Scoliosis, in most cases, is a progressive condition – this means it gets worse with time. For this reason, we recommend most people (and all young people who have not reached skeletal maturity) treat, and try to correct Scoliosis as soon as possible. There are, however, some circumstances where treatment of Scoliosis may not be required – let’s take a look.
Scoliosis in children – does it need to be treated?
We started out by saying that for young people, scoliosis should always be treated – the reason is simple – Scoliosis tends to progress over time, and in a very young person there is a lot of time for scoliosis to continue to progress. It’s true that once a person reaches adulthood the development of scoliosis slows considerably – and below a certain cobb angle the curve may stop completely, but sadly most young people will reach a surgical threshold before this.
Research has demonstrated that cases of Juvenile scoliosis greater than 30 degrees tend to progress quickly – studies suggest that as much as 100% of these patients will progress to the surgical threshold. Juveniles with curves from 21 to 30 degrees are more difficult to predict in terms of progression but can frequently end up requiring surgery, or at least are left living with a significant disability.[1]
There is always a chance that scoliosis may not progress as much as predicted, and an individual who experiences scoliosis at a young age may make it to adulthood without requiring surgery. There are, however, still many common symptoms that scoliosis sufferers will experience throughout their life without treatment. Some of the most common include pain, physical deformity, limited mobility and difficulty breathing during exercise.[2] Some recent research has also suggested that even a small cobb angle can have a significant negative impact upon a person’s ability to be active and keep fit and healthy.[3] Since we understand how important staying fit and active is to long term health, it is also fair to say that left untreated scoliosis could be a predictor for longer-term health problems.
Since, with modern, active, bracing there is an excellent chance of not only preventing scoliosis development but actually reversing it. So there are almost no circumstances where active treatment of scoliosis isn’t worth at least investigating.
The only significant exception here would be in the case of an individual who is certainly going to require surgery regardless of attempts to slow or reduce scoliosis through a non-surgical method such as bracing. Bracing can sometimes be used in severe cases as a way to try to delay surgery, but this is not always a net benefit in the long term.
How about in adults?
There are two types of scoliosis in adults – these are adolescent scoliosis in adults (ASA) (Essentially, scoliosis carried over from childhood) and de-novo scoliosis. De-novo scoliosis will be discussed in a moment, so let’s consider ASA first.
The rate of progression of scoliosis in adults varies – but is certainly slower than in children. As a rough figure, about 1 degree per year can be expected. There is, however, quite some variation in the actual worsening experienced by an individual – with research suggesting that this may be correlated to the degree of scoliosis on reaching adulthood – those with larger curves tend to progress more in adulthood, those with smaller curves progress less and many not progress at all.
This is the first case in which there are a large group of people who probably do not need to treat scoliosis – although they should have regular check-ups to ensure that the condition has not started to worsen. An adult with a relatively small curve, which does not cause pain or discomfort and is not progressing, does not stand to gain significantly from Scoliosis treatment. Although it is not impossible to slightly reduce a scoliotic curve in an adult, any correction will be much smaller than in a child hence, if there are no other symptoms, monitoring scoliosis is probably the best approach.
Adults with a curve which does seem to be progressing, or who are experiencing pain or other symptoms from scoliosis may want to consider either an exercise-based approach or bracing as a method to manage Scoliosis. Both approaches are suitable for adults since there is less concern about adherence to an exercise regime (a common problem with children). The appeal of bracing for adults is likely to be ease of use, and, although bracing is expensive, it’s worth keeping in mind that an adult brace will likely last a lifetime if well cared for.
While we often associate scoliosis with younger people – especially girls (certainly, these are the group we most often think about treating today) this stereotype is somewhat unhelpful. In fact, the group most often impacted by Scoliosis are the over 60’s – here, as much as 30% of the cohort suffer from degenerative or “de-novo” scoliosis, a condition caused by spinal degeneration induced by ageing which can cause pain and discomfort. [4]
In older adults, the decision to treat scoliosis is more nuanced – although de-novo scoliosis does progress, cases tend to do so more slowly, hence the main issue to be addressed is often pain. Approaches such as bracing can be an excellent option here, but they do come with a cost – for some older adults with only mild discomfort from their scoliosis the cost of bracing base treatment may therefore be too high to justify, although an exercised based approach can be an excellent compromise between cost and results.
[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] Sperandio EF, Alexandre AS, Yi LC, et al. Functional aerobic exercise capacity limitation in adolescent idio- pathic scoliosis. Spine J. 2014;14(10):2366–72. PubMed doi:10.1016/j.spinee.2014.01.041
[3] SARAIVA, BA; et al. “Impact of Scoliosis Severity on Functional Capacity in Patients With Adolescent Idiopathic Scoliosis”. Pediatric Exercise Science. 30, 2, 243-250, May 2018
[4] ‘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
