Scoliosis is a progressive spinal condition that causes an unnatural lateral spinal curve with rotation, and following a diagnosis, suitable treatment options are discussed. The watch-and-wait approach characterizes traditional scoliosis treatment, but a modern nonsurgical approach values early detection and intervention.
Some scoliosis patients are given a recommendation to watch and wait if a curve is assessed as stable and isn’t progressing quickly, but there are times when a proactive approach is necessary. There are a number of factors that contribute to curve progression, and when rapid growth is occurring in young patients, or age-related changes to spinal health are affecting older adults, watching and waiting is not enough.
There are no treatment guarantees, but managing curve progression is a focus of scoliosis treatment, and curves that are diagnosed early may be more flexible and responsive to treatment.
Understanding Progression
To fully understand the importance of scoliosis treatment, and the different treatment options available, progression needs to be considered.
Here at the Scoliosis Reduction Center®, new patients are comprehensively assessed with a focus on determining curve severity and risk of progression.
Curve severity is based on the size of the curve and is determined by a measurement known as Cobb angle. The higher a patient’s Cobb angle, the larger the curve, and severe curves are more likely to progress and progress quickly.
While scoliosis severity is an important factor for predicting progression, there are a number of other variables that direct curve progression including patient age and growth and age-related changes to bone and spinal health.
Determining a patient’s curve severity and risk of progression accurately are essential for treatment planning.
In mild cases, traditional treatment may only advise close monitoring, but in most cases, this is actually the best time to start treatment.
Mild Scoliosis
Recommendations to watch and wait following a diagnosis are most often given to patients with mild curves who are on the path of traditional treatment.
Scoliosis is progressive, but in some cases, curves may be small, assessed as stable, and don’t appear to be changing quickly, but the risk is that scoliosis can change quickly.
There are certain stages that are known to increase a patient’s risk of curve progression, and during these stages, a recommendation to watch and wait can have negative consequences.
Watching and Waiting During Growth
Watching and waiting during growth may not be the best choice because as a primary trigger for progression, even curves can change quickly during periods of rapid growth.
Growth is the main trigger for progression in children, and although scoliosis affects children of all ages, adolescents are most frequently diagnosed.
Adolescent idiopathic scoliosis (AIS) patients are often assessed at a high progression risk due to the rapid and unpredictable nature of growth during puberty. If a mild AIS patient is told that monitoring for changes is necessary, and a significant growth spurt occurs between assessments, significant progression may be triggered.
As progression occurs, the spine’s unnatural curve is increasing in size, and the spine’s rigidity is also increasing, potentially making the spine less responsive to treatment. Progression also increases symptoms and the potential for more invasive treatment being needed (scoliosis surgery) in many patients.
The best time to treat scoliosis is when curves are small, flexible, and there is more corrective potential. There are a number of variables that shape how a patient’s spine responds to scoliosis and treatment, and curve flexibility is key. One of the reasons there is less corrective potential for adult scoliosis curves is because growth has stopped, so the spine is more rigid and its position is more fixed than in young patients whose spines are still growing.
So the danger of watching and waiting while growth occurs is that it can trigger a young patient’s scoliosis to progress quickly, increasing symptoms, and treatment needs.
Watching and Waiting During Aging
There are two main types of scoliosis to affect adults: idiopathic scoliosis and degenerative scoliosis.
When an adult’s scoliosis is assessed, it needs to be determined if a patient’s curve is pre-existing, most often from adolescence, or if it’s a new curve.
An adult’s curve that’s assessed as pre-existing from adolescence is diagnosed as adolescent scoliosis in adults (ASA), and these cases highlight the detriment of watching and waiting because if the scoliosis was detected, diagnosed, and treated during adolescence, the patient may not be facing the somewhat limited potential of adult scoliosis correction. That being said, it’s never too late to start scoliosis treatment.
