Help - my child has scoliosis

Having a child diagnosed with idiopathic scoliosis is a traumatic experience for most parents, often accompanied with a daunting feeling of guilt and despair.

Parents initially seek help from their GP and are then mostly referred to a public hospital where they face the prospect of having to wait months for an appointment, during which time their child's idiopathic scoliosis could have rapidly progressed.

For some parents though this is untenable.

If they have not already searched for a facebook scoliosis support chat group, they do so.

Finally, they search for an alternative scoliosis treatment option.

For a child with idiopathic scoliosis their pubertal growth spurt is a critical time for both them and their parents, as not only is the child’s spine growing rapidly, there is a high risk of their existing curve progressing rapidly too.

It's a time when parents are faced with a difficult decision, take no action or act decisively; it's a 'fork in the road' moment. One road takes them to 'Watch and Wait", a dead end destination, most likely for many many months, during which time their child's curve could progress. The other road ensures immediate appropriate treatment for their child, a chance to probably reduce the curve, but at the very least stop further progression.

Could Treatment For Adolescent Idiopathic Scoliosis

In the public hospital system If a child's curve is less than 20º, it will simply be observed at 4 to 6 month intervals. This "waiting and watching" approach could stretch over several appointments over many months. With no treatment during this extended period, t he curve could rapidly progress. If the curve progresses to 25º or more, and the child is still in their rapid growth spurt, which in the case of a girl would be before menarche, the need for treatment is extremely urgent and bracing should be prescribed. Should bracing not be successful, and the child's curve continues to progress above 40º, spinal fusion surgery, as a matter of course, is always prescribed. No alternative treatment options are considered.

Critical Questions for Parents

Thoracic Spine Correction

Critical questions then for parents: should treatment be provided earlier, irrespective of the curve magnitude (Cobb Angle), rather than after many months of "watching and waiting". Would earlier intervention of bracing have been a timely and more appropriate treatment? And, if bracing is prescribed at some point, is the hospital's generic symmetrical Boston brace the only option, or is there a choice, perhaps a Chêneau style 3D asymmetricl brace?

If the hospital's brace is the only option, what is the likelihood it will reduce their child's curve, or at the very least stop it from progressing to over 40°, the arbitrary threshold at which spinal fusion surgery is prescribed? And, with regards to spinal fusion surgery, what are the risks and possible long term complications? Would living with and managing idiopathic scoliosis with conservative treatment be a better option?

Risk of Curve Progression

Scoliosis research (Marshall & Tanner 1969, Lonstein & Carlson 1984, Dimeglio 2001, Sanders 2008) has confirmed that the earlier the onset of idiopathic scoliosis, the greater the risk of progression. The highest risk of progression directly relates to rapid spinal growth. In girls, peak growth occurs on average 6 to 12 months before Menarche (first menstrual cycle), though there are exceptions. After Menarche the period of maximum growth has usually passed (Dimeglo 2001). However, significant spinal growth nevertheless remains, but progression risk decreases, unitl it stops at skeletal maturity. In general, for girls this is usually age 14 and for boys age 16.

In all cases of adolescent idiopathic scoliosis, especially where there is a high risk of progression, appropiate and timely conservative treatment is key to preventing curves progressing.

So finally, the question parents need to ask is what 'alternative' helpful treatment options are available, which if undertaken during and in addition to the hospital's approach of "watching and waiting", could help stop progression, and possibly even reduce their child's curve.

Schroth Method Scoliosis Exercise Treatment

The following images are those of an adolescent female patient, who over a 2 year period, committed to a Schroth Method Patient_Parent Program in conjunction with wearing a 3D Chêneau style asymmetrical brace. Her posture, as can be seen, improved dramatically.

: 07-04-2021

: 12-04-2023

: 07-04-2021

: 12-04-2023

Schroth physiotherapeutic scoliosis-specific exercise treatment has been proven to: improve posture, mobility and function; and reduce pain and disability; and prevent progression; in patients diagnosed with idiopathic scoliosis. Schroth exercises when performed in conjunction with bracing has improved bracing outcomes in patients with curvatures greater than 40º degrees, thus avoiding the need for spinal fusion surgery.

Adolescent Idiopathic Scoliosis is a three-dimensional (3D) disorder and therefore requires a 3D conservative treatment approach. As each patient's scoliosis is unique, our Schroth Patient-Parent Programs are customised to meet the needs of individual patients, redress their scoliosis, and elongate and stabilise their spine three-dimensionally.

Quality of Life

In terms of quality of life, as previously stated, there is evidence which suggests non-invasive conservative treatment, such as Schroth Method exercises and bracing, can prevent curvature progression in adolescent patients and avoid the risk of spinal fusion surgery.

A Critical Review written by the authors cited below concludes that: "there is no evidence that spinal fusion surgery improves quality of life for AIS [adolescent] patients versus natural history [of their scoliosis].”

Citation: Weiss HR, Moramarco M, Moramarco K. Risks and long-term complications of adolescent idiopathic scoliosis surgery versus non-surgical and natural history outcomes. Hard Tissue 2013 Apr 30;2(3):27.