Tag: scoliosis gender

Do Boys Get Scoliosis?

Posted on July 8, 2020 by - Blog

Do boys get scoliosis? It’s a good question – and it’s one which we don’t hear people ask enough. While it’s certainly true that the majority of scoliosis cases which you’ll hear about in the news are females – and if you know someone with scoliosis, they’re more likely to be female, Males, can, and do get scoliosis.

 

Scoliosis and Gender

It’s a generally stated fact that scoliosis affects girls more than boys, or, more broadly, it’s frequently noted that about 75% of adolescent idieopathic scoliosis cases are females. Both statements are true – but adolescent idiopathic scoliosis is not the only kind of scoliosis, and 25% is still a large number of people!

To be a little more specific, let’s break the question down – first, scoliosis in children.

Idiopathic scoliosis is a 3-dimensional distortion of the spine and trunk that occurs in otherwise healthy children. 80% of scoliosis cases in this age group are considered to be “Idiopathic” or “of unknown cause” – scientists are fairly sure that genetics can play a role, but the exact onset of scoliosis Is still not fully understood.

A well-recognised theory about how scoliosis develops in adolescence revolves around asymmetrical growth of the vertebrae which de-stabilises the spine and makes the vertebrae prone to becoming wedged. Wedging of the vertebrae then creates a lateral spinal curve which places uneven loading on the vertebrae and precipitates further asymmetrical growth and progression. It is then thought that spinal cord tension develops as the spine bends and twists and brain function and growth is altered as muscle asymmetry develops.

We break idiopathic scoliosis down further into age groups – and here’s where the numbers get interesting.

Infantile idiopathic scoliosis is the name given to idiopathic scoliosis cases which are diagnosed in children between the ages of 0 to 3 years. Statistically, it is the least common of all forms of idiopathic scoliosis and comprises about 1% of all idiopathic scoliosis in children – while the numbers of overall cases are smaller about 60% of patients are boys.

Juvenile idiopathic scoliosis is diagnosed when scoliosis of the spine is apparent between the ages of 4 and 10. It is less common than adolescent idiopathic scoliosis but more common than infantile. In total, it comprises 10-15% of idiopathic scoliosis cases.
Juvenile scoliosis is also found more often in boys between the ages of 4-6, whereas between 6 and 10 it becomes more common in girls.

Adolescent idiopathic scoliosis is the type which we most frequently hear about – and here is where between 75% and 80% of cases are girls. It is usually noticed around 11-12 years of age in girls and slightly later when diagnosed in boys.  AIS is estimated to affect between 3 and 4% of teenagers. In most cases, AIS begins to develop noticeably at the initial onset of puberty and becomes more apparent as is worsens during growth spurts.

While it’s clear that when taken as a whole, girls will tend to make up the majority of scoliosis cases, there are substantial age groups where boys are the most common patients. It’s also critical to understand that while all scoliosis cases should be considered as potentially debilitating, the time available for scoliosis to progress (it typically stops at skeletal maturity) is a huge factor in determining risk.  Scoliosis discovered in a 5-year-old boy has considerably more time to progress, than in a 16-year-old girl.

Finally, there’s another common form of scoliosis to consider – affecting a very different age group. 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.[1] De-novo scoliosis affects both males and females – and since such a large percentage of older people can suffer from this condition, there’s a very real argument to be made suggesting that taken over a lifespan, the rates of male and females scoliosis are much closer together than it might seem at first glance.

 

If you think you may have scoliosis

If you think you may have scoliosis, the advice is simple – regardless of gender, see a scoliosis specialist sooner rather than later. At the UK Scoliosis clinic, we offer in-person consultations at our Essex clinic, as well as online consultations from the comfort of your own home.

 

 

 

[1] ‘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

 

Does scoliosis always get worse?

Posted on May 14, 2020 by - Blog

One of the first questions which many people ask when they are diagnosed with scoliosis is “will it get worse?” There’s also a lot of misconceptions around this issue to deal with. It’s true that some scoliosis cases do simply stop developing – but despite what you might read on the internet, this is very rare. Today, we understand scoliosis much better than ever before, and so while we can’t fully explain the condition, we can now make some very sensible assumptions about its likely progression.

This week, let’s look at some of our current best information on this question.

 

Scoliosis development

Firstly, it’s important that we outline exactly what we mean by “worse” in this situation.  Scoliosis is a condition which causes a host of unpleasant symptoms, ranging from physical deformity to problems breathing and, perhaps most impactful for most people, a drastic impact on self-confidence. While these are all perfectly valid ways of understanding how ”bad” scoliosis is, in a clinical setting we tend to focus on an accepted measurement called  a “cobb angle”.  A Cobb angle measures the deviation of the spine from normal, such that a more pronounced scoliotic curve is said to have a greater cobb angle, or be of a greater magnitude. It is generally true that as cobb angle increases, symptoms will also become more severe. So, what do we understand about the factors which seem to predispose individuals to a greater increase in this regard?

 

Growth potential

Growth potential – that is to say, how much growing a skeleton has already done, and (roughly) how much more it has to do has been strongly correlated with curve progression.  This has been established since the early ’70s , when it was predominately believed that scoliosis progression was fastest during adolescent growth spurts.[1] More recently, however, we have come to understand that in fact, aspects such as the riser sign (an indication of skeletal maturity) and the onset of menstruation are closely correlated with the potential for curve increase.  Immature children

(Risser sign 0 or 1) with larger curves (20–29°) at initial diagnosis demonstrated a 68% risk for curve progression, whereas mature children (Risser 2–4) with similar curves at initial presentation had a 23% risk for curve progression. Conversely, immature children with smaller curves (5–19°) demonstrated 22% chance for curve progression, while mature children with smaller curves had only a 1.6% risk for curve progression. [2]

        The younger the child or the more growth left in the spine the greater the risk of progression.

