ADOLESCENT IDIOPATHIC SCOLIOSIS

Idiopathic scoliosis can begin in infancy, childhood, or adolescence, and curve progression is possible whenever substantial growth remains.

In infantile idiopathic scoliosis (0-3 years) some curves resolve spontaneously, while others progress rapidly. Where as in juvenile idiopathic scoliosis (4-10 years) progression is a constant major concern.

However, the most common form of idiopathic scoliosis occurs in adolescence (10 years to skeletal maturity) when it's especially noticeable during the adolescent growth spurt.

More girls than boys are affected by idiopathic scoliosis. In moderate curves the ratio of girls to boys is 7:1, and in severe curves the ratio is 10:1.

Progression varies widely during peak growth in adolescence. Some curves remain stable while others progress 5–10° within six months. High-risk curves though may progress 20–30° in a year, if untreated.

After skeletal maturity curves under 30° rarely progress significantly. Larger curves (>50°) though may continue to progress slowly, typically around 0.5–1° per year.

During the pubertal (adolescent) growth spurt, the most rapid growth phase is known as Peak Height Velocity (PVH), It's during this peak growth phase, which occurs in females on average 6 to 12 months before their first menstrual period (menarche), that earlier curves can become much larger.

After the peak growth phase, as a child continues to grow, though at a much slower rate until they reach skeletal maturity, the risk of curve progression subsides.

Adolescent Idiopathic Scoliosis

As mentioned above most Adolescent Idiopathic Scoliosis (AIS) is the most common type of scoliosis, it accounts for 80% of all scoliosis cases. Idiopathic means there is no single identifiable cause that has been proven to date. Scientific evidence however points to there being multiple predisposing factors and growth-related triggers. Research studies though do indicate hereditary is a contributing factor.

Risk of Curve Progression during Adolescent Growth Spurt

The earlier the onset of idiopathic scoliosis the greater the risk of progression which is primarily related to curve magnitude and growth potential (Lonstein & Carlson). For example a child with a thoracic curve (the most common AIS pattern) has a higher progression risk if their curve is greater than 30° before the peak growth phase of their adolescent growth spurt.

The main risk factors of curve progression based on documented scientific research and summarised by the SOSORT 2016 Guidelines are:

Curve magnitude (Cobb angle)
Skeletal maturity - remaining growth
Sex (females are at greater progression risk)
Curve pattern (as an additional, lesser factor)

”It’s estimated that females are 10 times more likely to develop AIS, before the age of 10, than males. [and] A girl diagnosed with scoliosis is approximately 10 times more likely to experience progression than boys of the same age."

Visible signs of Adolescent Idiopathic Scoliosis

Thoracic curves display the following noticeable characteristics:

Shoulder asymmetry.
Waist asymmetry.
Rib prominence on forward bending.
Visible trunk shift.
Shoulder height difference.
Shoulder blade prominence.
Rib hump visible even while standing.
Prominent Hip
Pelvic imbalance in larger curves.

In the images displayed below, patient (1) has a a single right thoracic curve and a prominent and elevated left hip, and her upper body shifts (leans) to the right. Patient (2) has a single left Thoracolumbar curve and a prominent and elevated right hip, and her upper body shifts to the left.

: (1)

: (2)

For a comprehensive explanation of the visible symptoms (clinical characteristics) of idiopathic scoliosis, go to: Common Types of Idiopathic Scoliosis and Prominent Hips - Idiopathic Scoliosis

Treatment for Adolescent Idiopathic Scoliosis

Today, for parents who have a child with AIS, there are treatment options available other than those prescribed by the 'Status Quo'. Two alternative treatment options, as opposed to those provided by the Public Hospital System are: Schroth Method Exercise Treatment; and 3D Chêneau style aymmetrical bracing.

Public Hospital System - Status Quo treatment

Treatment prescribed by the Public Hospital System for Infantile, Juvenile and Adolescent idiopathic scoliosis patients, falls into 3 categories: Observation-Bracing-Spinal Fusion Surgery.

Observation (Watch and Wait) is the most widely used treatment for idiopathic scoliosis curves below 20°. Bracing if a patient's curve is diagnosed as progressive which, is usually at around 25°. If bracing is not successful, and a patient's curve continues to progress to >40º, spinal fusion surgery, as a matter of course, is always prescribed. Alternative treatment options are not considered.

Schroth Method Exercise Treatment & 3D Chêneau Style Asymmetrical Bracing.

For juvenile and adolescent patients timely and appropriate treatment is a critical to stop curve progression, if possible before puberty.

Our conservative Schroth Method Patient-Parent Treatment Programs, together with 3D Chêneau Style Asymmetrical Bracing would compliment and enhance the Public Hospitals' prescribed treatment offering for AIS patients, but to date there has been litte interest shown by the Status Quo to engage and work in tandem.

Images (3) and (4) below show a patient performing a thoracic correction and a lumbar and thoracic correction respectively. Images (5) and (6) show a patient fitted with a 3D Chêneau style asymmetrical custom designed brace to correct her single right thoracic curve and left prominent hip.

: (3)

: (4)

: (5)

: (6)

Comprehensive conservative treatment of AIS takes into account the three dimensional (3D) nature of the condition and the risk of progression. Schroth Method 3D scoliosis exercise treatment and 3D Chênau style asymmetrical bracing can be very effective in preventing progression in childhood and adolescence.

Schroth Method 3D Scoliosis Exercise Treatment focuses on muscular and postural asymmetry in order to redress scoliosis, and elongating and stabilising the spine three-dimensionally. This creates an awareness in AIS patients that postural correction is not only possible, but it can improve their aesthetic appearance. This has a positive affect on their psychological wellbeing and quality of life. Seeing and feeling a positive change in their posture in everyday living empowers them to take back control of their scoliosis.

Comprehensive Conservative Treatment

Our Scoliosis Therapy Centre adheres to The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) 2016 Guidelines which, sets out (1) the basic objectives of comprehensive conservative treatment of idiopatic scoliosis, and (2) a specific set of goals for a non-surgical conservative treatment approach for idiopathic scoliosis during growth to stop curve progression at puberty or possibly even reduce it.

1. Basic Objectives:

To stop curve progression at puberty (or possibly even reduce it).
To prevent or treat respiratory dysfunction
To prevent or treat spinal pain syndromes
To improve aesthetics via postural correction

2. Goals

Comprehensive conservative treatment goals are defined as Absolute, Primary, and Secondary.

SOSORT's Absolute goal is to avoid surgery, improve aesthetics, and improve quality life. It's Primary and Secondary goals support the Absolute goal with the focus on preventing progression, irrespective of whether curvatures are categorised as low, moderate or severe.