Part of the reason scoliosis treatment plans need to be customized is because no two cases are the same, and part of the diagnostic process involves comprehensive assessment to further classify conditions based on a number of important patient/condition variables, the degree of curvature being of prime importance.
There are many different degrees of scoliosis, and this is based on a patient’s Cobb angle: a measurement that classifies a condition as mild, moderate, severe, or very severe. The wide severity range makes scoliosis a highly-variable condition.
Before getting into the specifics of different curvature-degree ranges, let’s first talk about what a diagnosis of scoliosis means.
For a person to be officially diagnosed with scoliosis, a number of parameters have to be met.
The spine has to have an abnormal sideways curvature, with rotation, making it a 3-dimensional condition; a scoliotic spine doesn’t just bend unnaturally to the side, but also twists from back to front and front to back.
In addition, the unnatural spinal curve has to be of a minimum size, and this is where curvature degree comes into play.
A measurement taken during X-ray, known as Cobb angle, involves drawing intersecting lines from the tops and bottoms of the curve’s most-tilted vertebrae at its apex.
The resulting angle is measured in degrees and places a condition on its severity scale of mild, moderate, severe, or very severe.
Scoliosis is also further classified based on a number of key patient and condition characteristics: patient age, condition type (causation), curvature location, and severity.
Classifying scoliosis helps streamline the treatment process and informs the design of effective treatment plans.
Patient age is important because children and adolescents experience the condition very differently than adults, and this is largely related to progression and compression.
Scoliosis is a structural progressive spinal condition, meaning it’s in its very nature to worsen over time, especially if left untreated or not treated proactively.
For condition type, the most common form of scoliosis is idiopathic, meaning conditions aren’t clearly associated with a single causative source, and this accounts for 80 percent of known diagnosed cases; the remaining 20 percent are associated with known causes: neuromuscular, congenital, degenerative, and traumatic.
To further specify, the most prevalent type of scoliosis is adolescent idiopathic scoliosis (AIS), diagnosed between the ages of 10 and 18, and while we don’t fully understand why idiopathic scoliosis develops initially, we do understand its main trigger for progression: growth.
So children and adolescents are at risk for rapid-phase progression due to the stage of growth they are in, and it’s not until growth has stopped, and skeletal maturity has been reached that the condition then becomes compressive, accounting for the big difference in how young and older patients experience the condition.
Prior to reaching skeletal maturity, the lengthening motion of a growing spine counteracts the compressive force of the curvature; as it’s compression of the spine and its surroundings, that’s the main cause of condition-related pain. This is why scoliosis is not commonly known as painful for children and adolescents but is for adults.
Curvature location indicates where in the spine scoliosis has developed, and there are three main spinal sections: cervical (neck), thoracic (middle/upper back), and lumbar (lower back).
Curvature location tells us where to concentrate our treatment efforts and can also indicate some likely symptoms and patterns of progression.
The final classification point is condition severity, and this is where the different degrees of scoliosis come into play.
First, I should mention that there are two main scoliosis treatment approaches: traditional and conservative, as we’ll touch on how each approach would address the different curvature degrees in treatment, so let’s start with a 10-degree scoliosis.
For patients with a 10-degree scoliotic curve, this is the minimum curvature degree necessary for reaching a scoliosis diagnosis.
In children and adolescents, a 10-degree scoliosis would likely produce no noticeable symptoms, pain, and/or functional deficits.
In most cases of idiopathic scoliosis in adults, the conditions are extensions of AIS that was neither diagnosed nor treated in adolescence. Meaning they would have experienced progression by the time they are finally diagnosed in adulthood, which is why most adult scoliosis cases don’t feature a 10-degree curve.
An abnormal spinal curve of 10 degrees, with rotation, would be diagnosed as mild scoliosis, and at this stage, under the traditional approach, no action would be taken, other than watching and waiting to see when/if the condition progresses.
