ADOLESCENT IDIOPATHIC SCOLIOSIS

Idiopathic scoliosis can develop at anytime during childhood and adolescence.

Predominantly though, it manifests itself during 3 growth spurts: 6-24 months, 5 to 8 years, and 11 to 14 Years of age.

Just before puberty, there is a significant growth spurt which can involve a rapid increase in curve Progression.

Curve progression is primarily related to curve magnitude and growth potential.

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.

Curves <25° are unlikely to progress, curves 25–50° will likely progress during growth,

And curves >50° will continue progress.

Orthopaedic Specialists use several relevant indicators - chronologic age; skeletal age; and menarchal stage - That correlate with skeletal maturity to assist with treatment decisions:

"The Risser stage classification" is perhaps the most widely used indicator for skeletal maturity.”

More females than males are likely to develop Adolescent Idiopathic Scoliosis

There are many causes of scoliosis but the most common type of scoliosis is Adolescent Idiopathic Scoliosis (AIS) which means no known cause. AIS accounts for 80% of all scoliosis cases. ”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 likely to experience progression than boys of the same age."

Visable signs of Adolescent Idiopathic Scoliosis

Patients with AIS exhibit visible symptoms which may vary depending on whether a single curve is present in either their thoracic or lumbar spine or, there are 2 curves - one in the thoracic and lumbar spine.

Signs to look for are: a noticeable 'hump' on one side of the back in either or both the thoracic and lumbar spines; one shoulder appearing higher than the other; the body shifting or leaning to one side; protruding front lower ribs on one side; one side of the pelvis looks higher and more prominent than the other; and an asymmetrical waistline.

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

: (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 of 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 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.

Whilst the public hospital system is gradually transitioning away from generic symmetrical bracing, other alternative treatment options are not usually considered.

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

For Juvenile and adolescent patients timely and appropriate treatment intervention is a critical factor. 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).

In the lead up to puberty there is a rapid growth spurt, a period which represents the highest risk of progression. Once girls experience menarche the risk slowly decreases, and on reaching spinal maturity the risk of progression is considerably reduced (2016 SOSORT Guidelines).

Conservative Schroth Method Exercise Treatment, 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 elongate and stabilize 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, which has a positve affect on their pychological wellbeing and quality of life. They are empowered to take back control of their scoliosis, because they can see and feel a positive change in their posture in everyday living.

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.