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Scoliosis

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of scoliosis.

Treatment

The treatments for scoliosis are not always straightforward. For one, some young people do not treatment at all--only careful observations. When treatment is warranted, then there are a number other options, including braces and different surgical procedures.

Decision to Treat or Wait

The general rule of thumb for treating scoliosis is to monitor the condition if the curve is less than 20 degrees and to consider treating curves greater than 25 degrees or those that progress by 10 degrees while being monitored. Whether scoliosis is treated immediately or simply monitored is not an easy decision, however. The percentage of cases that will progress more than 5 degrees can be as low as 5% in certain cases or as high as 50% to 90%, depending on the severity of the curve or other predisposing factors:

Age. In general, the older the child the less likely the curve will progress. Scoliosis in a child under 10, for example, is more likely to progress than scoliosis in an adolescent. Experts estimate that curves less than 19 degrees will progress 10% in girls between ages 13 and 15 years and 4% in children older than 15. (In some rare, severe cases, a curve may worsen even after a child has received treatment and stopped growing because of the weight of the body pressing against the abnormal curve.)

Gender. Girls have a higher risk for progression than boys.

Location of the Curvature. Thoracic curves, those in the upper spine, are more likely to progress than thoracolumbar curves or lumbar curves, those of the middle to lower spine.

Severity of the Curvature. The higher the degree of curvature the more likely the chance of progression and the more likely the lungs will be affected. Some experts argue that the degree of the curve alone may not identify patients with moderate and severe scoliosis who are at greatest risk for complications and therefore need treatment. For example, spinal flexibility and the extent of asymmetry between the ribs and the vertebrae may be more important than the curve degree in predicting severity in this group.

Presence of Other Health Conditions. Children in poor health may suffer more from stressful scoliosis treatments than other children. On the other hand, children who have existing conditions that predispose to lung and heart problems may warrant immediate, aggressive treatment.

For example, a young man of 18 who has a curvature of 30 degrees may require no treatment because his growth has probably almost stopped and his gender puts him at lower risk. A young girl of 10, however, with the same curvature requires immediate treatment.

Choosing Braces or Surgery

In general, the following criteria are used to determine whether a patient should be given braces and conservative therapies or surgery:

  • Braces tend to be used in children with curvatures between 25 and 40 degrees who still will be growing significantly.
  • Surgery is suggested for patients with curvatures over 50 degrees, in untreated patients, or when braces have failed. In adults, scoliosis rarely progresses beyond 40 degrees, but surgery may be required if the patient is in a great deal of pain or if it is causing neurologic problems.

The choice may not be so straightforward in certain cases and patients should discuss all options carefully with their physician.

Predicting the Extent of Curvature Progression

In Children and Adolescents:

Once a mild curve has been observed, the next step is more difficult: predicting whether the curve will progress into a more serious condition. Although as many as three in every 100 teenagers have a condition serious enough to need at least observation, progression is highly variable and individual. In a study of patients whose curves did progress after diagnosis, 34% progressed more than 10 degrees, 18% progressed more than 20 degrees, and 8% progressed more than 30 degrees. There are no definite risk factors for curve progression that help physicians predict with any certainty which patients will need aggressive treatment. Some evidence suggests the following factors may help determine patients at lower or higher risk:

  • Being female, particularly if taller than average.
  • Being younger at the onset of scoliosis.
  • Having a greater angle of curvature. For example, at 20 degrees, only about 20% of curves progress. Young people diagnosed with a 30-degree curve, however, have a risk for progression of 60%; with a curve of 50 degrees, the risk is 90%.
  • Curvatures caused by congenital scoliosis (spinal problems present at birth). These may progress rapidly.
  • Treatment with growth hormone. (Studies are mixed on whether this treatment poses any significant risk, although strict monitoring is still essential in young patients being given growth hormone.)

Curvatures may be less likely to progress in girls whose scoliosis was low in the back and whose spine was out of balance by more than an inch. Height also comes into play. For example, a shorter-than-average girl of 14 with low-back scoliosis of 25 to 35 degrees but whose spine is imbalanced by over an inch would have almost no risk. The same degree of curvature in the chest region of a tall 10-year old girl whose spine was in balance, however, would almost certainly progress.

In Adult-Onset Scoliosis:

In rare cases, unrecognized or untreated scoliosis in youth may progress, with the following curvatures posing low to high risk:

  • Curvatures under 30 degrees almost never progress.
  • Predicting progression at curves around 40 degrees is not clear.
  • Curvatures over 50 degrees are at great risk for progression.
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