Tag: scoliosis risk

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

Scoliosis FAQ with Dr Paul Irvine

Posted on September 30, 2018 by - Blog

This week, we take some of the most frequently asked questions we have here at the clinic and put them to our founder, Dr Paul Irvine. While these quick FAQ’s are a good starting point, please keep in mind that scoliosis is a complex, 3D condition which requires a personal treatment plan designed by a scoliosis professional to treat properly.

As always, if you have you own questions, just get in touch.

 

What causes scoliosis, can anyone get Scoliosis?

Paul with Tony Betts at the 2018 SOSORT conference

There are two types of scoliosis – scoliosis in adults, which is sometimes known as “degenerative”  scoliosis and scoliosis in children.

Degenerative scoliosis is just that – the product of degeneration of the spine with age. Degenerative (also called de-novo) scoliosis is actually much more common than many people think, nearly 40% of adults over 50 will experience it.

The other main type of scoliosis is childhood scoliosis – the truth  is that we aren’t 100% sure what causes childhood scoliosis. While about 20% of cases can be attributed to an underlying condition, spinal deformity or a neurological or congenital cause, 80% of scoliosis cases are classified as “Idiopathic” scoliosis. Idiopathic literally means “without known cause”.

Having said that, researchers believe there are some common threads which may raise your risk of scoliosis.  Firstly, some studies have suggested that certain activities, such as ballet, gymnastics and dancing might predispose someone to scoliosis – One study has suggested that gymnasts are as much as 12 times more likely to develop scoliosis, for example.

Secondly, having a family member with scoliosis does seem to predispose someone to developing the condition.

 

Do genes play a part in scoliosis?

We know that individuals with a family history of scoliosis are more likely to develop scoliosis than those without – this strongly suggests that there may be a genetic cause (or contributor) to the development of scoliosis. There is research being carried out in this area at the moment, but at this time there is still insufficient evidence to make a definite conclusion.

 

How common is Scoliosis? 

Two to three percent of adolescents between the age of 10 and 15 will develop scoliosis. That might seem like a small percentage, but in fact it’s about one per class at school. Some studies have suggested a higher level, but two to three percent is an accepted figure.  Among adults over 50, the rate is as high as 40% – this means that you almost certainly know at least a few people with scoliosis.

 

Will Scoliosis go away on its own?

On this issue research is clear – scoliosis almost never resolves on its own, whereas proactive treatment carries a very high success rate. Left untreated, scoliosis can be a life limiting condition, whereas the majority of patients treated with non-surgical methods today can live a totally normal life and often experience total curve correction. The exception to this rule is infantile scoliosis, which does sometimes resolve on its own – however if you suspect infantile scoliosis you should seek a professional consultation as soon as possible.

 

Does scoliosis affect males and females equally?

No. While both boys and girls can and do develop scoliosis, but 70% of cases are girls (with ballet dancers and gymnasts being 12 times more likely to be affected). My professional experience at the clinic backs this up – the majority of cases we see are females. That being said, its possible that scoliosis might be more prevalent in boys than we yet know.  Since girls are far more likely to be involved in sports such as ballet and gymnastics (where coaches now often look for scoliosis) the figures might be slightly skewed in their favour simply because scoliosis in girls is more often noticed.

 

Is scoliosis most common in young people, whose spines are still developing?

As we already mentioned, scoliosis is common in both adults and children. The cause in adults is usually spinal degeneration and is better understood.  Scoliosis in children usually starts to develop between 10 and 15, but the rate of scoliosis development increases rapidly form age 11 to 14.

 

How serious does scoliosis need to be before surgery is the only option?

When we talk about the severity of scoliosis, we consider a measurement known as cobb angle – cobb angle is simply the degree of curvature of the spine away from the normal position.

As a general rule, a cobb angle over 45 degrees will often be considered an indicator for surgery, however some braces (such as our ScoliBrace) have been shown to be effective in reducing the progression of scoliosis and improving the curve in patients up to 60 degrees cobb.

At our clinic we often combine bracing with exercise-based approaches to scoliosis treatment, such as SEAS and the Schroth method. These approaches teach patients to actively correct their scoliosis using physical therapy exercises and can be effective for treating small curves (less than 20 degrees) as a standalone treatment. That being said, many parents prefer part time, or night time bracing in these situations as exercise must be performed correctly and routinely to have a chance of success.

The latest generation of scoliosis braces are far more effective than older versions. There has been a great deal of research in the field over the last 10 years, so that today the majority of patients who wear a brace will see significant curve correction, and there is an excellent chance of complete correction of the scoliosis – especially when spotted early.

 

What is the prognosis for people with scoliosis? Can it be completely cured?

This depends mainly upon age and the severity of scoliosis. If curves are spotted early and treated before they reach 30 degrees, there is an excellent chance of avoiding surgery and it is highly likely that a complete or near complete curve correction can be achieved.

To give some numbers, studies show that 30-50% of scoliosis cases which are left untreated progress to the surgical threshold – whereas when bracing is used 70-90% will not progress and can be improved. Roughly 10% of cases will progress to surgery despite bracing.

Without a doubt, some cases will always progress even with bracing, however a significant number of the 10% of cases which do not respond to bracing will be as a result of the patient not wearing the brace for the allotted time.

In cases where bracing is not successful, surgery remains an option. At our clinic we strongly encourage people to try modern non-surgical approaches before taking the considerable step of undergoing a surgical procedure, as this comes with many risks and complications – but there is no doubt that orthopaedic surgeons can do fantastic work in treating scoliosis in cases where non-surgical approaches are not successful.

 

Does poor posture cause Scoliosis?

While many people with scoliosis might report poor posture, it is not thought that poor posture causes scoliosis. The main known factors are heredity and participation in some sporting activities, as mentioned above. There has been a small amount of research which has suggested that factors such as diet may have an impact, but far more research is needed before anything authoritative can be said in that regard.

 

Is there anything I can do to avoid scoliosis?

The best way to reduce your risk of having your life limited by scoliosis is to regularly screen for scoliosis in the first place. Scoliosis which is spotted early is much easier to treat and can almost always be prevented from developing.

There is no research which clearly indicates any positive action will reduce the chance of scoliosis developing – although avoiding ballet, gymnastics etc. might reduce risk.

Since that isn’t much fun – especially for young girls – Scoliosis screening is the best thing to do. Screening is easy to do (we even have an online screening tool people can use) with their friends or family at home – self screening takes about 5 minutes!

A great deal of research recommends screening in schools as a method for spotting scoliosis early – and most researchers agree that screening is an effective way to reduce the number of patients eventually requiring surgery. In the UK scoliosis screening is not implemented in schools, although some sports clubs (particularly ballet) do perform screening.  By contrasting example, Hong Kong offers scoliosis screening to all students.

 

Can I check if my child has scoliosis?

You certainly can, and it’s easy to do. We have an online tool called scoliscreen which you can use to perform a screening at home (try here) or you can simply follow the simple screening guidelines on this page. If you do suspect scoliosis, be sure to get a professional consultation from a scoliosis practitioner sooner rather than later. Most reputable clinics should offer this service for free.