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Presence of Other Health Conditions. Children in poor health may suffer more from stressful scoliosis treatments than other children. On the other hand, children who have existing conditions that predispose to lung and heart problems may warrant immediate, aggressive treatment.
For example, a young man of 18 who has a curvature of 30 degrees may require no treatment because his growth has probably almost stopped and his gender puts him at lower risk. A young girl of 10, however, with the same curvature requires immediate treatment.
Choosing Braces or Surgery
In general, the following criteria are used to determine whether a patient should be given braces and conservative therapies or surgery:
- Braces tend to be used in children with curvatures between 25 and 40 degrees who still will be growing significantly.
- Surgery is suggested for patients with curvatures over 50 degrees, in untreated patients, or when braces have failed. In adults, scoliosis rarely progresses beyond 40 degrees, but surgery may be required if the patient is in a great deal of pain or if it is causing neurologic problems.
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The choice may not be so straightforward in certain cases and patients should discuss all options carefully with their physician.
Predicting the Extent of Curvature Progression
In Children and Adolescents:
Once a mild curve has been observed, the next step is more difficult: predicting whether the curve will progress into a more serious condition. Although as many as three in every 100 teenagers have a condition serious enough to need at least observation, progression is highly variable and individual. In a study of patients whose curves did progress after diagnosis, 34% progressed more than 10 degrees, 18% progressed more than 20 degrees, and 8% progressed more than 30 degrees. There are no definite risk factors for curve progression that help physicians predict with any certainty which patients will need aggressive treatment. Some evidence suggests the following factors may help determine patients at lower or higher risk:
- Being female, particularly if taller than average.
- Being younger at the onset of scoliosis.
- Having a greater angle of curvature. For example, at 20 degrees, only about 20% of curves progress. Young people diagnosed with a 30-degree curve, however, have a risk for progression of 60%; with a curve of 50 degrees, the risk is 90%.
- Curvatures caused by congenital scoliosis (spinal problems present at birth). These may progress rapidly.
- Treatment with growth hormone. (Studies are mixed on whether this treatment poses any significant risk, although strict monitoring is still essential in young patients being given growth hormone.)
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