When a child is initially diagnosed with idiopathic scoliosis, parents are faced with the many choices as to treatment direction they should take.
Often within the UK and the NHS, “watchful waiting” is prescribed. This observation can occasionally be the right approach – depending on the patients age, severity of scoliosis and risk of progression – but observation is not a treatment for scoliosis and many scoliosis practitioners now recommend against it.
What is observation?
Observation is simply the act of continuing to monitor scoliosis, with the hope that it will not progress. In some limited circumstances, or in adults with stable scoliosis, a period of observation may be appropriate. This being said, scoliosis almost never resolves or corrects without treatment. Research has demonstrated that Juvenile scoliosis greater than 30 degrees increases rapidly and 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
Is observation effective?
The problem with so called “watchful waiting” is that it is never entirely possible to predict how progressive a scoliosis case will be. During growth spurts, a curve can go from being only mild to significant in only a few months and require immediate attention. When the right type of treatment is given to a patient during growth, it helps to ensure that the child or young person has a better chance of growing in the right alignment in the first place – rather than just waiting for the curve get worse. In a practical sense, this means observation is almost never the best long-term option for treatment.
In patients who have developed scoliosis, observation most often leads to the patient eventually requiring surgery, as the delay in treatment makes the case harder to treat down the line. By contrast, today, through modern bracing technology, it has been demonstrated that conservative treatment with a brace is now highly effective in idiopathic scoliosis.
Observation at the UK Scoliosis clinic
At the UK scoliosis clinic, we do not believe that observation is an appropriate treatment, except for occasional short-term data gathering, or in adult patients with a stable case of scoliosis. Our belief is that even in mild cases which otherwise may be candidates for observation, it is a better approach to use a preventative approach of scoliosis specific exercise, for example, to prevent the curve from developing further rather than waiting to see if it does.
The likelihood of scoliosis progression is linked to the age of onset/diagnosis, curve size and location, family history, maturation and amount of growth left. The larger the curve and younger the child the higher the risk of progression.
It is important to determine the potential risk of progression, so the right treatment can be given. We don’t want to over treat by prescribing a brace in an adolescent with a curve unlikely to progress, when scoliosis specific exercise could suffice. Likewise, we don’t want to under-treat in a 10 year old with high risk of progression.