Progressive Scoliosis

By Rosemary Marchese (Physiotherapist, Scoliosis Schroth and SEAS methods)

Defining progression and risk of progression in scoliosis 

Determining whether scoliosis is progressive is important for each patient. Not all scoliosis cases are as progressive as others. If the scoliosis is progressive, then it is important to try to work out when it started to progress. Did it occur during infancy? Before puberty? Early adolescence? The potential for progression correlates with, along with other factors,  the end results. 

Defining when a curve starts to become progressive helps with determining the best time to start bracing and more aggressive therapy. It also helps to determine when it is time to move beyond conservative management, where surgery may be the best option for a patient. Generally, surgery is recommended for a skeletally immature patient showing failure of bracing, or when a mature patient is not responding to conservative therapy options including Physiotherapeutic Scoliosis Specific Exercises (PSSE), such as Schroth or the Scientific Exercise Approach to Scoliosis (SEAS) methods combined with bracing. Often the decision to proceed with surgery may be cosmetic. Guidelines in regards to conservative treatment options can be found here. 

Progressive Adolescent Idiopathic Scoliosis (AIS) has been described as a growth-induced torsion. during the adolescent growth spurt. If we wait for progression to treat then we are also at risk of falling into the trap of ‘wait and see’, which may not end well. 

Progression is related to multiple factors and time, including:

• age
• Risser score (a mark out of 5 indicating how much growth the child has left, with a score of 4-5 indicating the child is nearing or close to end of growth)
• Cobb angle (the angle measured on X-ray).

The more growth remaining, and the larger the angle, the higher the risk of progression. 

Other factors influencing decision making 

While not conclusive, and certainly the impact of each can vary from person to person, the following factors may also affect decision making:

• age at which the patient was first diagnosed 
• menstruation history for females, which may play a part in indicating how much growth is left
• family history of scoliosis 
• additional factors related to trunk asymmetry, cosmetics
• additional factors on X-ray. 

The younger and more skeletally immature the patient, and the higher the curve at diagnosis, the higher the risk of progression. 

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