Scoliosis is a three-dimensional spinal curvature often diagnosed during adolescence, known as Adolescent Idiopathic Scoliosis (AIS). The pubertal growth spurt is the primary phase of concern because rapid spinal growth can accelerate the curve’s progression. The question of whether this progression stops once the teenage years are over is paramount for patients and their families. While the most dramatic worsening usually ceases with the end of growth, the long-term behavior of scoliosis is more nuanced than a simple stop-or-go answer.
Defining Skeletal Maturity and Stabilization
The key factor determining whether a scoliotic curve will stabilize is the attainment of skeletal maturity, meaning the bones have finished growing. Doctors assess this milestone using imaging techniques, often examining the ossification, or hardening into bone, of specific skeletal areas. A frequent method involves examining the iliac crest, the top edge of the pelvis, for fusion, graded on the Risser sign scale.
A Risser grade of 5 indicates the iliac crest has completely fused, correlating with the end of spinal growth potential. Once full skeletal maturity is achieved, the primary mechanical driver of rapid curve progression—the growth spurt—is removed. For the vast majority of patients with milder curves, reaching this stage means the curve stabilizes, and the risk of significant future progression drops dramatically.
Curve Size and Risk of Adult Progression
While the risk of rapid progression ends with skeletal maturity, it is inaccurate to say that the curve will never change again. The magnitude of the curve at the time growth stops is the most important predictor of its behavior throughout adulthood. Curves measuring 30 degrees or less at the end of adolescence are highly unlikely to progress significantly over a lifetime. These milder curves generally hold steady and require no further intervention.
Curves measuring 40 to 50 degrees or more at skeletal maturity carry a higher risk of slow, continuous worsening due to mechanical and gravitational forces. Progression in adulthood typically occurs at a rate of about one degree per year, which can lead to a significant increase over decades. The location of the curve also matters, as lumbar (lower back) and thoracolumbar curves often progress more readily in adulthood than those located solely in the thoracic (mid-back) spine. Understanding this relationship between curve size and long-term risk is crucial for managing the condition after growth has ceased.
Management Strategies for Adults with Scoliosis
For adults whose scoliosis has stabilized or is progressing slowly, the focus shifts from growth-based intervention to maintenance and symptom management. Routine monitoring is usually recommended, especially for those with larger curves, which may involve periodic X-rays to track changes. The primary symptom for many adults with scoliosis is pain, which is often managed through non-operative strategies.
Non-Operative Treatment
Physical therapy plays a central role in long-term care by focusing on core strengthening and spinal stabilization exercises. Strengthening the muscles surrounding the spine helps counteract the mechanical forces that drive slow adult progression and reduces discomfort. Pain management may also involve anti-inflammatory medications. In cases of nerve irritation, epidural steroid injections may be used to provide relief.
Surgical Intervention
Only a small percentage of adults with scoliosis will require surgery. Surgery is typically reserved for curves exceeding 50 degrees that are causing significant pain, neurological symptoms, or are progressing despite conservative treatment. This surgical threshold is generally higher than for adolescents. The goal of surgery is to stabilize the spine and alleviate compressive symptoms.