Age, bone maturity, menarche, peak growth age and curve pattern are key factors to be considered in choosing the ideal treatment option for people with idiopathic scoliosis (7). The following information covers how these factors can influence the treatment protocol.
- Age – There are 2 periods of rapid growth spurts that occur in life; one in infantile years and the other is in adolescent years. The height of an individual increases very fast during this time – about 9cm per year. Also, the second highest spinal height growth occurs between ten years of age until puberty (7; 8). During this period, as the curve progression is faster – it is best to start treatment if needed, instead of just monitoring as this is the golden window for spinal bracing.
- Peak Growth Age (PGA) – This is the period that both girls and boys show peak height velocity (PHV). It is very important to identify scoliosis patients before PGA, because there is a strong correlation with scoliosis curve progression with PGA. Many who had missed the opportunity to identify between the age of ten until puberty were unable to seize this period for bracing (7).
- Bone Maturity – The amount of growth remaining is typically estimated by the Risser sign indicator. Risser Sign is a bony marker based on the iliac crest ossification. It ranges from 0-5; 0 indicating immature bone profile and 5 for matured bone profile. Immature bones have yet to grow – thus worsens the scoliosis as the bones in the spine start to their growth?(7). Therefore, a Risser sign of 0-3 informs that curve progression is faster and early bracing is needed to prevent any further undesired development of the curve.
- Menarche – The onset of menstruation in girls and the development of an adult voice in boys are indicators showing signs of growth rate slowing down – as with curve progression. Therefore, the requirement of scoliosis treatment will mainly be based on the magnitude of the curve as mentioned in the SRS guidelines. In this case, parents and school nurses should be responsible and active in screening for curve developments in the spine after reaching the mature body state (7).
- Curve Pattern – Evaluation of patient history reports that the curve pattern also has a direct relationship with curve progression. Many researchers have noted that single lumbar and single Thoracolumbar curves are less progressive and more responsive to orthotic treatment. Also, Single Thoracic curves and Double curves are more likely to progress faster (7).
7. Weibin Shi, Amy Strouse, Davis R Gater Jr. Orthoses for Spinal Deformities. [book auth.] American Association of Orthopeadic surgeons. Atlas of Orthoses and Assistive Devices. Philadelphia : Mosby Elsevier, 2019, Vol. 65.
8. Physiology of Growth. Rosenbloom, Arlan L. Basel : Nestec Ltd, 2007, Vol. 65.
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