Scoliosis treatment plans need to be customized to address a number of patient/condition factors, one of which is a patient’s progression risk. The more growth a patient has to go through before reaching skeletal maturity, the more potential progression they face, and a young patient’s rate of progression is shaped by how fast growth is occurring, along with other key factors.
There are different types of scoliosis with unique characteristics and treatment needs, and the condition also ranges widely in severity from mild scoliosis to very severe cases. Scoliosis progresses at different rates, but growth spurts trigger progression in children, and degenerative changes in the spine can trigger the onset/progression of scoliosis in older adults.
With progressive conditions like scoliosis, the timing of treatment is key, and determining how fast a patient’s scoliosis is likely to progress informs the treatment approach.
Scoliosis Progression
Scoliosis causes the spine to curve unnaturally to the side and rotate, and as a 3-dimensional progressive spinal condition, the nature of scoliosis is to increase in severity over time.
The progressive nature of scoliosis is a challenge when it comes to treatment; no treatment outcome can ever be guaranteed, but nonsurgical treatment success is closely associated with early detection and intervention.
Starting treatment prior to significant progression occurring is key. Progression means the spine’s unnatural curve and rotation is increasing, as are the condition’s effects, and the more scoliosis progresses, the more it’s likely to continue doing so.
And it’s important to understand that even scoliosis diagnosed as mild can easily progress and become moderate, severe, or very severe, and if left untreated, increasing effects, potential complications, and the need for invasive surgical treatment becomes more likely.
Scoliosis progression makes the spine more rigid and less responsive, and increasing symptoms can impact quality of life.
In children, the main effect is postural deviation, and in adults, it’s most often pain that leads to assessment and diagnosis.
The earliest signs of childhood scoliosis are uneven shoulders, shoulder blades, and uneven hips, and with progression, increasing postural changes affect movement patterns and muscle strength/balance.
Curve size is measured in degrees, and progression is indicated by increases to a patient’s Cobb angle measurement.
There are different factors that shape a patient’s progressive rate including growth, curvature location, and lifestyle factors/degeneration.
Growth and Progression Risk
Part of diagnosing scoliosis involves a comprehensive initial assessment and the results of a scoliosis X-ray that helps determine how fast a patient’s scoliosis is likely to progress, and a key factor is growth.
Growth is the main trigger for scoliosis progression, so the more growth a patient has before reaching skeletal maturity helps shape their progressive rate.
Determining bone age (Risser sign) is important in children to shape treatment plans accordingly.
The most prevalent type of scoliosis overall is adolescent idiopathic scoliosis diagnosed around the onset of puberty and into young adulthood (10-18), and adolescents are also the most at risk for rapid curve progression due to the stage of growth they are in, or are entering into.
Puberty is characterized by rapid and unpredictable growth spurts and can trigger rapid progression in adolescents.
A danger of traditional scoliosis treatment is the watch-and-wait approach. Traditional scoliosis treatment can funnel patients towards spinal surgery because it doesn’t have a strategy for addressing scoliosis while mild.
A common recommendation for adolescents with mild scoliosis is to observe for signs of continued progression, and periodic examinations and X-rays are performed, but the risk of a significant growth spurt triggering significant progression in the interim shouldn’t be discounted.
Recommendations to watch and wait can mean wasting valuable treatment time.
There are a number of benefits associated with diagnosing scoliosis prior to an adolescent’s first significant pubescent growth spurt for early intervention.
Curvature Location
Scoliosis can develop in any of the spine’s main sections, or in more than one: the cervical spine (neck), thoracic spine (middle/upper back), and the lumbar spine (lower back).
The most common location for scoliosis is the largest spinal section, the thoracic spine, and thoracic scoliosis is also the most prone to rapid advancement, and because the thoracic spine attaches to the rib cage, it causes the most rotation (rib flaring is a common effect).
During growth, the rotational component can also increase rapidly, and because the thoracic spine is less stable than the cervical and lumbar spinal sections, it can progress rapidly during growth spurts of puberty.
In older adults, the lumbar spine is the spinal section most vulnerable to rapid progression, and this is because it has to support the weight of the spinal sections above, the torso, and its vertebrae feel the effects of strenuous movement.
Lifestyle/Degeneration
So if growth triggers progression, do adults who are no longer growing also face progression? There was a time when progression wasn’t considered a common risk for adult patients, but over the years, we have learned that scoliosis can still progress in incremental amounts that add up over time.
In the main type of adult scoliosis, idiopathic scoliosis, most cases are pre-existing from adolescence and are diagnosed as adolescent scoliosis in adulthood (ASA), and these cases tend to become noticeable once growth stops because compression starts and causes compressive pain.
But because growth is no longer occurring, cases of adolescent scoliosis in adulthood can progress slowly, sometimes at a rate of 0.5 to 1 degree a year, and while that may seem insignificant, the increase over time can affect spinal health.
Spinal Degeneration
And if the degenerative cycle is initiated, scoliosis can progress quickly; in fact, degenerative scoliosis can progress 4 degrees a year, which is significant, and the cumulative effect of certain lifestyle factors also play a role.
As we age, postural changes can occur; if we lean too far forward or too far backward, the instability introduces uneven pressure and strain to the spine, its discs, facet joints, and surrounding muscles.
Over time, if left unaddressed, chronic poor posture can initiate the degenerative cycle by causing uneven distribution of body weight, uneven loading on the spine and its structures, which causes uneven wear and the onset of degenerative changes in the spine.
Carrying excess weight, low activity levels, and improper lifting are additional lifestyle factors that can cumulatively shape the spine’s long-term health over time.
Spinal degeneration can trigger the onset and/or the progression of degenerative scoliosis, and because degenerative scoliosis involves increasing instability, almost all cases are progressive and painful.
Conclusion
Scoliosis progresses at different rates, but key factors include patient age and rate of growth, curvature location, and lifestyle factors/degenerative changes in the spine.
Adolescents are the most commonly diagnosed, and they are also the most at risk for rapid progression due to the rapid and unpredictable nature of pubescent growth spurts.
Adult scoliosis can also progress, and without spinal degeneration occurring, tends to progress at a rate of 0.5 to 1 degree a year, while degenerative scoliosis can progress 4 degrees a year once the degenerative cycle is initiated.
What’s important to understand about scoliosis is while it’s progressive, it can be highly treatable, and the sooner treatment is started, the better.
The best time to start childhood scoliosis treatment is prior to significant growth triggering significant progression, and in adults, the best time to start treatment is immediately following a diagnosis and prior to the onset of degenerative changes in the spine.
It’s never too late to work towards improvement, and regardless of patient age or severity level, the best time to start scoliosis treatment is always now.
So regardless of how fast, or slowly, a patient’s scoliosis is progressing, because scoliosis isn’t a static condition and is always changing, progression can be triggered by a number of factors and occur quickly.
Proactive treatment works towards preventing progression so patients can be spared the challenge of increasing symptom severity, and once the surgical threshold is crossed, the potential complications and side effects of future spinal fusion surgery.
