Dear Dr. Lowell,
I have a daughter, almost 14, diagnosed with scoliosis in July 97. The top curve is in the 30’s the bottom curve I was told is 42 degrees. My doctor said she must be braced immediately now and we had to hold that curve because she was now in a gray area where he would be close to recommending surgery if it was to get larger. Dr. Lowell, do you have any comments for me?
Scoliosis is one area of medicine where we know very well what is likely to happen without treatment, and so we know fairly well when and why treatment is necessary.
What is the natural history of scoliosis? Curvatures tend to stop getting bigger once a patient is done growing. Once a girl’s had periods for two years, her curves are unlikely to progress much after that for the rest of her life. The exception to this is if the curve gets bigger than about 50 degrees; these tend to progress slowly throughout a patient’s lifetime, at an average of about one half degree per year. The scenario is similar to a “leaning tower of Pisa”; it starts to tilt slowly, but the more it tilts, the more rapidly the tilting progresses. From this average, you can see that a 20 year old with a 50 degree curve would be expected to have at 70 years old a 75 degree curve. This doesn’t always progress this way, but it happens frequently enough to be of concern. The problem with curves this large, especially in the elderly, is that they are often painful, especially in the lumbar region. The incidence of pain in these curves is not 100% but it is high. That is a main reason why we treat scoliosis: to prevent pain later in life.
Treatment of scoliosis is therefore aimed at preventing a curvature from becoming 50° or greater by the time a patient is finished growing. Usually, in a curve of less than 20°, observation is the only treatment. If a curve grows to 25° greater, bracing may be required. Surgery is necessary only if it looks like bracing is not going to work, and the curvature will continue getting bigger and bigger. It’s a complicated topic, and it depends on a patients age, skeletal maturity, curve size and location in the spine. No other treatments have been proven effective with scoliosis, including vitamins, medicines, massage, exercise, electrical stimulation, or chiropractic.