No treatment outcome can be guaranteed, but regardless of patient age at the time of diagnosis, the sooner treatment is started, the better. As a progressive spinal condition, the nature of scoliosis is to become more severe over time.
Scoliosis affects all ages, but the most prevalent type develops at the onset of puberty as adolescent idiopathic scoliosis. The best time to start treatment is prior to the first significant pubescent growth spurt. Progression is triggered by growth and makes scoliosis more complex to treat.
As adolescent scoliosis is the most common type, let’s start with how adolescent idiopathic scoliosis is diagnosed and when treatment should be started.
Diagnosing Scoliosis
Being diagnosed with scoliosis means an unnatural lateral spinal curvature has developed, and because scoliosis also causes the spine to rotate, it’s a 3-dimensional spinal condition with complex treatment needs.
Because no two cases of scoliosis are the same, treatment plans need to be customized, and part of diagnosing scoliosis involves further classification based on patient age, scoliosis type, severity, and location.
Diagnosing scoliosis means treatment is needed, and the sooner it’s started, the better because as a progressive condition, the nature of scoliosis is to become more severe over time.
Ideally, diagnosing adolescent scoliosis prior to the first growth spurt is the goal so treatment can be started while the curve is small, the spine is still flexible, and before growth spurts have triggered significant progression.
Adolescent Idiopathic Scoliosis and Early Detection
Adolescent idiopathic scoliosis is the most prevalent form of scoliosis, and it’s commonly diagnosed at the onset of puberty in females and a little later in males.
Idiopathic scoliosis has no single-known cause, but we know its growth that triggers progression in children, and adolescents are the most at risk for rapid-phase progression due to the rapid nature of pubescent growth spurts.
So when should adolescent idiopathic scoliosis treatment be started? Immediately following a diagnosis is when treatment should be started because as a progressive condition, virtually all cases of scoliosi will get worse with time, and delaying treatment is wasting the potential benefit of early detection.
When scoliosis is diagnosed early while cases are still mild, curves are small and the spine is still flexible and responsive; starting treatment prior to significant growth spurts can help prevent progression and increasing effects.
Proactive nonsurgical treatment has the goal of preventing progression, increasing symptoms, and the need for invasive surgical treatment in the future.
There are a number of factors that shape how a patient responds to treatment, and flexibility of the curve is key.
Progression makes the spine’s unnatural curve and rotation worse and causes increasing spinal rigidity that makes the spine less responsive to treatment.
This is a key difference between treating childhood and adult scoliosis: treating a spine that’s still growing and flexible versus a rigid spine facing compression.
Adolescent Idiopathic Scoliosis and Early Intervention
With childhood scoliosis, because growth triggers progression, counteracting progression with treatment is key, and this is simpler with early detection and intervention.
When adolescent idiopathic scoliosis is diagnosed early, while still mild, and prior to significant progression occurring, treatment can be started early, and in some cases, early intervention with corrective bracing can have a powerful impact.
When bracing alone isn’t enough to stop progression, scoliosis-specific exercise and chiropractic care, as an adjunctive treatment, can be combined to work towards a curvature reduction, and then the challenge is holding the reduction during the constant trigger of growth.
So the best age to start treatment for adolescent idiopathic scoliosis is as soon as it’s diagnosed, but optimally, the best time to start treatment is prior to the first significant pubescent growth spurt triggering significant progression and increasing treatment needs.
The earliest symptoms of scoliosis in children involve uneven posture; uneven shoulders and hips are the earliest signs to watch for.
As progression occurs, postural deviation becomes more overt including the head being unentered over the torso, uneven shoulder blades, an arch in the rib cage (rib flaring), an uneven waistline, a prominent lean to one side, and arms and legs that appear to hang at different lengths.
The more posture is disrupted, the more it’s going to affect movement; unhealthy posture causes unhealthy movement patterns, and together, this exposes the spine and body to uneven wear and tear during daily activity. Over time, the uneven wear and degeneration can shape the spine’s long-term health.