 

Size of curve

Perhaps intuitively to most of us, the size of the curve at the point of discovery is also a factor in predicting its growth. Much research has examined the relationship between age and curve magnitude – for example, Nachemson et al, and Weinstein et al, correlated curve progression with age and curve magnitude,[3] however, today we also understand that curve magnitude can be an independent predictor of curve progression – that is to say that generally speaking, larger curves tend to get larger, and can also progress after skeletal maturity. Weinstein et al. and Ascani and colleagues reported that children with curves < 30° at skeletal maturity did not demonstrate curve progression into adulthood, while the majority of curves > 50° progressed at approximately 1° per year[4]

The larger the curve the more likely the curve will progress into adulthood.

 

Family History

A family history of scoliosis is a major indicator for the development of scoliosis – research indicates that those with a family member who has scoliosis go on to develop scoliosis in between 11.5 and 19% of cases – considerably more than the 2-3% average in the population as a whole. Research also suggests that those who have family members with severe curves are likely to develop more severe curves themselves, although the correlation is not total.[5] Other factors clearly influence scoliosis, which can also impact the severity of a curve, but those with family members with larger curves should be especially aware.

              If a family member has scoliosis and the bigger their curve is, the more likely other family members will have scoliosis.

 

Gender

On average, girls are up to 5 times more likely than boys to develop scoliosis and hen you also consider that many activities which are popular with young women and girls, such as gymnastics, have scoliosis rates up to 12.4 times as high as the general population. [6] While this is a complex area, since boys can, and do, get scoliosis – it’s important to note that 70% of scoliosis cases are girls. If you perform a home screening, or someone mentions that your child may have scoliosis, you should be especially cautious of that child happens to be a girl.

                      Girls and ballet dancers or gymnasts are more likely to have scoliosis.

 

And here’s the key takeaway

We now know a lot about the progression of scoliosis – far more than we ever did in the past. This means that we are far better able to predict the outcome of a case and to treat it appropriately. The keyword here is treat – since there’s one common theme which runs through each of these points – most of the time, scoliosis will progress, and often, it will progress quickly. While there is a chance that some curves may stop growing, it’s highly unlikely – research shows that juvenile cases, for example, almost never resolve spontaneously.[7]

Today, scoliosis treatment is highly advanced – if caught early, surgery can be avoided and most cases can be corrected quickly and in a non-invasive way. The longer cases are left to progress, however, the more difficult they are the treat, and the longer this will take.

At the UK scoliosis clinic, we see far too many young people in particular who have developed scoliosis and which has been allowed to progress. Sometimes the curve progression is sadly just too large for us to help – but each of these cases would have started out as a relatively small curve which, while certainly not desirable for a young person, would have been relatively simple to treat.

Please, do not wait to screen for scoliosis – do it today and if you have concerns get in touch!

 

 

[1] Duval-Beaupere G: Pathogenic relationship between scoliosis and growth. In Scoliosis and Growth Edited by: Zorab P. Edinburgh, Scotland: Churchill Livingstone; 1971:58-64.

[2] Bunnell WP: The natural history of idiopathic scoliosis before skeletal maturity. Spine 1986, 11:773-776.

Lonstein JE, Carlson JM: The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Joint Surg (Am) 1984, 66:1061-1071.

[3] Nachemson AL, Peterson LE: Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J Bone Joint Surg (Am) 1995, 77:815-822.

Peterson LE, Nachemson AL: Prediction of progression of the curve in girls who have adolescent idiopathic scoliosis of moderate severity. Logistic regression analysis based on data from The Brace Study of the Scoliosis Research Society. J Bone Joint Surg (Am) 1995, 77:823-827.

Weinstein SL, Ponseti IV: Curve progression in idiopathic scoliosis. J Bone Joint Surg (Am) 1983, 65:447-455.

Weinstein SL, Zavala DC, Ponseti IV: Idiopathic scoliosis: longterm follow-up and prognosis in untreated patients. J Bone Joint Surg (Am) 1981, 63:702-712.

[4]Weinstein SL, Ponseti IV: Curve progression in idiopathic scoliosis. J Bone Joint Surg (Am) 1983, 65:447-455.

Weinstein SL, Zavala DC, Ponseti IV: Idiopathic scoliosis: longterm follow-up and prognosis in untreated patients. J Bone Joint Surg (Am) 1981, 63:702-712.

Ascani E, Bartolozzi P, Logroscino CA, Marchetti PG, Ponte A, Savini R, Travaglini F, Binazzi R, Di Silvestre M: Natural history of untreated idiopathic scoliosis after skeletal maturity. Spine

1986, 11:784-789.

[5] ‘ Carol A Wise, Xiaochong Gao, Scott Shoemaker, Derek Gordon, and John A Herring, Understanding Genetic Factors in Idiopathic Scoliosis, a Complex Disease of Childhood’
Curr Genomics. 2008 Mar; 9(1): 51–59. doi:  10.2174/138920208783884874

[6] ‘ Carol A Wise, Xiaochong Gao, Scott Shoemaker, Derek Gordon, and John A Herring, Understanding Genetic Factors in Idiopathic Scoliosis, a Complex Disease of Childhood’
Curr Genomics. 2008 Mar; 9(1): 51–59. doi:  10.2174/138920208783884874

[7] Charles YP, Daures JP, de Rosa V, Diméglio A,  Progression risk of idiopathic juvenile scoliosis during pubertal growth‘ Spine (Phila Pa 1976). 2006 Aug 1;31(17):1933-42. DOI:10.1097/01.brs.0000229230.68870.97