The natural history of adolescent idiopathic scoliosis

Abstract

There have been great advances in the conservative and surgical treatment for adolescent idiopathic scoliosis in the last few decades. The challenge for the physician is the decision for the optimal time to institute therapy for the individual child. This makes an understanding of the natural history and risk factors for curve progression of significant importance. Reported rates of curve progression vary from 1.6% for skeletally mature children with a small curve magnitude to 68% for skeletally immature children with larger curve magnitudes. Although the patient's age at presentation, the Risser sign, the patient's menarchal status and the magnitude of the curve have been described as risk factors for curve progression, there is evidence that the absolute curve magnitude at presentation may be most predictive of progression in the long term. A curve magnitude of 25° at presentation may be predictive of a greater risk of curve progression. Advances in research may unlock novel predictive factors, which are based on the underlying pathogenesis of this disorder.

Efficacy of exercise therapy for the treatment of adolescent idiopathic scoliosis: a review of the literature

“…These patients who are from distinct geographical locations with different genetic and cultural influences may have been better matched using Risser sign giving better indication of skeletal maturity than age. In addition, there has been much variation in the documented natural history of disease progression [28] and therefore it would not be accurate to just compare with one study reporting on untreated patients who had a comparatively high rate of progression.…”

Hypothesis about an existent biomechanical cause–effect relationship between Schëuermann’s kyphosis and scoliosis

“…The relative importance of each factor, and the different interactions these factors have that result in the development of idiopathic scoliosis, has yet not been defined [29]. Nonetheless, according to the study conducted by Wong and Tan [29], an initial Cobb s angle of 25°was the most predictive factor for curve progression to this threshold magnitude.…”

“…In effect, axial loading of the ring apophyses affects the longitudinal growth in accordance with the Hueter-Volkmann principle, which states that increased pressure retards growth [22]. Furthermore, abnormal passive spinal system maintenance and asymmetric bone growth dysregulation are two of the main pathogenetic mechanisms of scoliosis [3,29].…”

“…Nonetheless, according to the study conducted by Wong and Tan [29], an initial Cobb s angle of 25°was the most predictive factor for curve progression to this threshold magnitude. From this perspective, it may be understood that mechanical variables are predominant factors in these cases, which are found in Schëuermanń s kyphosis.…”

Stretching Versus Mechanical Traction of the Spine in Treatment of Idiopathic Scoliosis

“…Idiopathic scoliosis is estimated to affect about 2-3% of 10-16-year-old adolescent females. The prevalence rate is slightly higher in girls, and it more rapidly increases with age 4,5). Scoliosis is a spinal deformity characterized as a lateral curvature of the spine greater than 10°, as measured by the Cobb method on standing upright spine radiographs.…”