The Centers for Advanced Orthopaedics
Maryland Orthopedic Specialists
A Division of The Centers for Advanced Orthopaedics
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Spine, Neck & Back

Adolescent Idiopathic Scoliosis

Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis and, in the vast majority of cases, is a manageable condition that never requires surgery. At Maryland Orthopedic Specialists, our non-operative spine team provides expert evaluation, curve monitoring, and bracing to keep your child's spine on track through the critical growth years. Most families leave their first visit with reassurance, a clear monitoring plan, and confidence about the path ahead.

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What is adolescent idiopathic scoliosis?

Adolescent idiopathic scoliosis is a curvature of the spine that generally occurs during the adolescent growth spurts. There are also infantile and juvenile forms. It is usually discovered by routine screening by pediatricians or possibly by parents/family. Treatments include observation, bracing, and occasionally surgery.

Scoliosis is a lateral (sideways) curvature of the spine that, by definition, measures greater than 10° on a standing X-ray using the Cobb angle method. In adolescent idiopathic scoliosis, the "idiopathic" label means that no single identifiable cause has been established — it is not caused by injury, a neurological condition, or a congenital vertebral anomaly. AIS affects approximately 2 to 3% of all adolescents and is the most prevalent musculoskeletal condition diagnosed in the school-age population. While the exact etiology remains under investigation, genetic factors, asymmetric growth plate loading, and connective tissue differences are all thought to play a role.

Girls and boys develop scoliosis at similar rates, but girls are significantly more likely to have curves that progress to a degree requiring treatment — roughly 8 to 10 times more likely than boys. The most common curve pattern is a right thoracic curve, in which the thoracic spine bows to the right and the spine rotates such that the ribs on the right side are pushed posteriorly, forming the characteristic "rib hump" visible on forward bending. Thoracolumbar and lumbar curves also occur and carry their own natural history considerations.

Understanding the natural history of AIS is central to good care. The most important predictor of curve progression is skeletal maturity — the more growth remaining, the higher the risk that a curve will worsen. Skeletal maturity is staged using the Risser sign, a radiographic grading of iliac apophysis ossification from 0 (fully open growth plates, maximum growth remaining) to 5 (complete fusion, growth complete). Curves under 25° in patients nearing skeletal maturity are very unlikely to progress and require only observation. Larger curves — particularly those exceeding 25 to 30° in a Risser 0 to 2 patient — carry meaningful risk of progression and warrant active intervention. Once skeletal maturity is reached, curves under 30° rarely progress further; curves over 50° at skeletal maturity may continue to progress slowly into adulthood.

Treatment options

Treatment depends on the size of the curve and how much growing the patient has left to do.

Observation

Curves under 25° in growing patients are monitored with standing spine X-rays every 4 to 6 months during active growth phases. Most small curves stay stable through adolescence and never need active treatment. Once skeletal maturity is reached, curves under 30° can be discharged from active monitoring.

Bracing

Bracing is recommended for curves between 25 and 45° in skeletally immature patients (Risser 0–2) to prevent further progression during the remaining growth period — not to correct the existing curve. The landmark BrAIST trial showed bracing was significantly more effective than observation alone, with success rates around 72% in the braced group. Scoliosis-specific exercises (the Schroth method) are integrated alongside bracing to build strength and body awareness throughout treatment.

Surgical Referral

Curves greater than 45 to 50° in a still-growing patient, or curves that continue to progress despite consistent bracing, are referred by MOS to a pediatric spinal deformity surgeon for evaluation. MOS coordinates the referral and supports the family through the process — the surgical decision is made in partnership with the consulting surgeon. The vast majority of patients who undergo spinal fusion return to full activity, including competitive sports, and report excellent outcomes.

Frequently Asked Questions

Q: Will my child need surgery?
A: The large majority of adolescents diagnosed with scoliosis do not require surgery. Fewer than 10% of patients with AIS ultimately need surgical intervention. Surgery is generally reserved for curves greater than 45 to 50° in a growing patient, or for curves that progress despite appropriate bracing. For the majority of patients — especially those with mild to moderate curves detected early — observation or bracing is all that is needed to get through adolescence safely. Our team will give you a clear picture of your child's specific curve, growth remaining, and probability of needing further treatment at every visit.
Q: Does scoliosis cause pain?
A: AIS is most often a painless condition during adolescence, and it is a common misconception that scoliosis is a significant source of back pain in teenagers. Most adolescents with scoliosis are completely asymptomatic aside from the cosmetic and postural findings. When a teenager with scoliosis does report significant back pain, we take it seriously — it often prompts a search for an underlying cause (such as spondylolisthesis, a spinal cord abnormality, or another diagnosis) rather than attributing it to the curve itself. In adulthood, very large untreated curves can cause progressive pain and functional limitations, which is one reason active management during the growth years matters.
Q: How often does my child need to be seen?
A: Visit frequency depends on curve size, skeletal maturity, and whether the patient is being observed or braced. During active growth phases, we typically schedule X-rays and visits every 4 to 6 months. As your child approaches skeletal maturity and the curve stabilizes, intervals can be extended. Braced patients are also seen to assess brace fit, compliance, and response. Once skeletal maturity is confirmed and the curve has been stable, annual or biannual check-ins are appropriate for most patients, with discharge from active follow-up for small curves that remain stable.
Q: What is the Schroth method?
A: The Schroth method is a scoliosis-specific physical therapy approach developed in Germany that uses customized exercises tailored to a patient's individual curve pattern. Rather than generic back-strengthening exercises, Schroth therapy focuses on three-dimensional postural correction — elongating the spine, de-rotating the trunk, and strengthening the muscles on the concave side of the curve to counteract the deformity. Multiple studies support Schroth as a useful adjunct to bracing, improving curve angles, trunk symmetry, and quality of life compared to bracing alone. Schroth is typically delivered by a certified physical therapist over a series of individualized sessions, with home exercise programs to maintain the gains between visits. It is not a substitute for bracing when bracing is indicated, but it complements it effectively.
Q: Can scoliosis get worse after treatment ends?
A: For most patients, curves that are stable at skeletal maturity remain stable in adulthood. Curves under 30° at skeletal maturity have very little risk of further progression. Curves between 30 and 50° may progress slowly (approximately 0.5 to 1° per year) in adulthood but rarely cause significant functional problems. Curves above 50° at skeletal maturity carry the greatest risk of adult progression and are the primary reason we refer patients for surgical evaluation before growth ends. After bracing is discontinued at skeletal maturity, the brace does not maintain correction — its job was to prevent progression during growth, and that is the benchmark for success. Patients who undergo surgical fusion have a stable, instrumented spine that does not progress at the fused levels.
Medically reviewed by Christopher S. Raffo, MD
Last reviewed June 16, 2026