Will my child’s Adolescent Idiopathic Scoliosis (AIS) curve get worse? – Daniel Firth

When parents and children receive the news that they have scoliosis, there is always the fear of the condition worsening. Questions and worries will often enter the mind such as; What are the risk factors? What can be done to help?

The main risk factors that determine if a scoliotic curve in a child will worsen are size of curve (known as the cobb angle), and the skeletal maturity of the child. 

Cobb angle  

The Cobb angle will tell you the severity of the scoliosis, Cobb angles from 10 -25 degrees are often described as mild, Cobb angles between 25-40 are known as moderate and curves over 40 degrees are classified as severe. Evidence has shown that the larger the Cobb angle the greater the risk that the curve will worsen in the future.

Skeletal Maturity

Scoliosis severity will often increase during growth, the more growth that remains the higher the risk the curve will worsen. The reason why scoliosis increases with growth is because the spine is growing. In idiopathic scoliosis some of the bones of the spine grow in an asymmetrical way, with one side of the vertebra growing more than the other. This causes the spine to increasingly bend and twist. Hence the time of the greatest risk of a scoliosis worsening  is during the main spinal growth spurt which usually happens during the peak of adolescent growth. 

Cobb Angle and Skeletal maturity 

When analysing Cobb angle and age, Weinstein et al. found that the higher the Cobb angle and the lower the age the greater the risk of Cobb angle progression. The table below gives us an indication of the risk of progression in Adolescent Idiopathic Scoliosis (AIS).  

Published in The Lancet 2008

Adolescent idiopathic scoliosis

  1. Weinstein, L. Dolan, J. C. Cheng, A. Danielsson, J. Morcuende

Conclusion 

Scoliosis Specific Exercises and 3d corrective custom scoliosis braces like ScoliBrace have been shown to reduce the risk of curve progression in AIS and in many cases improvements in the scoliosis are seen. 

It is internationally recognised that bracing and scoliosis specific exercises are the most effective conservative methods in treating scoliosis. 

Owing to the high risk of curve progression in cases of adolescent idiopathic scoliosis where the spine is still growing, it is important to receive timely intervention, be it through scoliosis specific exercise or bracing. As a rule of thumb, a scoliosis specific exercise program is recommended for curves classified as low risk, whereas bracing combined with exercise will be prescribed for those curves classified as moderate to severe. 

To determine which treatment for scoliosis is most appropriate for an individual patient, they should be assessed by a scoliosis clinician, have their Cobb angle accurately measured, and then given recommendations for suitable treatment options.


Daniel Firth
Orthotist: Scoliosis and Bracing Clinician  

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