According to the Scoliosis Research Society idiopathic scoliosis has been defined as a lateral (side to side) curvature of the spine greater than 10 degrees as measured using the Cobb method on a standing x-ray. The curve develops due to a 3-dimensional deformity of the spine causing changes from left to right, front to back and in rotation. It is a pathology of the neuro-musculo-skeletal system which involves postural changes and growth asymmetry and is thought to be of genetic origin.
Idiopathic Scoliosis is present in 2 – 4% of the population of children between 10 – 17 years of age. It is more common in girls than boys, 8 out of 10 are young girls.Idiopathic scoliosis is classified based on the age of the patient when it is first identified.
Infantile Scoliosis - accounts for less than 1% of all cases.
Juvenile Scoliosis - accounts for 12 - 21% of all patients with idiopathic scoliosis and is first detected between the ages of 3 - 10 years of age.
Adolescent Idiopathic Scoliosis - account for about 80% of cases found between the ages of 10 - 17 or skeletal maturity.
Adult Idiopathic Scoliosis may also be present as a pre-existing condition or as a new condition (Denovo Degenerative Scoliosis)
Signs & Symptoms
As a parent if you want to know if your child might have scoliosis assess them for the following:
• Shoulders different heights
• One shoulder blade is more prominent than the other
• Head is not centered directly above the pelvis
• Appearance of a raised, prominent hip
• Rib cage appears different heights
• Uneven waist
• Leaning of entire body to one side.
Secondary Causes of Scoliosis
|Inherited Disorders of Connective Tissue||Neurological Disorders||Musculoskeletal|
Marfan syndrome Homocystinuria
|Tethered cord syndrome
Familial dysautonomia (Riley-Day syndrome)
|Leg length discrepancy
Developmental dysplasia of the hip
Idiopathic scoliosis is a developmental deformation of the spine and the trunk, which significantly influences the form and function of a young person. The extensive interest of medical experts in the treatment of spinal deformities results from the incidence of such disorders in the adolescent population, health consequences of the disease progression as well as social wellness.
The predictors of progression of the curve are as follows:
- Genetic insult
- Degree severity
- Velocity of growth
- The starting time of treatment
If scoliosis appears at an early age it is more likely to progress. The incidence gradually decreases as the patient's age increases.
Dubal – Beaupere found an intimate relation between the velocity of growth of the upper body segment and the scoliosis curve progression.
Girls' ages 10 – 12 years old and boys' ages 11 – 13 years old with adolescent idiopathic scoliosis are at maximal risk of progression.
According to Lonstein and Carlson, children presenting with idiopathic scoliosis:
|Below the age of 9 there is a 67% chance of progression of the curve|
|10 years of age, a 50% chance of progression.
11 years of age, a 34% chance of progression.
12 years of age, a 34% chance of progression.
13 years of age, a 21% chance of progression.
14 years of age, a 15% chance of progression.
15 years of age, an 11% chance of progression.
Risser Sign / Tanner-Whitehouse Scale
Both the Risser sign and Tanner scale are indicators of the stage of physical development and skeletal maturity in children, adolescents and adults. These scales enable us to accurately measure whether a patient's is in their peak of their skeletal growth or slowing down in skeletal growth or has reached skeletal maturity.
According to Lonstein and Carlson, children presenting
with idiopathic scoliosis:
|Risser 0 there is a 38% chance of progression of the curve.
Risser 1 there is a 26% chance of progression.
Risser 2 there is a 13% chance of progression.
Risser 3 there is a 12% chance of progression.
Risser 4 there is a 10% chance of progression.
Risser 5 skeletal maturity is reached and there should not be further progression. There are always exceptions and should not be ruled out.
Degree of the Curve
The higher the curve at a younger age the higher the possibility of progression of the curve if it is left untreated.
According to Lonstein and Carlson:
Children aged < 10 years of age with a curve of 5º-19º Cobb angle there is a 45% chance of progression of the curve.
Children aged 11-12 years of age with a curve of 5º-19º Cobb angle there is a 23% chance of progression of the curve.
Children aged 13-14 years of age with a curve of 5º-19º Cobb angle there is a 8% chance of progression of the curve.
Children aged > 15 years of age with a curve of 5º-19º Cobb angle there is a 4% chance of progression of the curve.
Menarche / Voice Change
Menarche in girls and voice changes in boys are also an indication of the patient's skeletal maturity. It has been noted that 2 years after either of the two above have began the most amount of growth / maturation would have taken place.
Activity (exercise) and flexibility of the spine are areas that could contribute to more successful conservative treatment.