Research Review: The Prognosis of Scoliosis Using Patient Specific and Radiological Factors

Research Review: The Prognosis of Scoliosis Using Patient Specific and Radiological Factors

Rosemary Marchese, Physiotherapist

The risk factors for progression of idiopathic scoliosis are an important part of the history for a clinician and a patient. When dealing with adolescents in particular, there needs to be discussion around the predictive factors for progression so that parents and children can make an informed decision about treatment options. A systematic review by Lenz et al, (1) investigated the patient-specific and radiological predictive factors for curve progression in adolescents with idiopathic scoliosis.

Background

Researchers from Canada have now discovered that in fact it is common for teenagers with scoliosis to suffer from mild, chronic pain and that the pain gets worse with curve size. This research exposes a common myth that scoliosis is not associated with pain.

Their results are supported by further research from the United Kingdom which found that even children with small curves “had more days off school and were more likely to avoid activities that caused their pain”.

Despite this research it’s still common for children with scoliosis complaining of pain to be told “it is just growing pains” and “not to worry about it”.

This is a problem because if their pain is not taken seriously and is left untreated then the child continues to suffer. On the bright side, the Canadian research found that those children that were treated for their scoliosis had less pain.

In adults, it’s also a common misunderstanding that scoliosis is not a cause of their back pain. In fact there is a huge amount of evidence that there is a strong link between back pain and scoliosis, and recent evidence even shows a link to neck pain.

Unfortunately, adults are often told they have other conditions such as stenosis or a ‘bad disc’, meaning these patients often seek out treatments that are not designed to treat the underlying cause of the problems, allowing the scoliosis to progress for years until it is severe and treatment window opportunities have been lost.

Adult scoliosis is also recognised as “a medical condition of significant impact, affecting the fastest growing section of our society to a previously unrecognized degree.”

For adults with scoliosis, there is also good news. A 15-year study of a group of adult scoliosis patients found that left untreated their scoliosis progressed at approximately 2 degrees per year over 10 years.

However, when they were treated with an adult scoliosis brace it essentially stopped them getting worse. There is also evidence that using a specific adult scoliosis brace can help with the pain caused by scoliosis.,

In summary scoliosis is a common cause of spinal pain in both adults and children. Scoliosis specific treatments including special exercise programs and bracing have been shown to help stop or slow the progression of scoliosis7 and in many cases, alleviate the pain caused by scoliosis8,9. The key to the best outcome is seeking the right treatment at the right time.

Outcomes:

This systematic review summarised the current state of knowledge in regards to progression of scoliosis. The top five list of identified risk factors influencing curve progression were:

  1. Curve magnitude (initial presentation)
  2. Skeletal maturity (Risser, SMS, proximal humerus, distal radius/ulna)
  3. Curve location (thoracic and double thoracic curve
  4. Age
  5. State of menarche.

 Curve magnitude was the most relevant predictive factor.

Discussion:

Idiopathic scoliosis that progresses during adolescence can lead to surgical intervention. An algorithm for risk analysis of curve progression would be an important and useful tool for clinicians and families. The risk factors identified today are not unfamiliar, but the interaction between them and the impact on progression has not been identified.

This systematic review summarised the current literature as the basis for creation of patient specific algorithms regarding a risk calculation for a progressive scoliotic deformity.

References:

  1. Lenz M, Oikonomidis S, Harland A, Fürnstahl P, Farshad M, Bredow J, Eysel P, Scheyerer MJ. Scoliosis and Prognosis-a systematic review regarding patient-specific and radiological predictive factors for curve progression. Eur Spine J. 2021 Jul;30(7):1813-1822. doi: 10.1007/s00586-021-06817-0. Epub 2021 Mar 26. PMID: 33772381.

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