Scoliosis is a progressive condition – it does tend to get worse as you age. However, scoliosis is somewhat unusual in that it does not have what we might call a “predictable trajectory” – this is to say that you cannot simply assume that after X years, scoliosis will have increased by X degrees. Rather, it often accelerates during growth spurts – and even outside of this develops at an unpredictable rate. It’s for this reason that we encourage people never to “wait and see” when it comes to scoliosis – a year waiting may see very little change in the condition, or it might be a lot…
It is possible to predict the rate of growth to some extent – and indeed, in cases of adult scoliosis (that is to say scoliosis which began in childhood and was carried into adulthood), we can estimate the increase in curvature to be approximately 0.82° per year.[1] By contrast, the rate at which scoliosis increases in young patients depends more upon risk factors such as the severity of scoliosis considering age, the rigidity of curve, and family history. What we do know, is that Juvenile scoliosis greater than 30 degrees tends to increase rapidly and left untreated presents a 100% prognosis for surgery, whereas curves from 21 to 30 degrees are more difficult to predict but can frequently end up requiring surgery, or at least causing significant disability.[2]
With scoliosis, there is therefore a very real need to act quickly and proactively if the condition is to be halted and the curvature corrected before either surgery is required, or full correction is no longer possible.
Rapid progression in scoliosis cases
While we know that scoliosis is subject to rapid and unpredictable changes in severity, most of the research in this regard has only targeted more serious cases – however, it’s likely that the same basic principles apply to smaller curves, again underpinning the need for fast action when scoliosis is suspected.
Recent research by the British scoliosis society[3] has shown that in patients already waiting for scoliosis surgery, curve progression can be considerable just during the consultation process. Their 2018 study specifically looked at scoliosis progression whilst waiting for a consultation and eventual surgery. In the study, 41 females and 20 males with a mean age of 11.8 years with a mean Cobb angle (curvature) of 58° were followed – Average waiting time to be seen in the clinic for an initial consultation was 16 months – thereafter, the average waiting time for surgery was 10 months. Rapid curve progression was seen in twelve patients, of which 10 required more extensive surgery than originally planned. Their mean Cobb angle at presentation was 48° which increased to a mean of 58° at surgery.
Perhaps the saddest part about the study from the British scoliosis society was the specific data on the curves of the participants at the beginning of the research. While the study sought to examine curves which were already at the “surgical threshold”, the range of curves studied was actually between 17°–90°[4], and while a 90-degree curve would certainly be likely to require surgery, a 17-degree curve would almost certainly have not – indeed, a 17-degree curve would be an excellent candidate for the kind of conservative, non-surgical treatment we offer at the UK scoliosis clinic.
By the end of the study, however, after such a short time, the smallest curve was 30°and the largest was 120°. While it is certainly easier to treat a smaller curve, a 30-degree curve still has a good prognosis with modern conservative treatment through active bracing, such as scolibrace. This study goes to show that the right information at the right time makes a significant difference in scoliosis cases. Indeed – in stark contrast to the above – one recent study of 113 scoliosis patients treated with non-surgical approaches showed that vast majority achieved a significant curve correction and only 4.9% of patients needed surgery.[5]
Older adults
As we already mentioned, adult scoliosis cases – that is to say, childhood scoliosis which is carried into adulthood – does tend to progress at a more predictable rate, however as we age, there is an additional risk from Scoliosis.
Older adults are at considerable risk of another common form of scoliosis, known as “de-novo” (degenerative) scoliosis. De-novo scoliosis is caused by wear and tear to the spinal discs as we age, and is therefore quite common – research suggests that as many as 30% of the over 60’s suffer from scoliosis. Although de-novo scoliosis progresses much more slowly than childhood or adolescent scoliosis it can still have a major impact on quality of life, if not properly treated.[6]
Patients with de-novo or degenerative scoliosis, will often experience constant back and leg pain which makes it difficult for them to walk or stand for any period of time. They may become aware that they cannot stand up straight and lean towards one side, this becomes more noticeable the longer they are upright. Frequently they don’t find relief with standard conservative treatment such as chiropractic or physiotherapy and they are not suitable for surgery due to osteoporosis ie bone weakening. These patients often respond well to a gentle supportive brace, which helps to keep them upright and less tilted thus they can walk or stand more comfortably for longer periods of time.
[1] Progression risk of idiopathic juvenile scoliosis during pubertal growth, Charles YP, Daures JP, de Rosa V, Diméglio A. Spine 2006 Aug 1;31(17):1933-42.
[2] Progression risk of idiopathic juvenile scoliosis during pubertal growth, Charles YP, Daures JP, de Rosa V, Diméglio A. Spine 2006 Aug 1;31(17):1933-42.
[3] H V Dabke, A Jones, S Ahuja, J Howes, P R Davies, SHOULD PATIENTS WAIT FOR SCOLIOSIS SURGERY? Orthopaedic ProceedingsVol. 88-B, No. SUPP_II
[4] H V Dabke, A Jones, S Ahuja, J Howes, P R Davies, SHOULD PATIENTS WAIT FOR SCOLIOSIS SURGERY? Orthopaedic ProceedingsVol. 88-B, No. SUPP_II
[5] ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies –SOSORT award 2013 winner‘ Angelo G Aulisa, Vincenzo Guzzanti, Emanuele Marzetti,Marco Giordano, Francesco Falciglia and Lorenzo Aulisa, Scoliosis 2014 9:3 DOI: 10.1186/1748-7161-9-3
[6] ‘Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender‘
Kebaish KM, Neubauer PR, Voros GD, Khoshnevisan MA, Skolasky R, Spine 2011 Apr 20;36(9):731-6.
‘The prevalence and radiological findings in 1347 elderly patients with scoliosis‘
Hong JY, Suh SW, Modi HN, Hur CY, Song HR, Park JH., Journal of bone and joint surgery 2010 Jul;92(7):980-3
