Many things get better as we age, like wisdom, wine and credit scores. Scoliosis, unfortunately, tends to get worse.

“Scoliosis is a mechanical process that can progress with aging, to the point that it can cause significant back pain and poor function,” says Glenn Russo, MD, a spine surgeon at the Connecticut Orthopaedic Institute at MidState Medical Center.

But scoliosis surgery is a major procedure, and it’s only right for a small percentage of adults.

How do you know if you’re one of them?

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1. Have you already made these lifestyle changes?

Maybe you’ve been suffering from more pain and stiffness from your scoliosis, or noticing related nerve issues like sciatica. By focusing on key lifestyle changes, you may find you feel better and move more freely — no surgery required.

Lifestyle changes to help with scoliosis:

  • Exercise
  • Lose weight
  • Pack your diet with foods that promote bone health
  • Get screened for osteoporosis, which can lead to scoliosis

“While you can’t prevent scoliosis, the best advice is to maintain an active lifestyle, keep a healthy weight, and enjoy a diverse diet rich in fruits and vegetables,” says Dr. Russo.

> Related: How to Know When Back Pain Requires Surgery

2. Have you already tried nonsurgical treatments?

For most adults, the next step to addressing scoliosis is one or more nonsurgical treatments.

That includes:

  • Physical therapy
  • Supportive bracing
  • Pain management through oral medications — like anti-inflammatories or muscle relaxers — and corticosteroid injections

“Nonsurgical treatments can be highly effective for mild and moderate symptoms,” says Dr. Russo. “Typically, we only consider surgical treatment when nonsurgical options have failed.”

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3. Does scoliosis surgery make sense for you?

Even if you’ve answered “yes” to every question above, you’re not a shoo-in for surgery. It depends on your anatomy and overall health.

For example, your doctor will need to study X-rays to understand exactly how your spine is out of alignment, and whether and how it’s contributing to your symptoms. Then they’ll determine if surgery would actually be effective.

“Each patient, and each spinal curve, is different,” says Dr. Russo.

4. Will scoliosis surgery significantly improve your quality of life?

This question comes up for any major medical procedure, and it certainly applies to the particular risks and recovery process of spinal surgery.

What are you hoping to get out of surgery? Will you be able to bounce back better than ever?

“Surgery is only offered if it will provide a meaningful improvement in the quality of a patient’s life, and only if it aligns with their goals and medical conditions,” says Dr. Russo.

If you’re considering surgery for scoliosis, use a team that specializes in it.

Surgery for scoliosis is often considered a unique field within spinal surgery, so find a specialist.

“Today’s surgeons and patients benefit from years of research as well as significant advances in technology that make the surgery, recovery and outcomes much better than they had been in the past,” says Dr. Russo.

During the procedure itself, that may include computer-guidance, robotics or minimally invasive techniques. Before and after, it also includes anesthesia and pain management experts to help with post-operative pain, and physical therapists who speed along recovery.

“Putting together a comprehensive program, from start to finish, is extremely important in helping our patients through a difficult process to achieve the best possible outcomes,” says Dr. Russo.