Adult Scoliosis & Spinal Deformity Treatment | Jonathan G. Hobbs, M.D.

The condition

What Is Adult Scoliosis?

Adult scoliosis is a sideways curvature of the spine in a skeletally mature person. Some adults carry a curve from adolescence; many others develop degenerative ("de novo") scoliosis later in life, as uneven wear in the discs and facet joints lets the spine drift out of alignment. Deformity also includes problems in the front-to-back plane — kyphosis (excess forward rounding) and flatback (loss of the spine’s natural curves).

Unlike adolescent scoliosis, adult deformity usually announces itself with pain and function problems — not just appearance. Because degenerative curves often narrow the spinal canal at the same time, leg pain, numbness, and difficulty walking are common companions. Dr. Hobbs is specialty-trained in diagnosing and surgically treating complex spinal deformities, with a conservative-first philosophy and personalized surgical technology when correction is needed.

Two views of one spine

Curvature is only half the story.

The sideways curve (coronal)

What most people picture as scoliosis: the spine bending left or right when viewed from behind, measured on X-ray as the Cobb angle. In adolescents this is the whole focus. In adults it matters, but it is rarely what limits your day.

Often matters more

The side-view balance (sagittal)

Whether your head still stacks over your pelvis when you stand. Adult deformity usually comes from decades of disc and joint wear, and how you feel tracks less with the sideways curve than with this front-to-back alignment. It is exactly what Dr. Hobbs measures on standing X-rays.

Interactive — compare the types

Types of Adult Spinal Deformity

Tap each type to see how the spine’s shape changes.

Front view of a realistic spine and pelvis model with a lower-back sideways curve and uneven lumbar disc spaces. — Front view **A lower-back curve with uneven disc wear**

Front view of a realistic spine and pelvis model showing an S-shaped curve through the thoracic and lumbar spine. — Front view **A lower-back curve with uneven disc wear**

Degenerative (de novo) scoliosis Develops in adulthood — typically after 50 — as discs and facet joints wear unevenly and the lumbar spine drifts into a curve. It very often occurs together with spinal stenosis, which is why leg pain and trouble walking are frequently the first symptoms patients notice.

3D educational illustrations — not patient scans. Curve patterns vary from person to person.

Why alignment matters

Balance is cheap. Imbalance is exhausting.

Your spine’s job is simple to state and hard to do: hold your head balanced over your pelvis, all day, for a lifetime. When the spine is well aligned, standing takes almost no muscular effort — your skeleton does the work. Spine specialists call the small zone where this is true the “cone of balance.”

When wear, a fracture, or a previous surgery pitches the trunk forward out of that cone, muscles have to fire constantly just to keep you upright. That shows up as deep fatigue, aching that builds through the day, and the feeling of “running out of standing.”

Research in adult spinal deformity has repeatedly shown that the further forward a person drifts, the worse their pain and function scores become. It drives one of the most important lessons in modern spine surgery: an operation that fixes a pinched nerve but leaves the spine poorly balanced usually gives a poor result. That is why Dr. Hobbs measures alignment in every deformity plan — and why patient-specific rods are bent to those measurements before surgery.

Interactive — feel the physics

What Your Body Does When Alignment Slips

Drag the slider to tip the spine forward and watch the body’s hidden compensations kick in — the same sequence Dr. Hobbs looks for on a standing X-ray.

Educational illustration — not a diagnosis. Your actual numbers come from standing full-length X-rays reviewed with Dr. Hobbs.

Interactive — the measurements

The Numbers on Your Standing X-Ray, Explained

Click each measurement to see it drawn on the spine — and what it means for you in plain language.

PI = PT + SS

Your pelvis’s fixed shape (pelvic incidence) is always the sum of its posture parts: tilt plus slope. When one goes up, the other must come down — which is how surgeons detect hidden compensation on an X-ray.

LL ≈ PI ± 10°

Everyone’s ideal lumbar curve is personal — set by the pelvis they were born with. Dr. Hobbs plans alignment against your blueprint, not an average.

Symptoms

Symptoms of Adult Scoliosis & Deformity

Back pain that worsens with standing or activity and eases when sitting or lying down

A visible change in posture — leaning to one side or pitching forward

Uneven shoulders, waistline, or hips; clothes fitting differently

Loss of height over time

Leg pain, numbness, or cramping with walking (from accompanying stenosis)

Fatigue and difficulty standing upright as the day goes on

Interactive — quick self-check

Quick Symptom Self-Check

Check any that apply. This is an educational guide only — it is not a diagnosis, and a licensed clinician makes all care decisions.

My posture has visibly changed — leaning sideways or forward I’ve lost noticeable height Leg pain, numbness, or cramping when I walk or stand Hard to stand fully upright, especially late in the day Back pain that hasn’t improved over several weeks New loss of bladder or bowel control

Select any symptoms above to see general guidance.

