Conditions · Carrollwood · Tampa Bay
Scoliosis & Curvature of the Spine
What the degrees on your report mean, what an examination here does about the pain that travels with a curve, and when a curve belongs with a specialist.
A radiology report is written for other doctors, not for you. So when yours says dextroscoliosis, a Cobb angle of 18 degrees, or de novo degenerative scoliosis, the words land without a translator. This page is the translator. It also says where the work here ends and a specialist begins. Dr. Bobby Koser, DC, chiropractic physician, completed post-doctoral training in spinal MRI interpretation and clinical correlation, and reading the report with the person it belongs to is part of the examination here. Bring yours.
Scoliosis Overview
What the words on your report mean
Scoliosis names a spine that curves toward one side when viewed from behind. A report describes that shape with a number, a direction, a place in the spine, and often a note about rotation.
Cobb angle, direction, and the degrees on your report
The radiologist picks the two vertebrae, the bones stacked up your spine, that tilt the most at the top and bottom of the curve, draws a line along each, and measures where those lines cross. That angle is the number in degrees on your report, and it describes that curve on that film, in that position, on that day. Dextro beside it means the curve points right and levo means it points left, with thoracic for the mid back and lumbar for the low back. Two curves pointing opposite ways is the S curve people talk about, and one curve is the C.
Also written as: Cobb measurement, Cobb method, curve magnitude, degrees of curvature, apical vertebra, end vertebrae, dextroconvex, levoconvex, right thoracic curve, left lumbar curve, double major curve, thoracolumbar scoliosis, structural and functional scoliosis, bending films.
Rotation, the rib hump, and the scoliometer
A curve is not only sideways. The vertebrae also turn on their axis, and that turn is what lifts one side of the ribcage or the low back when a person bends forward. A scoliometer is the small tool laid across the back during that bend, and it reports the angle of trunk rotation.
Also written as: vertebral rotation, rotatory scoliosis, Nash-Moe grade, ATR, Adams forward bend test, rib hump, rib prominence, uneven shoulders.
Adolescent idiopathic and adult degenerative scoliosis
Idiopathic means no single cause has been identified, and adolescent names the stage of life when the curve was found, not anything about the curve. Risser sign is a 0 to 5 grade read off the pelvis on the same X-ray, describing how much growing is still ahead. Adult degenerative scoliosis, or de novo scoliosis, is the wording for a curve measured in an adult spine, most often in the low back, on a film that also shows changes in the discs and the facet joints, the small paired joints at the back of each segment. De novo means the curve was not on record earlier in that person’s life.
Also written as: AIS, idiopathic scoliosis, juvenile or infantile scoliosis, early onset scoliosis, Risser grade, skeletal maturity, Lenke and King classifications, adult scoliosis, degenerative lumbar scoliosis, adult spinal deformity, kyphoscoliosis.
A finding is not a diagnosis
Many adults first read the word scoliosis in a report from an X-ray taken for something else. In one study, not a review, 75 healthy volunteers aged 60 or older, none with a known history of scoliosis and none with prior spine surgery, each had a full-length standing X-ray. Mean age was 70.5 years, mean Cobb angle was 17 degrees, and 68 percent met that study’s definition of scoliosis, a Cobb angle greater than 10 degrees. The authors wrote that their 68 percent is significantly higher than rates reported in other studies, that previous reports had noted a prevalence of adult scoliosis up to 32 percent, and that their own figure most likely reflects the targeted selection of an elderly group. Read the other way, about a third of those 75 volunteers did not meet that definition.1
That figure belongs to those 75 volunteers. What it is good for is holding two things at once. A curve on a film is not automatically the cause of what you feel, and your pain is not less real because a finding is common.1
Which of the two you are looking at is what the examination works out.
1. Schwab F, et al. Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine (Phila Pa 1976). 2005;30(9):1082-1085. PubMed
A growing spine and an adult spine are two different conversations
The spine that is still growing
A spine that is still growing is measured over time by a specialist, and that schedule is the plan while growth continues. Any child or adolescent with a measured curve, or asymmetry on the forward bend test, is referred to a pediatric orthopedic or scoliosis specialist, and that schedule is not taken over here. If one film reads differently from the one before it, or a parent says the back looks different, that goes back to the specialist then, not at the next re-examination. A curve found before roughly age 10, a left-sided curve in the mid back, night pain that wakes a child, a skin marking over the spine, or anything abnormal on the neurological examination goes to a physician for further imaging.
Bracing, and who prescribes it
Bracing is not offered at this office. It is prescribed, fitted, and monitored by an orthopedic or scoliosis specialist working with an orthotist, the person who makes and fits the brace. Bracing was tested in a multicenter trial that was stopped early, and the reason given was the efficacy of bracing. In that trial, success was defined as reaching skeletal maturity without the curve progressing to 50 degrees or more, which is the point that trial defined as treatment failure, and not as the curve getting smaller. Those in the bracing group were instructed to wear the brace at least 18 hours a day. 242 adolescents who met that trial’s indications by age, skeletal immaturity, and degree of scoliosis were in the analysis: 116 randomly assigned to bracing or observation, and 126 who chose between the two themselves. Across both groups combined, success was 72 percent after bracing and 48 percent after observation, which also means roughly a quarter of the braced adolescents did not reach that endpoint, and nearly half of those who were observed reached maturity without progressing to 50 degrees. In the intention-to-treat analysis, which counts every patient in the group they were assigned to whether or not they followed it, success was 75 percent with bracing and 42 percent with observation.2 Those figures belong to adolescents with idiopathic scoliosis who met that trial’s enrollment criteria, and the decision belongs to the specialist measuring the curve.
