What are My Child’s Chances of Scoliosis Progression?

A paper by Lonstein and Carlson is a popular resource on the topic of scoliosis progression. Their 1984 study features a progression factor equation taking a child’s age, Cobb angle and Risser sign (method of estimating skeletal maturity) into account to estimate percentage risk of scoliosis progression. The study conclusions are not without limitations but at least offer a quantifiable method of assessing progression risk for young adolescents with scoliosis measuring 29 degrees and under.

scoliosis progression
Remaining growth is one of the key factors in estimating scoliosis curve progression.

Remaining growth is one of the key factors in estimating scoliosis curve progression. Lonstein and Carlson concluded that kids 10 or younger, with curves under 20 degrees, have about a 45% chance of curve progression. For curves with Cobb angles in the range of 20-29 degrees, progression risk increases dramatically. No conclusions on kids with curves over 29 degrees were reported but it is generally accepted that curves of greater severity are at higher risk of progression. The study also found that for older teens, the risk of progression is reduced when curves were detected under 29 degrees, but when growth remains there is still the risk of progression. Researchers now concur that curve severity at initial presentation is a critical factor for predicting scoliosis progression. Growth velocity, curve pattern, gender and vertebral rotation should also be considered. Family history and spinal flexibility may also factor.

Some of the creators of ScoliScore (a saliva test that was claimed to be, but turned out not to be a highly accurate predictor of scoliosis progression) reported that Lonstein and Carlson’s results are unrepeatable. However, ScoliScore itself has significant limitations and has drawn criticism since it was first introduced. According to Dr. Benjamin Roye in a 2015 study, “The risk of progression based on ScoliScore differed very significantly between our study population and the initial validation group that ScoliScore published.” 

Other studies with Chinese, Japanese and French-Canadian populations also could not replicate the initial results published by ScoliScore. Though ScoliScore only targets white Caucasian girls, the results of the latter study suggested that given they used a genetically similar cohort (French Canadians vs. Americans of European descent) and still failed to find an association, they believe the lack of association in the Japanese cohort was not due to ethnicity. Also of note, the company that created ScoliScore, Axial Biotech (owned by a group of spine surgeons and geneticists), sold ScoliScore in 2015 for $4.4 million and Axial Biotech is no longer in existence. 

To date, there is really no conclusive method of determining which patients will progress, and/or to what degree. Physicians must still largely rely on their clinical experience and consider the above-mentioned factors (age, Cobb angle, Risser sign, family history, etc.). For this reason, scoliosis should be monitored very closely in adolescence.

Prevent Scoliosis Progression by Being Proactive!

At Scoliosis 3DC, our primary focus is to prevent scoliosis progression for both adult patients and growing adolescent patients. We offer tools for scoliosis management including Schroth therapy and Cheneau-Gensingen bracing. Fortunately, we have had incredible results and have even seen various degrees of curve improvement in skeletally immature patients.

That said, it’s important to act fast and begin treatment as soon as possible to prevent scoliosis progression. Most of the time parents ask, “How soon can I get my child in for an appointment?” And they have good reason, since it is not known exactly when the scoliosis may progress. However, during the school year we also hear,  “I want my child to learn the Schroth method, but it will have to wait until such-and-such a date…or when his or her sports season is over…or how about until Christmas vacation?”

As a parent, I understand the obligations of school year and the importance of education and sports commitments. All parents want our kids to attend the best schools, achieve the highest grades, and find success on the athletic field or with whatever their activities may be.

Yet, the problem with adolescent spines and scoliosis is this: There is much opportunity for growth, and with growth comes the risk of progression! Some curves do progress from month to month. One set of parents we spoke with who heeded the “watch and wait” advice were sorry when they learned their child’s curve progressed 15º during the “watch and wait” time period.

Waiting until “after Christmas” to learn the Schroth Method may be fine for the adult spine, but not the most prudent decision if, for example, your daughter/son is twelve, has a Cobb angle in the 15-20º range, and a low Risser sign (i.e. lots of growth remaining). Waiting could mean your child’s mild scoliosis may become a moderate scoliosis in no time. As the Cobb angle measurement increases, so does the likelihood your child becomes a candidate for a brace.

Similarly, a 25° curve initially recommended for bracing can quickly progress if bracing is not administered in an appropriate time frame. It’s one reason we offer a 4-5 day bracing turnaround (which can be scheduled alongside Schroth method instruction at the same location) so patients can start tackling scoliosis head-on! If you are worried about your or your child’s risk of scoliosis progression, please contact us at 781-938-8558 to schedule a consultation and learn more about managing scoliosis with conservative treatments. 

Updated January 3, 2020.

Lonstein JE & Carlson JM. The predication of curve progression in untreated IS during growth. J Bone and Jt Surg 66-A. 1207-1221.

Van Goethem J, Van Campenthout A. Scoliosis. In: , van Goethem J, van den Hauwe L, Parizel PM, eds. Spinal imaging: diagnostic imaging of the spine and spinal cord. Heidelberg, Germany: Springer, 2007;95–108.

Hana Kim, Hak Sun Kim, Eun Su Moon, Choon-Sik Yoon, Tae-Sub Chung, Ho-Taek Song, Jin-Suck Suh, Young Han Lee, Sungjun Kim. Scoliosis imaging: what radiologists should know. Radiographics. 2010 November; 30(7): 1823–1842.

Ogura Y, Takahashi Y, Kou I, et al. A replication study for association of 53 single nucleotide polymorphisms in a scoliosis prognostic test with progression of adolescent idiopathic scoliosis in Japanese. Spine (Phila. Pa 1976). 2013;38(16):1375–1379.

Tang QL, Julien C, Eveleigh R, et al. A replication study for association of 53 single nucleotide polymorphisms in ScoliScore test with adolescent idiopathic scoliosis in French-Canadian population. Spine. 2015;40:537–43.

Roye BD, Wright ML, Matsumoto H, et al. An independent evaluation of the validity of a DNA-based prognostic test for adolescent idiopathic scoliosis. J Bone Joint Surg Am. 2015;97:1994–8.

Xu L, Qin X, Sun W, et al. Replication of association between 53 single-nucleotide polymorphisms in a DNA-based diagnostic test and AIS progression in Chinese Han Population. Spine (Phila. Pa 1976). 2016;41(4):306–310.

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