The associated problems vary and include changes in appearance, back pain, sciatica, imbalance and difficulty walking long distances.

Most adult spinal deformities don’t cause serious impairment and people can live functional lives.

In older adults, physical function and well-being is impacted more by kyphosis associated with stooping (sagittal plane deformity) than scoliosis.

Adult Scoliosis

In adults, scoliosis of less than 35o is benign, and of little concern; though if the patient’s symptoms are significant or sustained it may well need an individual diagnosis.

Curves of over 50o have a greater risk of degeneration, especially in the thoracic spine.

I recommend expert advice for

  • Persistent nerve pain
  • Severe back pain
  • Significant curve progression (more than 15 to 20o, or > 1o per year)
  • Imbalanced spinal posture
  • Genuine concerns about appearance.


Initial treatment should be aimed at maintaining strength and mobility through exercise like hydrotherapy. Pain killers such as anti-inflammatories (Nurofen, Mobic etc) and even strong analgesics can be useful if used carefully. Walking aids such as sticks, and frames can be very helpful.


Surgical intervention is a major procedure and therefore needs to be carefully considered. However, surgery is available for degenerative scoliosis and is considered appropriate for severe deformity, or if there is associated nerve pain that makes life intolerable.


Often termed ‘sagittal plane imbalance’, kyphosis presents as forward stoop. In of itself this is a natural part of ageing and can be managed with the use of a walking stick or frame.

Sometimes it is part of a more aggressive degenerative deformity: Ankylosing spondylitis.

Ankylosing spondylitis is a more debilitating kyphosis. The disease results in a spontaneous fusion of the spine which becomes rigid, leading to stiffness and often deformity of the spine.

Either can cause significant impairment and can have a measurable and severe impact on function and quality of life:

  • Acute Back pain
  • Significant restriction of mobility

Treatment & Surgery

In either case, we will consider surgical correction of the deformity to enable your patients to look forward; and for easier walking.

This is major surgery that can completely change people’s lives.

As always there needs to be a full consultation with your patient and an extensive diagnosis. Only then can I recommend a way forward.

If you have any questions about a patient, please feel free to call me on 02 9650 4893 and I will call you back to see how we can help.

You can also reach me via

Dr Ralph Stanford is a spinal surgeon with over 20 years’ experience. He is adept in all surgical approaches to successfully treat his patients.

Dedicated to lifelong learning and sharing his expertise with others, Ralph attends spinal conferences worldwide and regularly consults with colleagues about successful treatments.

As a teacher Dr Ralph Stanford is Conjoint Senior Lecturer at the University of New South Wales; Supervisor of Training for Orthopaedic Trainees, Prince of Wales Hospital; and Education Secretary for the Spine Society of Australia.

As a researcher and scientist, he is a well published author and Honorary Senior Scientist at Neuroscience Research Australia (NeuRA). He is also a current member of Spinal PFET.

Posted 16 October 2019

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