Here at the Scoliosis Reduction Center, I offer patients a conservative chiropractic-centered treatment approach that believes in proactive treatment initiated as close to the time of diagnosis as possible.
I feel that watching and waiting because a 10-degree Cobb angle is mild, is wasting valuable treatment time; I see this as the best time to act and as an opportunity to keep the curve mild and prevent further progression.
In a 15-degree scoliosis, this falls under the mild scoliosis classification, and is still unlikely to produce any functional deficits or noticeable symptoms.
The earliest signs of the condition are postural changes as the uneven scoliotic curve introduces uneven forces to the body, which is why scoliosis affects the body’s overall symmetry.
In the mild severity level, symptoms are subtle and likely are only noticeable to an expert trained in precisely what to look for.
Many adolescents with a 15-degree scoliotic curve could still be unaware at this stage, and for adults, idiopathic scoliosis would generally involve a larger curvature degree as progression would have occurred throughout adolescence.
After idiopathic, the second most common condition type to affect adults is degenerative scoliosis. That natural age-related spinal deterioration and/or arthritis can come into play, making even mild curvatures painful. Coupled with spinal deterioration in adults, this can produce some postural changes that disrupt the body’s symmetry.
It’s far more common to diagnose scoliosis in the moderate stage, as this tends to be when symptoms become noticeable to the average person.
Treatment for 15 Degree Scoliosis
Under the traditional treatment approach, the only recourse is to continue monitoring the condition for further progression.
Here at the Center, proactive treatment would have been applied, and this involves a combination of different treatment disciplines for the most specific and customized results.
Patients with a 20-degree scoliosis are moving towards the end of the mild scoliosis bracket and are heading towards moderate scoliosis.
Remember, as a progressive condition, scoliosis getting worse means the abnormal spinal curvature is increasing in size, meaning its Cobb angle is getting higher.
At the end of the mild stage and prior to the moderate designation, the condition is likely to become more symptomatic.
In children and adolescents, a 20-degree spinal curve would likely start to disrupt the body’s overall symmetry noticeably, which often involves uneven shoulders, an uneven waistline, and hips.
In adults, a 20-degree spinal curve is likely to start becoming painful, and in addition, postural changes would also become more noticeable.
Treatment for 20 Degree Scoliosis
In terms of traditional treatment, observation is the only recourse, while a conservative approach would have treatment well underway in an attempt to prevent further progression into the moderate level.
Conservative treatment would involve combining multiple condition-specific treatment disciplines such as chiropractic care, in-office therapy, custom-prescribed home exercises, and corrective bracing.
With a 25-degree Cobb angle, conditions would be officially classified as moderate scoliosis; mild scoliosis is classified for curvatures that range between 10 and 25 degrees.
At the 25-degree mark, scoliosis has progressed from mild into the moderate stage of progression, and this is where the majority of my patients are because it’s commonly not until conditions have progressed from mild to moderate that they start to become noticeable to the average person.
At this level, symptoms become more overt. For children and adolescents, they are likely to be experiencing some level of muscle pain as the muscles surrounding the spine are struggling to provide it with support, but as it’s not yet a compressive condition, it still isn’t overly associated with back pain.
Symptoms would include uneven shoulders, shoulder blades, the presence of a rib arch, uneven hips, uneven waistline, and the arms and legs can appear to hang at different lengths, making clothing ill-fitting.
In addition, at this severity level, balance, coordination, and gait are likely to be affected as the body tries to adjust to the curvature’s presence and the body’s shifting center of gravity.
In adults, symptoms would likely include varying levels of back pain, largely determined by the degree of nerve involvement.
Postural symptoms would likely include a prominent lean to one side as the condition has disrupted the body’s natural symmetry, and these postural changes, in both patients young and old, are far more noticeable when in a forward-bend position.
Treatment for 25 Degree Scoliosis
In terms of treatment, a traditional approach would continue its reactive response by solely monitoring for signs of further progression.
