t wait to seek evaluation. Early detection of worsening curves allows for more treatment options and better results.
Dr. Siambanes serves families throughout the Tampa Bay area, including Tampa, St. Petersburg, Clearwater, Brandon, Wesley Chapel, and surrounding communities. He provides comprehensive evaluation and treatment for scoliosis in both children and adults, from initial diagnosis through long-term management.
Whether you need monitoring for a stable curve, are considering treatment options for progression, or want a second opinion about your current care, specialized expertise is available right here in Tampa Bay.
Ready to take control of your or your child’s scoliosis care? Contact us today to schedule a consultation.
