Can Scoliosis Worsen and when do we Refer out?
A Progressive Condition
Scoliosis is often poorly misunderstood as there are many reasons why scoliosis can arise and because of this, it can affect people of all ages.
Causes of scoliosis:
Most cases are idiopathic, meaning that there is no known cause. Some of the other reasons are:
- neuromuscular (eg. cerebral palsy)
- spinal degeneration
Can a scoliosis get worse?
Scoliosis is a progressive condition, meaning it can and often does get worse. Here are some of the times that it can progress rapidly:
- During infancy
- At puberty
- In the elderly
Adolescent idiopathic scoliosis (AIS)
This the most common type of scoliosis and is usually diagnosed during puberty. It is also the most likely to worsen and progress as the child goes through a rapid growth phase. 80% of idiopathic cases occur in adolescence and approximately 30% of AIS have a family history, which may suggest a genetic link.
Why can scoliosis progress in adolescence?
The progression and development of scoliosis is directly related to the rate of trunk growth. AIS curves progress during the rapid growth spurt period of puberty, as the development of scoliosis is related to the intense increase in height and weight that occurs during this time.
Girls suffer more than boys (Research):
The prevalence and severity of AIS is higher in girls than it is in boys. The Latrobe Hospital Excela Health Family Medicine Residency found that ‘females have up to a 10-fold greater risk of curve progression’, and unfortunately there is no conclusive evidence to understand why this is the case.
Adult onset scoliosis:
It is not only adolescent idiopathic scoliosis that can worsen over time. A common misconception is that once we are skeletally mature, scoliosis can no longer progress. However, this isn’t the case, as there can be a very rapid progression of scoliosis for women going through menopause and after the age of 60.
Arthritis and scoliosis in adults:
For adults with scoliosis over the age of 40, there can be a progression of 1-2 degrees a year! Adult scoliosis can be pre-existing from childhood or can be a result of spinal degeneration (Degenerative De Novo scoliosis). Therefore, it is important to manage and monitor scoliosis over the different stages of life.
When do we refer out for a scoliosis?
- In children with a scoliosis between 10-20 degrees, we monitor the scoliosis and manage it through conservative treatments such as home rehabilitation exercises and home care with an orthotic called a Scoliroll.
- For curves >20 in children we refer to Scolicare for assessment and consideration of a dynamic brace.
- In adults, if their abnormal thoracic curve is >45 degrees or their abnormal lumbar curve is >40 we will refer them to Scolicare for assessment and consideration of a dynamic brace.
The goal of the dynamic brace is to help teach the patient’s body to correct abnormal posture.
Reference:Adolescent Idiopathic Scoliosis: Diagnosis and Management
If you would like to know more about what ideal posture looks like, then CLICK HERE.