In a conservative approach, active treatment would be applied in an attempt to prevent further progression, increasing condition severity, related symptoms, and the need for more invasive treatment in the future.
At the Center, for a 25-degree curve, I would be working closely with patients to achieve a curvature reduction, increase core strength so the spine is optimally supported, and when appropriate, corrective bracing can augment treatment results and provide the spine with additional support and stabilization.
A 30-degree Cobb angle still falls within the moderate scoliosis classification, where symptoms and functional deficits are more noticeable.
As a patient’s Cobb angle increases, the uneven forces of the unnatural spinal curve are increasing, and can affect the body in a myriad of ways.
For children and adolescents, functional deficits are still not overly common at this level, although the more a condition progresses, the more likely it is that they will occur, mainly in terms of activity restrictions.
The condition isn’t likely to be overly painful at this level, but postural changes in young patients are going to become increasingly noticeable as the body tries to adapt to the unnatural spinal curve’s presence, and a degree of muscle pain is likely.
For adults with a 30-degree curve, pain is likely to be an issue, and this can range from mild and intermittent to chronic and debilitating, and can involve back and/or muscle pain, and when nerve compression is an issue, sciatica is a common complication of scoliosis, particularly lumbar scoliosis.
At this level, adults are likely to experience noticeable visual changes such as uneven posture and a more prominent lean to one side.
While progression tends to slow in adulthood once the trigger of growth is removed, age-related spinal degeneration can account for increased progressive rates in adults.
At 30 degrees, patients are approaching a severe classification, and for both young and older patients, headaches/migraines are a common symptom due to irregularities in cerebrospinal fluid flow that helps protect the brain and eliminate waste.
Treatment for 30 Degree Scoliosis
The traditional approach would recognize that at 30 degrees, progression is virtually guaranteed to continue, particularly as no treatment would have been applied prior.
At this level of moderate scoliosis, traditional treatment providers are likely to attempt scoliosis bracing as the sole means of preventing further progression into the severe classification. However, it’s important to understand that just as different treatment approaches offer different potential outcomes, there are also different scoliosis braces to choose from.
While a conservative approach would favor a modern corrective ScoliBrace, the most common traditional brace is the Boston brace, known for a number of shortcomings, and as its design is driven by stopping/slowing progression and doesn’t address the condition as 3-dimensional, it’s efficacy is limited.
Conservative treatment for a 30-degree scoliosis would involve the continued application of different treatment modalities in an effort to impact the condition on a structural level and prevent further progression into the severe classification level.
At 40 degrees, scoliosis moves from the moderate into the severe classification, and the farther a patient moves along the condition’s progressive line, the more noticeable symptoms will become and the more likely it is that they will need more invasive treatment in the future.
With a severe scoliosis diagnosis, children and adolescents are likely to have overt postural changes that are difficult to hide.
Uneven shoulders with one sitting higher than the other, one shoulder blade protruding more on one side than the other. The development of a rib arch makes one side of the rib cage more prominent than the other, the hips are uneven, the waistline is uneven, the head is uncentered over the torso, and the legs and arms appear to hang at different lengths.
At this level, balance, coordination, equilibrium, and gait issues can make it difficult to participate in certain sports/exercises/activities.
While children and adolescents can live with severe scoliosis without significant amounts of pain as they are still growing, other issues mentioned, such as muscle pain and/or headaches, are more likely to be an issue due to the increased curvature size.
As we move into severe scoliosis, it becomes more obvious that conditions will not stop progressing in patients both young and old.
For adults, severe scoliosis can be very painful as there is likely to be extensive nerve involvement.
In addition, postural changes are overt, functional deficits can become increasingly noticeable, and related complications also become more likely: sleep problems, digestive issues, irregular menstrual cycles, and lung impairment.
For treatment, a traditional approach would likely involve the continued use of the Boston brace, and if at 40 degrees, a patient is deemed as high risk for continued progression, a spinal-surgery recommendation becomes increasingly likely.
