By Marc Darrow, MD, JD

A newly reported mild curve may or may not explain persistent back pain. An injection should be considered for an identified painful structure, not simply because a report contains the word “scoliosis.”

When someone asks this question, I want to understand the operation, how the symptoms changed afterward, and whether the curvature was visible before surgery. A longstanding curve, a newly progressive deformity, and a difference caused by imaging position are different situations. They cannot be distinguished from the wording of one report.

A newly reported curve is not necessarily a new curve

In a study of 500 adults aged 25–64 without back symptoms, 13.4% had thoracic scoliosis on routine chest radiographs. Most curves measured 10–19 degrees. This demonstrates that a curve can exist without pain; it does not establish that a particular postoperative lumbar curve is harmless. (1)

Another study reviewed lumbar MRI scans from 1,299 adults seeking care for low-back pain. Scoliosis was present in 19.9%, and 66.9% of the curves had not been mentioned in the original reports. Because these patients had pain, the study cannot tell us how many curves were incidental or responsible for symptoms. It does show why an earlier report that did not mention scoliosis cannot prove that the curve was absent. (2)

Comparing the actual images is therefore useful. Standing radiographs and a supine MRI do not show the spine under identical loading conditions. Scoliosis is conventionally defined by a Cobb angle of approximately 10 degrees or more; a curve of only a few degrees may be described as spinal asymmetry. The degree, progression, overall alignment, and relationship to nerve compression matter more than the label alone.

Adult curvature can develop or progress as discs and joints degenerate. It should not automatically be dismissed as something the spine has “always had,” especially when posture, walking tolerance, or symptoms have changed.

Imaging findings need clinical context

A systematic review of 3,110 asymptomatic people estimated disc degeneration in 37% of 20-year-olds and 96% of 80-year-olds. Disc bulging increased from 30% to 84% across those age groups. Those figures show why a scan finding is insufficient by itself to diagnose the source of pain. They do not prove that all disc degeneration or scoliosis is painless. (3)

A separate comparison found several degenerative MRI findings more frequently in adults with back pain than in those without it. Both observations can be true: a finding may be associated with pain across populations without identifying the pain generator in every individual. (4)

The history and examination help establish whether symptoms fit the imaging. Does pain remain in the back, travel down a leg, or concentrate near the pelvis? Does standing, sitting, bending, or walking reproduce it? Is there weakness or altered sensation? A small curve can coexist with painful narrowing around a nerve, facet-joint disease, or another condition; curve size alone does not settle the question.

Persistent pain after surgery has several possible explanations

The type of operation matters. A discectomy removes disc material; decompression creates room around nerves; fusion changes motion across particular segments. Persistent symptoms may involve recurrent compression, an adjacent level, incomplete fusion, hardware problems, nerve injury, scar tissue, muscle changes, or the sacroiliac joint. A 2024 review calls this broader clinical problem persistent spinal pain syndrome type 2 and emphasizes diagnosis through history, examination, and appropriate imaging. (5)

Our article on persistent pain after back surgery discusses this setting. Sacroiliac joint dysfunction is another possible source when pain is concentrated near the posterior pelvis. Neither diagnosis should be assumed solely from the location of pain.

What does marrow concentrate research actually show?

Bone marrow aspirate concentrate, often shortened to BMC or BMAC, is a preparation from the patient’s own marrow. It contains mixed cells and biological factors, including a small population of mesenchymal stromal progenitor cells. PRP comes from blood and contains concentrated platelets. These are different products, and research on one does not establish the effectiveness of the other.

An open-label pilot followed 26 patients receiving intradiscal BMC for discogenic pain and reported improvements in pain and disability. Without a control group, however, improvement cannot be attributed confidently to the injection. The study was not a trial of correcting scoliosis or treating all causes of postoperative pain. (6)

A 2024 randomized crossover study examined intradiscal PRP and BMC in 40 patients. Its control involved saline trigger-point injections rather than an identical intradiscal procedure, and crossover complicated longer-term comparisons. It contributes to the evidence but does not establish that either treatment reliably works for pain after surgery. (7)

In contrast, a 2025 double-blind randomized study of 63 patients compared intradiscal BMC with a sham procedure. Both groups improved, and the study did not demonstrate superiority of BMC over sham. This is an important limitation when discussing expected benefit. Failure to show superiority is not proof that every patient’s response is identical, but it prevents a confident claim of an established treatment effect. (8)

New 2026 research involving disc surgery

A prospective pilot gave intradiscal BMAC to 27 patients during lumbar microdiscectomy. No injection-related complications were observed through one year, but outcome and imaging follow-up were incomplete and there was no control group. The study supports preliminary feasibility and safety assessment; it cannot establish added benefit over surgery alone. It also does not answer whether an injection two years after an operation will relieve persistent pain. (9)

Can an injection straighten scoliosis?

