Being diagnosed with adolescent idiopathic scoliosis (AIS) can be a ‘big deal’ to a teenager who is already trying to navigate challenging teenage years.
While I have seen many teens take the diagnosis all in their stride, not all find it that easy to cope. Coupled with the often unnecessary dramatisation of the diagnosis, stress can easily build in the patient. Unhelpful comments by even well meaning adults and peers can be disastrous: ‘You will end up in a wheelchair.’; ‘You are definitely needing surgery immediately.’ and other comments are not uncommon in this industry according to many of my colleagues.
So, how can we truly know what the future holds for these patients? And how do we not add to the stress to better help our patients? Knowledge is key! Let’s take a look at some of the findings from one of the most recent reviews of the natural history of scoliosis in adolescents by Weinstein (2019).
Will the Curve Progress?
Factors in determining major curve progression include:
- curve location
- size of the curve
- skeletal maturity as determined by age, onset of menses, closure of the triradiate cartilage.
In general, major curves that are less than 30 degrees at skeletal maturity tend not to progress, no matter the curve pattern (1). Curve progression risk increases when the major curve is measuring between 50 degrees and 75 degrees at maturity (1). This is particularly true of thoracic curves, whereas patients with major thoracic and lumbar curves tend to have curves that balance with age (1).
Curves less than 30 degrees at skeletal maturity tend to not progress, whereas curves that are between 50 and 75 degrees at skeletal maturity have a higher risk of progression.
What about Lung Function?
Generally these patients will not have any lung function issues. However, having a Cobb angle of 50 degrees or more at skeletal maturity is a significant predictor of reduced pulmonary function (1). Patients with very large major curves of more than 80 degrees with a thoracic apex have more chances of having shortness or breath compared to patients with major lumbar curves of 50 degrees or more (1).
Will there be Pain or Function Issues?
Patients with AIS can lead happy, healthy, ‘normal’ lives just like everyone else! There is some evidence that patients with AIS have more acute back pain and with greater intensity and duration than their peers (1). However, remember that most of us with or without AIS will have back pain at some point in our lives!
Teens with AIS will go on to lead normal lives, with no evidence to say that they won’t get married (or have partners) or that females cannot become pregnant. There is no indication that pregnancy causes curve progression or increases the risk of problems with mothers who have scoliosis.
One important and interesting fact is that many AIS patients do have a general dissatisfaction with their general appearance. Some also report that they feel that their life is limited as a result of the scoliosis, for example with the scoliosis affecting their choice of clothes (1).
Take Home Message
Adolescents with idiopathic scoliosis can lead great lives! There is no need for the dramatisation that often comes with a diagnosis, however early assessment and treatment can definitely increase the chances of a ‘successful’ outcome. Untreated scoliosis tends to be where more of the problems potentially arise! If in doubt, and you are not a scoliosis specialist, refer!
Reference:
Weinstein, SL. (2019). The Natural History of Adolescent Idiopathic Scoliosis, Journal of Pediatric Orthopaedics: 39(S44-S46) doi: 10.1097/BPO.0000000000001350
