What it is
Scoliosis is a sideways curvature of the spine; spinal deformity more broadly includes loss of the spine's natural front-to-back balance (kyphosis, flat-back, or leaning posture). Adolescent scoliosis usually appears during growth; adult deformity typically develops from asymmetric degeneration or progresses from an earlier curve. Deformity care is a core focus of Dr. Pompliano's fellowship training, which included advanced training in complex spinal deformities, and of his published research.
Common symptoms
- Visible curvature, uneven shoulders or waistline
- Progressive leaning forward or to one side, especially late in the day
- Fatigue and pain with standing
- In adults: leg symptoms when degeneration narrows nerve corridors
Why it happens
Adolescent idiopathic scoliosis has no single known cause and runs in families. Adult degenerative scoliosis develops when discs and facet joints wear asymmetrically, letting the spine drift out of alignment. Curves are measured and tracked on standing X-rays; progression risk depends on age, curve size, and pattern.
How Dr. Pompliano evaluates it
Every evaluation starts with listening — a detailed history of your symptoms, how they behave, and how they limit your life — followed by a focused physical and neurological examination and a careful review of your imaging. The diagnosis drives the plan, not the other way around.
Treatment: conservative first
Most patients with this condition improve without surgery. Depending on your specific situation, a plan may include:
- Monitoring: many curves simply need scheduled imaging and an informed eye
- Physical therapy & conditioning: strength and endurance work that supports posture and function
- Bracing: for growing adolescents with progressing curves
- Targeted symptom care: injections and therapy for the painful degenerative elements of adult curves
Surgery is recommended only when symptoms persist despite a genuine course of conservative care, or when there are signs of progressive nerve or spinal cord compromise.
When surgery makes sense
Surgery is considered for significant progression, imbalance that degrades quality of life, or nerve compression within the curve. Correction is individualized — from focused fusion of a painful segment to full reconstruction — with alignment planning at the center of every decision.
Related procedures: Spinal Reconstruction · XLIF · Second Opinions