The curve measured in an adult spine
An adult report may put a curve, the discs, and the facet joints in the same paragraph, because a standing X-ray shows all three. Some patterns belong with a physician: leg pain, heaviness, or numbness that comes on with walking and eases when you sit or lean forward, which points at narrowing inside the spinal canal; a trunk leaning further forward or to one side over months, or lost standing height; and any abnormal neurological finding, meaning reflex asymmetry, weakness, sensory loss, or a change in how you walk. A prior scoliosis fusion with new symptoms goes back to the operating surgeon.
2. Weinstein SL, et al. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013;369(16):1512-1521. PubMed
Symptoms, and the warning signs we screen for
A curve does not come with one fixed set of symptoms. What people bring in varies: an ache on one side of the back, stiffness after holding one position, a shoulder or hip that sits higher, muscles along one side that stay tight. Where any of that is coming from is what the examination sorts out. Pain, tingling, or numbness running down a leg is examined on its own terms, whether as a pinched nerve, a disc finding, or sciatica.
Common, and examined here
- Aching or stiffness on one side of the back
- A shoulder, hip, or shoulder blade sitting higher than the other
- Muscles along one side of the spine that stay tight
- Pain that arrives after standing or sitting in one position
- A report that says scoliosis, dextroscoliosis, or a Cobb angle
Emergency, not an appointment
- New loss of bowel or bladder control, or a new inability to urinate
- New numbness in the groin, buttocks, or inner thighs, the saddle area
- New or worsening weakness in a leg or foot, or a foot that drags
- Legs that have become stiff, heavy, or unsteady, new falls, or new clumsiness in both hands
- New shortness of breath at rest, or new chest pain
- Back pain that came on suddenly after a fall, a crash, or a lifting event
- New back pain with fever or unexplained weight loss, or night pain that wakes you, in a person with a history of cancer
Go to the emergency department now. This is part of what the examination here screens for.
What we do here, and what we refer out
The examination comes first: your history, a physical and neurological examination, a look at how you stand, bend, and move, and your imaging report read with you, not at you. Dr. Koser’s post-doctoral training in spinal MRI interpretation and clinical correlation exists for that conversation, and the visit is the Pain Source Exam.
The curve is not what care at this office changes. No adjustment, no exercise, and no plan of care here is offered to reduce, straighten, or alter the shape of your spine, and a goal stated as a different number in degrees is a conversation about bracing or surgery, which live with a specialist. Dr. Koser does not hold Schroth or any scoliosis-specific exercise certification.
Care here is for the person carrying the curve. Pain, stiffness, and muscles that guard an uneven load are examinable and treatable, and that is the work: chiropractic care chosen from what the examination found, dry needling for muscles that stay tight, in-office therapies where they fit, and movement you can keep doing. Care is monitored, so if you are not progressing, the plan changes.
When a curve belongs somewhere else, you hear it at the visit and your records go with you. Someone already under a scoliosis specialist keeps that schedule and imaging, and the symptoms are co-managed alongside it. For the wider picture, start with spine care, or joint pain for a shoulder or hip.
Hurt in a car accident? Florida’s PIP law requires care to begin within 14 days. Start at our auto accident page.
Common questions about scoliosis
Can a chiropractor fix scoliosis, or straighten my curve?
No. Nothing done at this office is offered to change the shape of your spine. Curve size is managed by orthopedic and scoliosis specialists: measurement over time, bracing while a spine is still growing, and surgery in some cases. What is offered here is an examination, care for the pain that travels with a curve, and a referral.
My report says my Cobb angle is 18 degrees. What does that number actually mean?
It is the angle where two lines cross. The radiologist drew one along the most tilted vertebra at the top of your curve and another at the bottom, then measured between them. So 18 degrees describes that curve, on that film, on that day. Whether it has anything to do with what you feel is what an examination sorts out.
Is it safe to get adjusted if I have scoliosis?
That is settled by the examination rather than by the word on your report. It looks first for the reasons manual care would not be delivered in the usual way: known or suspected osteoporosis, measured height loss, an abnormal neurological finding, a prior spinal fusion, or a back that looks different after a fall. Those go to a physician first.
Do you do the Schroth method?
No. Schroth is a scoliosis-specific exercise certification, and Dr. Koser does not hold it or an equivalent one. If a scoliosis-specific exercise program is what you are looking for, ask an orthopedic or scoliosis specialist for a certified therapist. What happens here is the examination, care for the symptoms that accompany a curve, and the referral.
My daughter’s school screening picked up a curve. What happens now?
A screening result is a reason to be measured, and measuring a growing spine belongs with a pediatric orthopedic or scoliosis specialist. They take a standing X-ray, measure the Cobb angle, read her Risser sign for how much growing is still ahead, and set the next film. If she also has back pain, that can be examined here.
Will my curve get worse as I get older?
A single film shows the curve on the day it was taken. Measuring a curve over time is done on a schedule set by an orthopedic or scoliosis specialist, and that schedule is what answers the question for one person. What an examination here answers is what is producing the pain or stiffness you have now.
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This page is general health information and is not medical advice for any individual. The studies summarized describe groups, not any one person’s outcome, and whether any finding on your imaging explains your symptoms can only be determined by examination. Talk to Dr. Bobby Koser, DC, about your own situation, and seek emergency care immediately for the warning signs listed above.
Bring the report. Leave knowing what it says and what comes next.
A complete examination with Dr. Bobby Koser, DC, your report reviewed with you, and a referral when it is called for.