My approach for a 40-degree curve would be to continue proactive treatment by applying multiple treatment modalities, including corrective bracing; at this level, I’m doing everything I can to prevent a patient’s 40-degree curve from progressing past that surgical threshold level.
At 50 degrees, patients are still in the severe scoliosis classification, which means the symptoms, as mentioned above, will increase alongside condition severity. Also, an important factor that determines the level of postural changes and pain a patient is likely to experience.
The risk of developing complications such as migraines, sleep troubles, digestive issues, etc., are higher once a patient crosses into that severe scoliosis level.
In children and adolescents, at this level, some form of pain is likely to be an issue, even if it’s related to headaches and muscle pain, more so than back pain.
Postural changes for children and adolescents with severe scoliosis are going to be overt, and this is often where the desire for surgery is ignited as cosmetic reasons are the most common motivation behind getting scoliosis surgery.
Adults with a 50-degree curve have progressed significantly and are bound to have some degree of spinal degeneration to also contend with, and as progression causes spinal rigidity, at this level, the spine is going to be less responsive to treatment.
Adults with severe scoliosis are likely to experience mobility issues and find it difficult and painful to remain sitting or standing for long periods of time, and once severe, while rare, adult scoliosis can also cause varying levels of limb impairment.
Treatment for 50 Degree Scoliosis
In terms of traditional treatment, it’s highly likely that spinal fusion would be recommended as the best and only remaining treatment option at this level.
Here at the Center, with a 50-degree curve, I would continue to treat patients with a variety of chiropractic adjustments, home exercises, rehabilitation, and corrective bracing, but at this level, the possibility is there, particularly if treatment wasn’t applied early on, that I might not be able to reduce curvatures enough to keep them below the surgical-level threshold.
At 60 degrees, scoliosis is still considered severe, with symptoms being overt, the condition being painful, especially for adults, and the risk of complications being high.
Even if the condition has not yet become compressive for children and adolescents, issues with muscle pain and/or headaches are likely, as is continued progression.
Postural symptoms are going to be increasingly overt at this level, making it more likely that patients are living with activity restrictions due to related mobility issues.
Life is likely to be a challenge for adults living with a 60-degree curve. To move into the 60-degree range means significant progression has already occurred, likely over many years, and with a curvature of this size, the spine is likely to be extremely rigid, as well as its surrounding muscles.
It’s also likely that nerve-related back pain will be severe in adults with a 60-degree curve.
Treatment for 60 Degree Scoliosis
In terms of treatment under a traditional approach, spinal fusion is likely, and while all surgical procedures come with their share of risks, spinal fusion is a costly and lengthy procedure that comes with some heavy potential risks and side effects.
The process of spinal fusion involves fusing the most-tilted vertebrae (bones of the spine) together into one solid bone; this eliminates movement in the area, so when effective, it can prevent further progression, but this comes at the cost of mobility with an average of 20-percent loss of spinal flexibility post-surgery.
Under conservative treatment, I would continue with the aforementioned treatment disciplines to try and avoid the need for surgery, but the more severe scoliosis gets, the more challenging it is to treat nonsurgically.
With a 70-degree scoliosis, this is still classified as severe but is moving towards the very-severe level.
At this stage, symptoms like pain and postural changes are going to be noticeable for both adolescents and adults.
Treatment for 70 Degree Scoliosis
At this point, spinal fusion becomes increasingly likely, especially if nonsurgical treatment options have been ineffective at preventing increasing condition severity.
Once a patient progresses into the 80+ curvature-degree range, this is classified as very-severe scoliosis.
Both for adolescents and adults, this level of severity means noticeable postural changes, varying levels of pain, and the increasing risk of complications.
Remember, the brain and spine work in tandem to form the body’s central nervous system (CNS), so the spine is involved in the function of multiple systems at work within the body, which is why spinal conditions can affect so many different parts of the body.
