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An abnormal sideways curve of the spine ranges from a mild, watch-and-wait finding to a curve that needs correction — and most cases never reach the operating room.
Scoliosis is a sideways curvature of the spine, often shaped like a C or an S when viewed from behind. It falls into two broad groups. Adolescent scoliosis appears during the growing years and is usually painless, picked up on a school or pediatric screening as one shoulder or hip sitting higher than the other. Adult degenerative scoliosis develops later in life as the discs and joints wear unevenly, letting the spine drift into a curve it never had before.
The two forms behave very differently. A young, flexible curve is mostly about monitoring growth and preventing progression, while an adult degenerative curve tends to bring pain and, at times, nerve symptoms as the curve crowds the nerves. Understanding which type you have — and whether the curve is stable or progressing — drives every decision that follows.
Dr. Melamed was Director of Scoliosis at Cedars-Sinai Marina del Rey Hospital from 2013 to 2021, including complex adult deformity, and he is a member of the Scoliosis Research Society. He sees scoliosis patients at the Beverly Hills office, in the greater Los Angeles area, and from farther away who travel in to have a curve evaluated.
According to the Scoliosis Research Society, scoliosis affects 6 to 9 million people in the U.S., or about 2% to 3% of the population.
Though many cases are mild and only require monitoring, others can lead to more visible spinal deformities, impacting physical function over time. Most commonly, scoliosis is diagnosed between the ages of 10 and 15, when children are growing rapidly.
✓A visible sideways curve of the spine or a rib prominence
✓Uneven shoulders, waist, or hips
✓One side of the back appearing higher when bending forward
✓Low back pain and stiffness, more common in adults
✓Leg pain, numbness, or fatigue if nerves are crowded
✓Feeling of leaning or being off-balance in adult curves
Scoliosis symptoms can vary depending on the degree (extent) of spinal curvature and the age of the person affected. In mild cases, scoliosis may not cause any pain or noticeable signs. If the curve gets worse, however, certain physical changes can become more apparent. Other scoliosis symptoms include:
Difficulty standing up straight
Weakness in the core muscles
Even if you don’t have any noticeable symptoms, other physical signs may point to scoliosis. These can include:
Shoulder blades that stick out on one side or both
Uneven leg length
If left untreated, worsening scoliosis can lead to complications, such as breathing problems due to the spine pressing against the lungs or chronic back pain.
What Causes Scoliosis?
Unknown cause in most adolescent cases (idiopathic)
Age-related, uneven wear of discs and joints in adults
Loss of disc height that lets the spine tilt to one side
Underlying neuromuscular or congenital conditions
Prior spine surgery or vertebral fracture
Scoliosis can develop for multiple reasons, but in most cases, the exact cause remains unknown. This is referred to as idiopathic scoliosis and accounts for about 80% of all cases. Despite extensive research, no definitive root cause has been found for idiopathic scoliosis, although it tends to run in families, suggesting a possible genetic link. Men and women are affected in roughly equal numbers; however, women and girls may be more likely to have a more severe disease course and require treatment.
In addition to idiopathic cases of scoliosis, two other types have been described:
Congenital scoliosis: This is a rare form caused by abnormal spine bone formation during fetal development.
Neuromuscular scoliosis: This occurs when the muscles and nerves supporting the spine are affected by another medical condition, such as cerebral palsy, muscular dystrophy, or spina bifida.
Scoliosis can happen because of a spinal injury, tumor, or other condition affecting the nerves and muscles around the spine. Some scoliosis causes are also linked to genes and hormones.
Diagnosis and Assessment
Dr. Melamed measures the curve on standing X-rays, which capture how the spine balances under gravity and give the true magnitude of the curve. He also checks whether the curve is flexible or rigid and whether it is progressing over time. When leg pain or weakness is present, an MRI shows where the curve is compressing nerves, so treatment can target the symptom that actually bothers you rather than the curve number alone.
Scoliosis is often first detected during routine checkups or school screening programs, especially in children and teens who may not show obvious symptoms. Diagnosis typically starts with a detailed medical and family history to identify any underlying conditions or genetic patterns. This is followed by a physical exam to check for uneven shoulders, hips, or rib cage prominence, especially when bending forward.
An X-ray can be used to confirm a scoliosis diagnosis. This allows your doctor to measure the degree of spinal curvature using the Cobb angle, which helps determine the severity. A curve of 10 to 20 degrees is considered mild, while moderate cases range from 20 to 40 degrees. In severe cases, between 40 and 50 degrees, you may need to consider surgery.
Scoliosis Treatment Options in Beverly Hills
For most people, scoliosis is managed without surgery. Growing adolescents with moderate curves are monitored and, when needed, braced to limit progression. Adults with degenerative curves usually do well with a focused strengthening and physical therapy program, activity changes, and image-guided injections to calm irritated nerves.
Surgery comes into the conversation only for curves that are large, clearly progressing, or causing nerve compression and imbalance that conservative care cannot control. When Dr. Melamed does operate, the plan is specific to your spine. The rods are custom-made, shaped to your anatomy and the correction he is aiming for. Larger corrections are planned in two stages, so each operation is shorter and you recover in between. Recovery follows his non-narcotic protocol. He uses muscle-sparing, minimally invasive technique wherever the curve allows, and he is candid that big corrections are still big operations.
Initial management may include physical therapy, posture training, and core strengthening exercises. Activity and ergonomic adjustments can also help.
Spinal decompression therapy — a non-invasive technique that gently relieves pressure on the spine — may be included as part of a comprehensive treatment plan.
Spinal fusion surgery can be very effective in stopping the curve from getting worse.
Living with Scoliosis: Tips for Management and Support
Managing scoliosis is also about maintaining a healthy, active lifestyle and finding the right support. Regular low-impact exercise, such as swimming or yoga, can improve flexibility and reduce pain and discomfort. Maintaining a good posture and using ergonomic seating can also relieve daily strain.
For people struggling with scoliosis, finding support can make all the difference. Support groups, counseling, or community programs — like the Scoliosis Awareness Club founded by Natasha Melamed — can connect individuals with others facing similar challenges.
Watch Dr. Melamed explain
What Is Scoliosis & How To Treat It · Dr. Hooman Melamed on YouTube
Sources
American Association of Neurological Surgeons, “Scoliosis”
Questions, Answered
Questions About Scoliosis Curves and Surgery
Does every scoliosis curve need surgery?
No — most do not. Mild and moderate curves are monitored or managed with bracing and therapy, and many adult degenerative curves stay comfortable with strengthening and the occasional injection. Surgery is reserved for large, progressing, or nerve-compressing curves that conservative care cannot control.
What is the difference between adolescent and adult scoliosis?
Adolescent scoliosis appears during growth and is usually painless, so the focus is on watching and limiting progression. Adult degenerative scoliosis develops later from uneven wear of the discs and joints, and it more often brings back pain and nerve symptoms, which changes how it is treated.
How does Dr. Melamed approach scoliosis surgery?
With custom-made rods shaped to your spine, larger corrections planned in two stages, and a non-narcotic recovery plan. He brings experience from his years as Director of Scoliosis at Cedars-Sinai Marina del Rey Hospital (2013-2021), including complex adult deformity.
Can scoliosis be corrected without a large open operation?
In many cases the goal is comfort and function rather than a perfectly straight spine, and that is achieved without surgery at all. When correction is truly needed, Dr. Melamed uses muscle-sparing, minimally invasive techniques wherever the curve allows, keeping open surgery as a last resort.
