February 13, 2020
Why are so many children with Scoliosis ‘missed’?
Adolescent Idiopathic Scoliosis (AIS) affects approximately 2% to 3% of the population. Many of these children will not have curves that progress beyond 20 degrees. So what happens to patients with AIS that are left untreated? According to a recent update on the natural history of scoliosis, they will function well as adults, get married, have children and grow to become active adults just like people without AIS (1).
In order to completely understand treatment options, it is important to understand what the natural history of a condition. We want treatment to positively impact the natural history of a condition. In regards to AIS, Weinstein recently published a paper outlining the results the Iowa natural history studies (1). Let’s look at what was in that paper.
There are a few factors that seem to determine the progression of the major curve in AIS. These include:
In general, major curves < 30 degrees at skeletal maturity tend not to progress, regardless of the curve pattern (1). Curves between 50 and 75 degrees tend to progress the most, especially if they are thoracic curves (1). Curves that are fairly balanced between thoracic and lumbar tend to balance with age (1) with it being somewhat easier to maintain some postural balance.
Does AIS affect lung function?
Lung function is the only symptom in untreated AIS that is associated with curve size. The other facts that affect lung function include:
If AIS patients have a curve that is greater than 50 degrees at skeletal maturity then this is a predictor of reduced pulmonary function at some point (1). Thoracic curves over 80 degrees tend to result in greater odds of having shortness of breath compared to those with large lumbar curves (1). Pulmonary hypertension and right heart failure in AIS is extremely rare (1).
Back pain and AIS
Back pain can be present in AIS regardless of curve size of location (1). Patients with AIS had more chronic back pain and more acute pain of greater intensity and duration than their peers (1). A history of back pain however, is unrelated to whether or not they had arthritic changes or the severity of the curve (1).
Back pain does not tend to affect function in AIS (1).
Marriage, Babies and Psychosocial Aspects
Contrary to what has been previously reported, marriage rates in AIS are the same as controls (1). So there is no need to worry that scoliosis will affect someone’s ability to get married! There is also no indication that pregnancy affects curve progression (1). There is also no indication that scoliosis creates the need for a higher rate of complications or caesarean sections (1).
From a psychological perspective, it is apparent that AIS patients are generally not happy with their physical appearance (1). Some patients sometimes report feeling that:
Overall however the psychosocial and depression signs of AIS patients are similar to non-AIS patients (1).
The natural history information can provide a great basis for patients and families to make informed choices about treatment options. In many countries, there are often numerous conservative and surgical choices available to patients. Having an understanding of how AIS affects the person, not just the spine, is a great first step to making those informed choices.
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*The triradiate cartilage is the growth plate where the three parts of the pelvis meet.
** The Risser sign is an indication of how much growth is remaining using the ilium, one part of the pelvis.
***The Sanders Score is an indication of how much growth is remaining using the cartilage in the fingers and wrist areas.
Weinstein, S. (2019). The natural history of adolescent idiopathic scoliosis. J Pediatr Orthop, 39: 6, Supplement 1.