How Scoliosis Progresses
Scoliosis, a condition that results in a curvature of the spine, affects 6 to 9 million people in the United States, and 3 million new cases are diagnosed each year. For some people, the curve or curves remain mild and never cause any discomfort or complications. But in more severe cases, the curves worsen over time and require treatment. Scoliosis progression depends on factors including the type of scoliosis, the individual patient’s symptoms and medical history, and the effectiveness of scoliosis treatment options.
The Different Degrees of Scoliosis
A healthy, straight spine keeps your posture upright and allows you to balance, walk, turn and lift things. It also helps provide enough space in your chest and abdomen for your organs to stay in place and to grow as they should. With scoliosis, a curve in the spine may cause a person to lean to one side or forward, or push the rib cage inwards. This puts pressure on organs, particularly the lungs and heart.
Scoliosis curves can take a “C” shape with one curve or an “S” shape with two. Doctors measure these curves by degrees to indicate severity:
- Mild: The curve or curves are less than 20 degrees.
- Moderate: The curve or curves are between 25 degrees and 40 degrees.
- Severe: The curve or curves are more than 50 degrees.
The degree of a scoliosis curve is one factor doctors use to determine effective treatment options and an indication of likely scoliosis progression.
Mild scoliosis isn’t always easy to detect and may not even show symptoms; whereas, moderate to severe curves are more noticeable and potentially debilitating.
Initial scoliosis symptoms include:
- One shoulder or hip may be higher than the other.
- You may look like you’re leaning to one side.
- When bending forward, one side of your back looks higher than the other.
- One side of your rib cage may be more pronounced.
Most people with mild scoliosis don’t need treatment right away, and instead doctors will monitor symptoms to see if the curve or curves worsen. Children with mild scoliosis should be checked at least twice a year while they are still growing. If the curve or curves do start to get worse, the earlier treatment starts, the better the chances of stopping the progression. Generally, any worsening of curves occurs during growth spurts, such as during adolescence, when the curve can increase by 1 degree a month. Girls generally see this growth up to age 14 and boys to 16.
Over the years, many people believed scoliosis could be caused or worsened by carrying heavy bags or doing certain types of physical movements. This doesn’t seem to be the case and, in fact, doctors encourage patients with scoliosis to be as active as possible to help keep supporting muscles strong.
Stopping or Slowing Scoliosis Progression
If spinal curvature is getting worse, your doctor will propose treatment to stop the progression. These treatments won’t correct the curve but may stop or slow it.
Bracing is usually the first option. Your doctor may recommend bracing if you have a combination of two or more the following:
- A curve between 20 and 40 degrees
- A curve that has worsened by more than 5 degrees
- A curve of more than 30 degrees when scoliosis was first diagnosed
- You have not completed growing yet
The location of the curvature can affect the likelihood of progression. A single “C” curve in the thoracic (upper) or middle back may increase more than a “C” curve in your lumbar (lower) back. An “S” curve in which the upper curve goes towards the right and the lower to the left tends to worsen more quickly than the opposite shape. The larger the curve, the more likely it is to worsen. Finally, scoliosis diagnosed at a younger age tends to progress, as the body has more time to grow.
For moderate to severe cases, doctors may recommend a full body brace that must be worn most of the day and night, only removed for bathing or to participate in an activity that would be hampered by the brace. The longer the brace is worn, the better the chances of successful treatment. In children and teens, a brace is typically worn until growth stops, unless the doctor determines surgery is necessary before then.
For more serious scoliosis, doctors may use a body cast to help slow or stop the curve progression. Casts cannot be removed but must be replaced every few months to accommodate your growth.
If bracing or casting haven’t worked or the scoliosis is severe enough, surgery is the final treatment option. Depending on the curve’s severity and location, surgery could involve a bone graft with screws and wires to hold the spine in place, or rod implants on either side of the spine to help guide it as it grows. The rods have to be lengthened regularly as you grow.
Successful treatment means the curve or curves haven’t progressed. However, it is possible your spine may start to curve again once the bracing or casting is complete. Speak with your doctor about your options and how you can keep your back as straight as possible.
Living With Scoliosis
As mentioned above, certain exercises and movements will not worsen the curves in your back; however, some may be more uncomfortable or difficult, especially if you wear a brace or cast. Wearing a brace can make some people, especially teens, self-conscious about how they look. Check to see if there’s a support group where you can talk to others who are undergoing the same treatments so you can exchange tips and tricks. There are national online groups as well.
If your doctor suggests surgery, you may also want to get a second opinion, as well as talk to others who have had the same or similar surgery. This gives you a better idea of what to expect during and after the procedure.
Scoliosis can be a challenging and life-altering diagnosis, but by working with your treatment team, you can work to address symptoms early and find effective ways to slow or stop further progression.