Scoliosis: Symptoms, Causes, and Treatments in Singapore

Dr Colum Nolan
Senior Consultant Spine & Neurosurgeon
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)

Scoliosis is a condition where the spine curves sideways (like a “C” or “S” shape) and may rotate. Some people develop scoliosis during childhood or adolescence, while others develop it in adulthood due to wear-and-tear changes in the discs and joints (often called adult degenerative scoliosis).

In adults, scoliosis is not only about the curve. It can also involve changes in spinal alignment, age-related degeneration, and nerve compression, which may lead to leg pain, numbness, or weakness. In these situations, scoliosis assessment and treatment may involve a spine specialist familiar with nerve-related spinal conditions.

What Causes Scoliosis in Adults?

Adult scoliosis commonly falls into two broad patterns:

1) Idiopathic scoliosis that persists into adulthood

Some people were diagnosed younger, and the curve remains or progresses slowly over time. Symptoms may change with age as discs and joints degenerate.

2) Adult degenerative scoliosis

This develops later in life, usually due to disc degeneration and facet joint arthritis. As the spine becomes less stable, a curve can form and the same degenerative changes can contribute to spinal canal narrowing (stenosis).

Symptoms: When Scoliosis Is More Than a Posture Issue

Not everyone with scoliosis has symptoms. When symptoms occur, they may be due to muscle fatigue, joint strain, disc degeneration, or nerve compression .

Common scoliosis symptoms

Back pain (often worse after prolonged standing or walking)
Stiffness, reduced flexibility, fatigue in the back muscles
Visible changes: uneven shoulders/hips, uneven waistline, rib prominence on one side
Feeling “tilted” or less balanced when standing or walking

Symptoms that suggest nerve involvement

If scoliosis is associated with stenosis or narrowing around nerves, you may develop:

Leg pain that travels from the back/buttocks down the leg
Tingling or numbness in the leg or foot
Weakness in the leg
Reduced walking tolerance (needing to stop more often)

When to Seek Urgent Medical Attention

Seek urgent care if you develop:

new or worsening leg weakness
numbness in the saddle area (groin/inner thighs)
loss of bladder or bowel control
severe pain after a significant fall/accident, or pain with fever/unexplained weight loss

Diagnosis: What’s Involved in a Scoliosis Assessment?

Clinical Evaluation

A clinician will review pain patterns, walking tolerance, balance, daily function, and any nerve symptoms. A neurological examination (strength, sensation, reflexes) is particularly important when leg symptoms are present.

Imaging

X-rays to measure the curve and assess alignment/balance
MRI if there are leg symptoms, concern for nerve compression, or persistent pain
CT may be used in selected cases for bony detail and surgical planning

Non-surgical Scoliosis Treatments

Most patients start with non-surgical scoliosis treatment. The aim is to reduce pain, improve function, and manage nerve symptoms if present.

Physiotherapy and rehabilitation
A structured plan often focuses on core endurance, trunk control, hip strength, mobility, and posture strategies.
Medication and symptom control
Pain relief may be used during flare-ups. Anti-inflammatory medication may help some people, but it is not suitable for everyone.
Injections (selected cases)
Targeted injections may be considered when pain is driven by inflamed joints or nerve irritation, often to support rehabilitation.

When Is Scoliosis Surgery Considered?

Many adults will not need surgery. However, scoliosis surgery may be discussed when the main problem is nerve compression, especially if symptoms remain significant despite a structured course of non-surgical care (physiotherapy, medication optimisation, activity modification, and selected injections).

Nerve-related reasons surgery may be considered

In adult scoliosis, curvature is frequently accompanied by degenerative narrowing around the nerves. When compression becomes persistent, the issue is often less about back shape and more about how nerve function affects mobility and independence.

If pain, numbness, or weakness begin to limit walking distance, disturb sleep, affect work, or reduce day-to-day function, surgery may be discussed. This is particularly relevant when symptoms continue to progress or fail to improve despite appropriate non-surgical care.

The aim of surgery in such situations is to relieve pressure on the nerves, help stabilise the spine, and prevent further neurological decline.

Persistent leg pain (often described as sciatica) that travels from the back or buttocks down the leg
Numbness or tingling in the leg or foot that does not settle
Weakness (e.g., difficulty lifting the foot, legs “giving way”, reduced stamina on stairs)
Reduced walking tolerance — needing to stop frequently because of leg pain/heaviness, sometimes improving when sitting or bending forward
Symptoms that progress over time, or repeatedly flare despite good conservative care

When these nerve symptoms become the main driver of disability and limit walking, work, sleep, or daily function, surgery may be discussed because ongoing nerve compression can lead to persistent pain and, in some cases, worsening weakness.

What Surgery Is Aiming To Achieve (Nerve-Focused)

Surgical goals often include:

1) Relieving pressure on nerves (decompression)

This is done to create more space for the nerves when stenosis is present. The aim is to reduce leg pain, numbness, and nerve-related walking limitation.

2) Stabilising the spine (fusion) when needed

In adults with scoliosis, simply “freeing the nerve” may not be enough if there is instability or significant imbalance. Spinal fusion may be considered to prevent painful movement, maintain alignment, and reduce the chance of nerves being re-compressed as the spine continues to degenerate.

3) Improving balance and alignment (selected cases)

Where imbalance is significant, correcting alignment can reduce uneven loading and help restore a more efficient standing and walking posture.

When Is Surgery More Urgent?

Surgery may be recommended more promptly if there is:

Progressive weakness
Worsening neurological findings on examination
Severe nerve compression on imaging that matches symptoms
Red-flag symptoms such as bladder/bowel changes or saddle numbness (urgent assessment)

Speak to Oxford Spine & Neurosurgery Centre

Scoliosis is more than a spinal curve. Scoliosis in adults may involve imbalance, degeneration, and sometimes nerve compression, leading to leg pain, numbness, weakness, or reduced walking tolerance.

At Oxford Spine & Neurosurgery Centre, Dr Colum Nolan combines clinical assessment with detailed imaging review to understand how your curve pattern, alignment, and nerve pathways relate to your symptoms. Contact us to book an appointment with Dr Colum Nolan today.

Frequently Asked Questions

Is scoliosis treatment always surgery?

No. Many adults do well with non-surgical treatment focused on pain relief and function.

Is scoliosis surgery mainly for back pain?

In adults, surgery is generally more reliable for leg pain due to nerve compression than for isolated back pain.

Do I need an MRI?

MRI is most useful when there are leg symptoms, weakness, or signs suggesting nerve compression, or when pain persists despite initial care.

Medical disclaimer

This article is for general education and does not replace a medical consultation. If you have severe symptoms, progressive weakness, or bladder/bowel changes, seek urgent medical attention.

Our Spine & Neurosurgeon in Singapore

Dr Colum Nolan

MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)

Dr Colum Nolan is a Senior Consultant Neurosurgeon with over 20 years of experience, specialising in minimally invasive spine (keyhole) surgery and other spine procedures.

A graduate of the Royal College of Surgeons in Ireland, Dr Nolan underwent neurosurgical training in Ireland and Australia, followed by a fellowship in complex spine surgery at Addenbrooke’s Hospital, Cambridge, as well as rotations at the Orthopaedic Spine Unit in Norfolk and Norwich Hospital.

Dr Colum is committed to delivering compassionate, patient-centred care, combining surgical precision with a genuine dedication to improving his patients’ quality of life.

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