Scoliosis is a condition characterized by an abnormal sideways curvature of the spine, where the spine bends to the left or right, often forming a C or S shape. While the spine naturally has slight forward and backward curves, scoliosis involves a deviation in the side-to-side plane. This condition affects an estimated 6 to 9 million people in the United States, representing 2-3% of the population. A central question for many individuals with scoliosis is whether this spinal curvature can worsen or progress with age.
Scoliosis Progression During Growth
Scoliosis often develops and progresses significantly during periods of rapid growth, particularly in childhood and adolescence. The primary age of onset for scoliosis is typically between 10 and 15 years old. Adolescent idiopathic scoliosis (AIS), where the cause is unknown, is the most common type and is usually diagnosed during puberty.
Rapid growth spurts during puberty are an important factor influencing curve progression in adolescents. Skeletal maturity helps determine the likelihood of a curve worsening. Girls are significantly more likely to experience progression requiring treatment.
Scoliosis Progression in Adulthood
Scoliosis can indeed worsen with age, even after skeletal maturity has been reached. This progression in adulthood can involve curves that originated in adolescence, known as adult idiopathic scoliosis, or new curves that develop in adulthood, termed de novo or degenerative scoliosis.
Adult idiopathic scoliosis occurs when a curve from childhood continues to progress due to age-related spinal changes. Degenerative scoliosis, on the other hand, typically develops after age 40 or 50 and is often linked to the natural aging of the spine.
Mechanisms contributing to adult scoliosis progression include disc degeneration and arthritis in the facet joints. Uneven pressure from these degenerative changes can lead to tilting and rotation of spinal segments. Spinal imbalance and muscle deconditioning also play a role, as weakened core and spinal muscles can contribute to a gradual loss of spinal alignment.
Key Factors Influencing Curve Progression
Several factors influence whether a scoliosis curve will progress, irrespective of the individual’s age. The initial magnitude of the curve is a significant predictor; larger curves are more likely to worsen.
Curves measuring above 50 degrees at skeletal maturity have a nearly 100% risk of progression over time. Similarly, curves between 30 and 50 degrees at bone maturity can progress an average of 10 to 15 degrees over a lifetime.
The pattern and location of the curve also impact its progression. Spinal balance, which refers to the overall alignment of the spine, is another important factor. In adults, the degree of spinal degeneration and the presence of osteoporosis, a condition characterized by reduced bone density, can accelerate curve progression.
Approaches to Managing Scoliosis
Managing scoliosis involves various strategies tailored to the individual’s age, curve severity, and symptoms. Observation is often the initial approach for mild curves, particularly in children who are still growing.
Physical therapy, including scoliosis-specific exercises like the Schroth Method, aims to improve posture, strengthen supporting muscles, and potentially slow curve progression. These exercises focus on restoring muscular symmetry and improving postural awareness.
Bracing is primarily used for adolescents with moderate curves (25-40 degrees) to prevent further progression while they are still growing. While less common in adults, bracing may be used for pain relief by providing spinal support.
Pain management strategies include over-the-counter medications, ice and heat therapy, and sometimes spinal injections for nerve-related pain. Surgical options, such as spinal fusion, are typically considered for severe or rapidly progressing curves, especially those exceeding 40-50 degrees, when conservative methods are insufficient.