FAQ Scoliosis

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.

There is much global debate about when and how to treat Idiopathic Scoliosis (IS). The American Association for Orthopaedic Surgeons⁽⁶⁾ indicates that a scoliosis curve will not get straighten up by itself and Spinal Braces or Spinal Fusion with Physiotherapy are essential in scoliotic curve management. The Scoliosis Research Society (SRS)⁽⁵⁾ has gathered information and evidences globally surrounding the ideal treatments along with factors that should be considered when treating IS.

We have summarized SRS treatment recommendations for your easy understanding in the above picture. Any treatment should be re-evaluated in every 6 months with X-rays. Though there are certain negative effects with frequent exposure to X-rays, these are necessary in observing the curve progression(6).

The above treatment options are suggested mainly considering the curve magnitude as the base. But there are also other factors taken into consideration when prescribing the above treatment options.

5. Scoeity, Scoliosis Research. Conditions & Treatments: For Parents: Scoliosis. https://www.srs.org. [Online] Scoliosis Research Scoeity, 2020. [Cited: March 9, 2020.] https://www.srs.org/patients-and-families/conditions-and-treatments/parents/scoliosis.

6. Surgeons, American Association for Orthopaedic. OrthoInfor. Nonsurgical Treatment Options for Scoliosis. [Online] 1995-2020. https://orthoinfo.aaos.org/en/treatment/nonsurgical-treatment-options-for-scoliosis/.

When you consult a professional, you will be guided through a few examinations to ensure your spinal condition is diagnosed accurately.

• You will need to undergo a spinal X-ray from the sagittal (side) and coronal (front) views to confirm the curvature – it is recommended to take a full spine X-ray from neck to pelvis.

• After an X-ray exam, the medical professional will provide you with information regarding:
  • Magnitude of the curvature (Cobb measure)
  • Laterality of the curve
  • Bone maturity
  • Curve pattern

Scoliosis has a typical range of characteristics, also known as clinical presentations or physical compensations. These signs help determine the severity of each individual when medical professionals perform physical examinations to assess and differentiate a scoliotic (bent) spine from a normal one. According to the Scoliosis Research Society,

• When you stand in a relaxed position with your hands by the sides of your body; the back view may present with lateral (side) curvature, uneven shoulder blades, hips and trunk shift:

• When you bend forward from the hips, a hump and a flank may be see from the back.

If you notice these signs, you should consult a professional that can refer you for further examinations.

When there is a frontal misalignment in the spine, it will present with a lateral curvature of more than ten degrees to the left or right with vertebral rotation. This spinal condition is called scoliosis. This is the most common abnormal curvature that occurs in the spine, considered as a global health problem with its prevalence at 0.5% to 3% of the world’s school population. On an x-ray of a scoliotic spine, you will be able to see the presentation of a C or S shape, instead of a straight spine. 80% of scoliotic curves belong to the Idiopathic Scoliosis category because it cannot be explained under a particular reason.

The vertebral column, also known as the backbone or spinal column, is structurally balanced in front and by the side to support our body weight and maintain optimum flexibility. There are 3 gentle curves (Cervical, Thoracic and Lumbar) that maintains a straight alignment.

The body’s Center of Gravity (COG) lies around the level of the naval area and all of the spine?s flexibility helps to maintain this COG within the Base of Support (BOS) to stabilise the body during various activities. Maintenance of correct alignment helps to reduce fatigue and the work load of the spinal muscles during these times.

As seen above, sagittal (side view) and coronal (front view) spinal deformities can occur in the human spine due to various reasons. When the spine is deformed, the body posture and position of the COG changes. The muscles and body joints are required to work hard with an extra effort to stabilise the body with these changes.