Scoliosis is a condition characterized by a sideways curvature of the spine, often appearing as an “S” or “C” shape. While it can affect individuals of any age, it is most frequently diagnosed during adolescence, a period of rapid growth. Understanding when this spinal curvature typically ceases to worsen is a common concern for those affected and their families. This article explores the relationship between growth and scoliosis progression, how skeletal maturity is determined, and other factors that can influence the curve’s behavior over time.
The Link Between Growth and Progression
The primary driver behind the progression of scoliosis curves is spinal growth. During periods of rapid growth, such as the adolescent growth spurt, the spine elongates quickly, and any existing curvature can become more pronounced. This is because the forces acting on the growing spine can exacerbate the abnormal alignment, leading to an increase in the curve’s magnitude.
Conversely, the progression of scoliosis typically slows down or halts once skeletal growth concludes. When the bones have reached their full adult size and density, the mechanical forces that previously contributed to the worsening of the curve are significantly reduced. This cessation of growth-related progression is a key reason why medical professionals closely monitor scoliosis during adolescence.
How Skeletal Maturity is Assessed
Determining an individual’s skeletal maturity is a crucial step in predicting when scoliosis progression is likely to stop. Medical professionals often use specific indicators to assess bone development rather than relying solely on chronological age, as growth rates vary among individuals. One widely used method involves evaluating the Risser sign, which assesses the ossification of the iliac apophysis, a growth plate located at the top of the hip bone.
The Risser sign is graded on a scale from 0 to 5, with 0 indicating no ossification and 5 signifying complete fusion of the apophysis, meaning skeletal maturity is reached. Another common assessment involves examining X-rays of the hand and wrist to observe the fusion of growth plates. These images provide valuable information about a person’s remaining growth potential. Skeletal maturity often occurs in the late teens.
Factors Influencing Continued Progression
While skeletal maturity generally marks the end of significant scoliosis progression, some curves may continue to worsen, albeit at a slower rate. Larger curves, typically exceeding 30 degrees, are more prone to progression in adulthood. The curve’s location, such as thoracic (mid-back) curves, can also play a role.
Underlying conditions can also influence curve progression beyond typical growth periods. Neuromuscular scoliosis, associated with conditions affecting the brain, spinal cord, or muscles, may behave differently than adolescent idiopathic scoliosis. Degenerative changes in the spine with aging can also lead to new or worsening curves in adulthood, known as adult degenerative scoliosis. Therefore, ongoing monitoring may still be necessary for certain individuals, even after growth ceases.