An adult with a stable curve that’s not progressing may be told to watch and wait, and while this may not be as risky as saying the same to an adolescent with scoliosis because growth is no longer occurring in adults, an increasing risk facing adults is natural age-related changes to the spine’s health and function.
Watching a Degenerative Curve
Degenerative scoliosis develops later in life, often over the age of 50, and the actual rate of scoliosis increases among the aging population due largely to changing spinal health. There are, however, a number of factors that shape a person’s level and rate of spinal degeneration, but as we age, it becomes more important to be proactive with our health, including our spines.
The cumulative effect of negative lifestyle factors, for example, may, over time, contribute to the onset of degenerative scoliosis and/or curve progression, and these include obesity, a sedentary lifestyle, chronic poor posture, repeatedly lifting heavy objects incorrectly, and excessive alcohol consumption and/or smoking.
Declining posture as we age is another issue. It’s common to experience a loss of muscle strength and endurance with increasing age, and this can cause changing levels of spinal support and stability. Not addressing declining posture can be detrimental to spinal health and function by contributing to even wear and tear on the spine and body.
Changing bone health can also affect curve progression and may make a recommendation to watch and wait more risky, particularly for women experiencing low bone density due to menopause, osteoporosis, or osteopenia. If weak bones develop, a curve can change quickly and injury may also be more likely.
Disc and facet joint degeneration can also increase the spine’s instability. When instability is causing too much movement in the spine, fall-prevention strategies may be necessary, and diagnosing and treating a degenerative curve early may mean preventing injury from a fall.
Diagnosing and treating adult scoliosis while mild may mean preventing a damaging cycle of poor posture, uneven wear, and degeneration from being established.
Mild Scoliosis and Proactive Treatment
Curves that are diagnosed as mild are small and flexible and may be more responsive to treatment, and when a curve is mild, disruption to the spine’s balance is minimal and easier to restore.
In cases of childhood scoliosis, how scoliosis is treated during periods of rapid growth is key, and starting treatment while mild can mean before a lot of growth has triggered significant progression that makes corrective results harder to reach.
Starting mild scoliosis treatment early may also mean avoiding the hardships associated with increasing symptoms and a future surgical recommendation.
When curves are small and flexible, they may be responsive to a scoliosis-specific exercise based program or corrective bracing alone, but as curves progress and increase, a broader more-complex treatment plan may be needed.
For curves that are larger and/or are progressing, treatment recommendations often involve a combination of scoliosis-specific exercise, corrective bracing, and scoliosis-specific chiropractic care known as Chiropractic BioPhysics®.
For curves that are severe, atypical, highly progressive, causing neurological symptoms, and/or have been unresponsive to nonsurgical treatment, a recommendation for surgical treatment may be given. Spinal fusion may straighten a scoliotic spine, but some patients are disappointed with the cosmetic results, an increase in back pain around the fusion site, and a noticeable loss in spinal flexibility and range of motion.
Fused spines are usually weaker and more vulnerable to injury, so a goal of proactive nonsurgical treatment is to prevent patients crossing the surgical threshold, and the best way to manage curve progression is to start treatment early while curves are mild.
Conclusion
Watching and waiting following a scoliosis diagnosis is not enough when there is any risk of progression, and the reality is that a patient’s risk of curve progression can change quickly, especially during growth or age-related degenerative changes to spinal health.
So patients that should not be recommended to watch and wait are growing children and aging adults.
Scoliosis diagnosed while mild has the potential benefits of early intervention within reach, and these can include better curve reductions and proactive progression management, but only if the mild curve is responded to proactively.
Most untreated scoliosis will progress at some point. Modern conservative treatment prioritizes the spine’s long-term health and function by decreasing the need for surgical intervention and valuing a focused and proactive care plan.
So if you, or someone you care about, has been given a diagnosis of mild scoliosis and a recommendation to watch and wait, awareness of when curve progression is more likely helps patients make informed treatment choices.