Evaluation

How Adult Deformity Is Evaluated

Just as important as the imaging is understanding what bothers you most — pain, walking distance, standing tolerance, posture — because treatment targets the symptoms, not the X-ray.

Standing, full-length X-rays

The cornerstone. They show how the spine behaves under gravity — the curve’s size, the spine’s overall balance, and the SVA, pelvic tilt, and PI–LL numbers explained above — and how alignment changes over time.

MRI

Evaluates the discs and any nerve compression driving leg symptoms, which so often accompany a degenerative curve.

Bone-density testing

Bone quality shapes every treatment decision, from whether a brace helps to how hardware is planned if surgery is needed.

Treatment

Treatment Options

Dr. Hobbs strongly believes nonsurgical solutions should be explored first — most adults with scoliosis are managed without surgery.

Conservative Care

Physical therapy & core strengthening — supporting the spine and improving standing tolerance
Anti-inflammatory medication and activity modification
Targeted injections — relief for the stenosis-related leg symptoms that often accompany degenerative curves

Surgical Treatment

When the deformity progresses, pain becomes disabling, or nerve compression can’t be relieved conservatively, Dr. Hobbs tailors surgery to the true problem:

Focused decompression — when stenosis symptoms dominate and the curve itself is stable
Deformity correction — realigning and stabilizing the spine to your measured targets with image-guided navigation

Personalized to Your Alignment

Deformity surgery is where personalized technology matters most. Dr. Hobbs uses UNiD™ patient-specific rods — custom-bent before surgery from your imaging and an AI-assisted alignment plan built around your SVA, pelvic tilt, and PI–LL targets — and aprevo® personalized interbody implants designed for your anatomy, so the correction is planned around your spine, not a standard template.

UNiD patient-specific rods aprevo personalized implants

Jonathan G. Hobbs, M.D.

Board-Certified Neurosurgeon · Spine Surgery

ABNS
Certified

Residency
Chicago

M.D.
Kentucky

Why Dr. Hobbs

Why Choose Dr. Hobbs for Deformity Care

Deformity Specialty Training
Specialty-trained in diagnosing and surgically treating complex spinal deformities.
Elite Training
University of Kentucky medical degree; University of Chicago neurosurgery residency, chief resident.
Alignment Measured, Not Eyeballed
Every plan is built on standing X-ray measurements — SVA, pelvic tilt, PI–LL — against your personal targets.
Personalized Technology
AI-assisted alignment planning, UNiD™ patient-specific rods, aprevo® personalized implants.
Conservative-First
Most adult scoliosis is managed without surgery — surgery only when it clearly helps.
Lakeshore Bone & Joint Institute
Practicing at Northwest Indiana's most preferred orthopedic and spine practice, with offices in Crown Point & Chesterton.

Call (219) 250-5010 How alignment planning works

Related: Spinal stenosis· Spondylolisthesis· Spinal fusion & stabilization· Revision surgery

Frequently Asked Questions About Adult Scoliosis

It can progress slowly as the discs and joints continue to degenerate, though the rate varies widely. Warning signs include a visible change in posture, loss of height, increasing lean, and new or worsening leg symptoms. Periodic monitoring with standing X-rays lets Dr. Hobbs track change and adjust the plan before symptoms escalate.

A curve that develops in adulthood — typically after 50 — when discs and facet joints wear unevenly. It frequently occurs together with spinal stenosis, which is why leg pain and difficulty walking are often the first symptoms patients notice.

Yes — most adults with scoliosis never need surgery. Physical therapy, core strengthening, medication, and targeted injections manage symptoms effectively for many patients. Surgery is considered when the deformity is progressing, pain is uncontrolled, or nerve compression can’t be relieved conservatively.

It depends on the problem. When leg symptoms dominate, a focused decompression may be enough. When the curve must be corrected, Dr. Hobbs performs deformity correction using image-guided navigation and personalized technology — UNiD™ rods custom-bent from your alignment plan and aprevo® implants designed for your anatomy.

Flatback (sagittal imbalance) is the loss of the spine’s natural front-to-back curves, leaving you pitched forward and struggling to stand upright — often with fatigue that worsens through the day. Restoring that alignment is a central goal of modern deformity surgery and exactly what AI-assisted planning is designed to achieve.

Stand Taller. Move Easier.

Adult scoliosis doesn’t have to set the limits of your day. Specialty-trained deformity care — personalized to your spine — is right here in Northwest Indiana.

(219) 250-5010

Monday – Friday · 8:00 AM – 4:30 PM

Crown Point Office

500 E. 109th Avenue
Crown Point, IN 46307

Chesterton Office

601 Gateway Boulevard
Chesterton, IN 46304

Adult Scoliosis & Spinal Deformity