Scoliosis is an abnormal, three-dimensional lateral curvature of the spine, often appearing as an “S” or “C” shape. This condition most commonly develops during the growth spurt just before puberty. Effective treatment requires a coordinated approach from several medical specialists, whose involvement depends on the patient’s age, the severity of the curve, and whether the condition is actively progressing.
Screening and Initial Assessment
The first point of contact is typically a primary care provider (PCP) or a pediatrician. They are responsible for routine scoliosis screenings, often conducted during annual wellness exams for adolescents between the ages of 10 and 15. The standard initial evaluation involves the Adam’s forward bend test, where the physician looks for asymmetry or rib prominence as the patient bends over.
If screening suggests a potential curve, the next step is ordering standing X-rays to confirm the diagnosis and measure the curve’s magnitude using the Cobb angle. Scoliosis is classified when the measurement is 10 degrees or more. The PCP’s role is limited to this initial diagnostic confirmation and referring the patient to a spine specialist, as they do not typically oversee long-term treatment.
Non-Surgical Orthopedic Specialists
For mild to moderate scoliosis cases, an orthopedic specialist, often a pediatric orthopedic surgeon, leads non-surgical management. This doctor monitors the curve’s progression through regular clinical examinations and follow-up X-rays, typically every four to six months. For curves between 25 and 40 degrees in a growing child, the specialist may prescribe a spinal brace, such as the Boston brace, worn daily to prevent the curve from worsening until skeletal maturity.
These specialists also prescribe and oversee specialized physical therapy programs, such as the Schroth method. This method uses specific exercises, muscle strengthening, and breathing techniques to elongate the trunk and correct spinal rotation. A physiatrist, a doctor of physical medicine and rehabilitation (PM&R), plays a complementary role by focusing on non-surgical treatments to improve function and manage musculoskeletal pain. The physiatrist diagnoses and treats conditions affecting nerves and muscles, often designing comprehensive rehabilitation plans to maximize mobility and quality of life.
Surgical Intervention Experts
When the spinal curve progresses beyond 45 to 50 degrees, or if non-surgical treatments fail in a growing child, an orthopedic spine surgeon becomes the primary expert. These surgeons perform procedures to correct the deformity and prevent further advancement. The most established surgical approach is spinal fusion, where the surgeon uses bone grafts, rods, and screws to permanently join two or more vertebrae into a single, solid bone.
A more modern alternative for growing adolescents is vertebral body tethering (VBT). This motion-sparing technique uses a flexible cord anchored to the vertebrae on the outer side of the curve. The tether applies tension, using the child’s remaining growth to gradually straighten the spine over time. While the orthopedic spine surgeon handles most cases, a neurosurgeon may also be involved in complex care, particularly those involving the spinal cord or neurological compromise. These surgical interventions are only recommended when the benefits of correction outweigh the risks of a major operation.