There is no established evidence that PRP or marrow concentrate straightens adult structural scoliosis. Pain relief, if achieved, would be a separate outcome from changing the curve. Likewise, an injection cannot be expected to fix a loose implant, mechanically decompress a nerve, or reverse every consequence of surgery.

An injection discussion is more relevant when a particular painful disc, joint, or tissue has been identified and the proposed target matches it. The remaining uncertainty, alternative treatments, and procedure-specific risks still matter. Intradiscal injection has risks that include infection and worsening pain; a review documented complications and emphasized the need to consider them alongside possible benefit. (10)

Rehabilitation, medication when appropriate, targeted pain procedures, and sometimes surgical reassessment remain part of the available options. No regenerative medicine product is FDA-approved to treat scoliosis or orthopedic back pain.

Questions that help guide the decision

  • Was the curvature present before surgery, and has it measurably changed on comparable images?
  • What operation was performed, at which levels, and did the current pain begin before or afterward?
  • Which finding best explains the symptoms: the curve, nerve compression, a joint, or another structure?
  • What exact material and injection target are proposed, and does the supporting study include patients with similar surgical histories?
  • How will pain and function be measured, and what happens if there is little improvement?

New or progressive leg weakness, saddle numbness, loss of bladder or bowel control, or fever with worsening back pain requires urgent medical assessment.

A report of mild scoliosis should prompt clarification rather than an automatic treatment decision. The useful goal is to determine what is causing the pain and whether a particular intervention has evidence relevant to that problem.

References

  1. Chen JB, Kim AD, Allan-Blitz L, Shamie AN. Prevalence of thoracic scoliosis in adults 25 to 64 years of age detected during routine chest radiographs. European Spine Journal. 2016;25(10):3082–3087.
  2. Anwar Z, Zan E, Gujar SK, Sciubba DM, Riley LH III, Gokaslan ZL, Yousem DM. Adult lumbar scoliosis: underreported on lumbar MR scans. AJNR American Journal of Neuroradiology. 2010;31(5):832–837.
  3. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR American Journal of Neuroradiology. 2015;36(4):811–816.
  4. Brinjikji W, Diehn FE, Jarvik JG, et al. MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and meta-analysis. AJNR American Journal of Neuroradiology. 2015;36(12):2394–2399.
  5. Van de Minkelis J, Peene L, Cohen SP, et al. Persistent spinal pain syndrome type 2. Pain Practice. 2024;24(7):919–936.
  6. Pettine KA, Murphy MB, Suzuki RK, Sand TT. Percutaneous injection of autologous bone marrow concentrate cells significantly reduces lumbar discogenic pain through 12 months. Stem Cells. 2015;33(1):146–156.
  7. Navani A, Ambach M, Calodney A, Rosenthal R, Li G, Mahoney CB, Everts PA. The safety and effectiveness of orthobiologic injections for discogenic chronic low back pain: a multicenter prospective, crossover, randomized controlled trial with 12 months follow-up. Pain Physician. 2024;27(1):E65–E77.
  8. Levi D, Tyszko S, Horn S, Pham N, Levin J. Bone marrow concentrate intradiscal injection for chronic discogenic low back pain: a double-blind randomized sham-controlled trial. Interventional Pain Medicine. 2025;4(3):100611.
  9. Fidai AB, Berger J, Robayo A, et al. Safety and feasibility of intradiscal autologous bone marrow aspirate concentrate at the time of lumbar microdiscectomy: a prospective pilot study. World Neurosurgery. 2026;211:124998.
  10. Jerome MA, Lutz C, Lutz GE. Risks of intradiscal orthobiologic injections: a review of the literature and case series presentation. International Journal of Spine Surgery. 2021;15(s1):26–39.