So when it comes to childhood scoliosis, the best age to start treatment is prior to significant growth spurts triggering significant progression.
Adults are no longer growing, but progression can still occur slowly over time, and if degenerative changes in the spine are occurring, progression can increase.
Adult Scoliosis
The two most common types of adult scoliosis are idiopathic scoliosis, most of which are pre-existing from adolescence, and degenerative de novo scoliosis that develops later in adulthood.
Idiopathic scoliosis in adulthood often involves pre-existing cases of adolescent scoliosis; in these cases, adolescents were unaware of their scoliosis and were undiagnosed and untreated.
It’s not uncommon for adolescent scoliosis to go unnoticed for years, especially in mild cases, and once growth stops, scoliosis becomes compressive, and this is often when back and/or radiating pain starts.
Adolescent scoliosis in adulthood shows how important early diagnosis and intervention are; the spine is more responsive when it’s still growing and flexible, so this is the ideal time to start treatment, not after years of progression and increasing spinal rigidity.
In addition, positural changes and body compensations become more established and difficult to improve the longer they’re left unaddressed.
Degenerative Scoliosis
The second most common type of scoliosis to affect adults is degenerative de novo scoliosis that affects adults over the age of 45 and is caused by degenerative changes causing the spine to become unstable.
In these cases, degenerative changes in the spine, often involving the discs and facet joints, have been occurring slowly over time, and lifestyle factors also play a role in the types of forces the spine is exposed to.
Chronic poor posture, low activity levels, and carrying excess weight can introduce uneven pressure to the spinal discs and facet joints, and uneven pressure during daily activity and movement causes uneven wear and can trigger the onset of the degenerative cycle.
Poor posture, uneven loading, and degeneration are also effects of scoliosis, and when they are occurring and degeneration is started, the growing instability in the spine can cause it to shift out of alignment; early intervention is key.
The best time to start treatment for adult scoliosis is immediately following a diagnosis, and ideally, before the cumulative effect of postural changes and lifestyle factors takes shape.
Leaving scoliosis untreated means leaving the spine, its surroundings, and the entire body, exposed to the effects of uneven forces and wear and tear.
Over time, scoliosis can increase in severity, and once the degenerative stage is entered, degenerative scoliosis can progress up to 4 degrees a year, which is significant. With progression, related postural changes, and disruptions to healthy movement patterns, will increase, along with lower back pain.
Postural collapse is the leading cause of disability among older adults, and as the spine becomes less functional, loss of leg strength can develop, increasing disability and dependence on others.
When it comes to degenerative scoliosis, the best age to start treatment is at the onset of degenerative changes because the longer they are established, the more damage they can do, and the less potential there is for correction without surgical intervention.
Conclusion
The best age to treat scoliosis is immediately following a diagnosis. As a progressive condition, where a scoliosis is at the time for diagnosis, in terms of severity, doesn’t mean that’s where it will stay. Proactive treatment is needed to counteract the progressive nature of scoliosis.
When it comes to childhood scoliosis, early detection is crucial. As growth triggers progression, children with significant growth remaining before reaching skeletal maturity are facing the most potential progression, so starting treatment prior to significant growth spurts triggering significant progression is ideal.
Progression makes the spine more rigid and less responsive, and the longer posture and mobility are disrupted, the harder it can be to reverse the changes; regardless of patient age or severity, the sooner treatment is started, the better.
For children and adolescents, the best age to start treatment is immediately following a diagnosis, and the goal of early detection is to diagnose cases while they are still mild, before growth spurts trigger progression and the condition becomes more complex to treat.
With adults, the prevalence of adolescent scoliosis in adulthood highlights the importance of starting scoliosis treatment close to the time of diagnosis, and what can happen when scoliosis is left untreated for years.
When scoliosis develops later in life, the best time to start treatment is prior to the condition initiating the degenerative cycle; early intervention can prevent increasing disability, pain, and injury.