As mentioned earlier, lung impairment can accompany severe and very-severe scoliosis as an unnatural spinal curve of that size, particularly when located in the thoracic spine, is associated with rib arches that encroach upon the space used by the lungs to expand/contract fully.
While each case is unique, lung impairment, even in severe and very-severe levels, is often only noticeable during times of extreme physical exertion or to those who place higher-than-average demands on their respiratory systems, such as professional athletes.
Treatment for 80 Degree Scoliosis
Treatment under a traditional approach would involve spinal fusion, while a conservative approach would work towards reducing the curvature on a structural level to avoid further progression and focus on making improvements to their quality of life.
With very-severe scoliosis, my approach, particularly for adults, is often more about spinal support and stabilization than working towards a significant curvature reduction.
With a 90-degree scoliosis, this is still classified as very-severe scoliosis.
Another important aspect of scoliosis is the mental/psychological effects of living with a progressive structural spinal condition.
Of course, psychological effects can be felt at many different stages of scoliosis progression but tend to be the most intense with more extreme forms and severity levels.
Once a condition becomes severe enough to cause noticeable visual symptoms such as postural deviation, ill-fitting clothing, and changes to balance, coordination, and gait, there is likely to be a psychological impact as well.
People with severe physical abnormalities can suffer from negative self-image issues, and when it comes to adolescents who just want to blend in, this can lead to feelings of depression and even suicidal thoughts.
Treatment for 90 Degree Scoliosis
At this level, once again, traditional treatment would recommend spinal fusion, and while it can be effective at preventing further progression, there are no guarantees.
Under a conservative approach, treatment efforts would continue to be made, but would focus more on pain management and stabilizing the spine than working towards a significant curvature reduction.
At a 100-degree scoliosis, this is still classified as very severe, as will anything that exceeds 100 degrees.
At this stage, both for adolescents and adults, postural changes will be overt, and pain is likely to be intense, especially in adult scoliosis.
Interestingly enough, the largest curvature degree I’ve seen was 150 degrees in a child, and while noticeably affected posturally, he didn’t complain of pain.
For adults, however, in addition to noticeable postural changes, a 100-degree scoliotic curve could cause chronic and debilitating pain, not to mention related complications such as digestive issues and lung impairment.
Treatment for 100 Degree Scoliosis
At this level, spinal fusion would be done under the guidance of a traditional treatment approach, while a conservative treatment approach would, again, focus on making changes to improve quality of life, such as pain management.
Scoliosis is a highly-variable condition, meaning no two cases are exactly the same; this is due to a variety of important patient/condition characteristics such as patient age, condition type, curvature location, and severity.
Condition severity is determined by a measurement known as Cobb angle that measures the different degrees of scoliosis.
Cobb angle measurements between 10 and 25 degrees are classified as mild scoliosis; Cobb angle measurements between 25 and 40 degrees are diagnosed as moderate scoliosis, and 40+ degrees is classified as severe, while 80+ is considered very severe.
As you can see from the different degrees of scoliosis, there is a wide range of condition severity, which is why effective treatment has to be fully customized to address the specifics of each patient and their curvature type.
The answer will depend on the chosen treatment approach when addressing what degree of scoliosis requires treatment.
Under a traditional treatment approach, treatment isn’t started until a curvature has shown significant progression, generally in the moderate and/or severe classification, and even then, the only form of treatment applied before recommending spinal fusion is traditional bracing.
When it comes to what degree of scoliosis requires surgery, under a traditional approach, the surgical threshold is crossed when patients show continued progression in the severe classification at 40+ degrees.
Under a conservative approach, I believe in starting treatment as close to the time of diagnosis as possible; here at the Scoliosis Reduction Center, I see a mild curvature as an opportunity to keep it that way.
Through combining multiple treatment disciplines such as condition-specific chiropractic care, in-office therapy, custom-prescribed home exercises, and corrective bracing, I work towards helping patients avoid increasing condition severity and the need for invasive surgery in the future.