Scoliosis is defined as a curve in the spine of more than 10 degrees and affects roughly 3% of the population and more commonly girls. The most common type of scoliosis is called Adolescent Idiopathic Scoliosis (AIS). This type starts in early adolescence with no known cause at this time. The AIS type of scoliosis curve will typically continue to increase while the child is growing and then stops once they have reached their full height and hit skeletal maturity.There are several other types of scoliosis that I won’t get into for this article as they are much rarer and have a different type of cause and progression.
There are three general treatment options for scoliosis.
The first is called watch and wait. This phase is exactly what it sounds like. There won’t be any treatment recommended and they come in usually every 6 months for a new x-ray to measure if the curve has increased. If it progresses to 30-40 degrees they will likely move into the next treatment phase. It’s important to note there is no specific curve number that will cause a person to move from one treatment option to the next it is all based on the doctor.
The next phase is some sort of bracing. The most common is the rigid or hard brace. These have been around for many years but how well they work to stop a curve from increasing is still debated. There are also newer braces that are termed dynamic or flexible like the SpineCor system. I’m not going to review them all now as I want to take a different focus for this article but I’ve written about the SpineCor brace here and here oh and here.
If despite bracing the curve continues to increase then the last phase of treatment will be surgery. Like bracing there is no specific curve number that has to be hit in order for the doctor to recommend surgery. It all depends on how aggressive they are and if the patient pushes for it. There are also several types of surgery that are done. Digging into the different types is beyond this article. I did review one paper that showed after one of the common type of scoliosis surgery over 50% of the patients had to have revision surgeries to correct issues.
What happens if the patient decides to do nothing and not follow any of the normal treatment plans.
That is exactly what this research paper studied and it’s what we’re gong to really get into. They followed patients with scoliosis for 50 years that did not have any bracing or surgery and compared them to people of the same age that did not have scoliosis to see how they were doing. A paper like this that follows patients for this long is very rare and very important.
A key point is these were not patients with small curves. Some had curves in excess of 100 degrees. These were not patients who did not have treatment because of the size of the curve, it was their choice.
If you are reading this and you or someone you know has scoliosis you may have been told that if the curve gets large enough it will damage your heart or lungs and could be fatal. Is that true? That is one of the questions this paper aimed to answer.
So how did the scoliosis patients do at 50 year follow ups with no treatment?
Many different factors were compared between the scoliosis group and the non-scoliosis group. They looked at how much pain they had, how their lungs and heart functioned, if they were able to perform their daily activities, depression, body image and how long they lived.
Guess what they found. In nearly every category they compared the two groups, the scoliosis patients matched the patients without scoliosis. There were only three categories that were slightly different.
The first had to do with back pain. Those with scoliosis curves in excess of 80 degrees had back pain a little more frequently than those without scoliosis but most of them described the pain as mild or moderate. The pain didn’t stop them from doing any of their daily activities or put them on disability more often. An interesting point I noticed in this paper was that only one of the scoliosis patients were on strong narcotics for pain while 3 of the non-scoliosis patients were using them for pain. Guess scoliosis makes you a little tougher?
Another category that was different between the two groups was in lung function. If the scoliosis was in the mid back where the rib cage was and was over 100 degrees there was a small decrease in lung capacity. Some of the patients in this particular category reported they would get out of breath if they had to walk the distance of a city block. Again it wasn’t all of them and some of the patients without scoliosis had the same issue it was just more likely with the large curve near the rib cage.
The last category had to do with body image. Patients with scoliosis especially the larger curves tended to be more conscious of their image. They did not have serious concerns but some mentioned that how clothes fit would bother them.
In all other ways measured there was no difference between those who had scoliosis and those who did not. They lived just as long, held jobs, had families and led normal lives.
So where did the warnings that untreated scoliosis would affect your lungs and heart and lead to early death come from?
Well some early papers followed scoliosis patients and reported these figures. However they did not separate out the most common type of scoliosis AIS, what this paper is about, and included other types. Types that start in infants, or due to muscular dystrophy, or alongside other disorders were all grouped together. As I mentioned earlier these types of scoliosis are much rarer and don’t apply to the common AIS type.
As you can see from this paper even with large scoliosis curves you can lead a normal healthy life. I would encourage anyone with scoliosis to explore all conservative treatment options before doing anything irreversible like surgery. That includes specific exercise programs, newer bracing alternatives like SpineCor, and seeing a chiropractor. Even something as simple as using a shoe lift can impact scoliosis.
The key when seeking out a conservative care provider is to find someone that will look at all aspects of the spine. They should then be able to put together a plan to address all of the potential issues that are affecting the spine. Treatment also shouldn’t always be focused on just reducing the curve. Especially in adults as changes to the degree of curve are much less likely. As this study pointed out even with a large curve you can lead a normal healthy life. Treatment, therefore, should focus on making the spine function better with any changes to the structure being a bonus.
These recommendations are for a child that is still growing and for adults with scoliosis. It is never too late to start taking care of your spine.
Since your spine is under more stress due to the scoliosis it is all the more important that you take care of yourself with healthy exercise, eating right, controlling your weight, and these other conservative methods.
By: Dr. Scott Szela
Ref: JAMA 2003;289(5):559-567