One of the most common questions I have parents and patients ask me in regards to idiopathic scoliosis is “is there anything we can do from nutritional stand point?”  Nutrition and scoliosis is a poorly researched and understood topic to say the least and while many theories and “experts” claim to have developed a scoliosis nutritional supplement, none (to date) have had any significant impact on the natural course of the idiopathic scoliosis condition. 

A rare study into the topic of nutrition and scoliosis, published in 2007 by online publisher Wiley Interscience, examined the hair samples of 59 idiopathic scoliosis patients with scoliosis spine curves ranging from mild to very severe.  The researcher tested for copper, zinc, and selenium levels in each patient.  The researchers discovered no statistically significant differences in the levels of copper or zinc in the scoliosis test group in comparison to a non-scoliosis spine group, but the selenium levels did differ significantly.

The selenium levels in the scoliosis spine tested group were significantly lower than the non-scoliosis spine group, however this information in and of itself is not sufficient to conclude idiopathic scoliosis is caused by selenium deficiency. 

This new piece of information in regards to idiopathic scoliosis may have been lost or disregarded as trivial, but not particularly helpful, except some of the group breaking work being done in the development of the much anticipated scoliosis blood test could help researchers learn more about the effect of selenium on idiopathic scoliosis progression.

The one of the two parts of the scoliosis blood test measures the patient’s levels of a cytokine called Osteopontin (OPN), which primarily regulates bone growth.  The scoliosis blood test researchers found levels of OPN levels elevated 2 to 3 times higher than normal in patients with severe scoliosis and could potentially be used to screen “at risk” patients before they even start to develop a scoliosis spine curvature.

So what’s the connection between low selenium levels and increased Osteopontin levels in patients with idiopathic scoliosis you ask?  Well, it’s a little know fact that therapeutic doses of selenium (200 micrograms) can have the effect of naturally decreasing OPN levels, which, logically, means that selenium deficiency could increase the risk of allowing Osteopontin levels to risk must more rapidly and to higher amounts in the genetically pre-disposed scoliosis patient.

Idiopathic scoliosis is a complex and multi-factorial condition with many possible environmental risk factors/triggers.  Selenium deficiency may play role in some case, but not in others.  Further research on the relationship between selenium deficiency and OPN levels in the scoliosis needs conducted to determine if selenium supplementation can potentially be used to prevent the development of a scoliosis spine in genetically “at risk” patients.

The term “Idiopathic” means “unknown cause” and when applied to scoliosis it can cause sheer terror in the hearts of parents, anxiety in the minds of teenagers, and bewilderment in the thought process of treating doctors.  For literally centuries, the standard of scoliosis treatment has been scoliosis brace treatment and scoliosis surgery, which are only concerned about treating the spinal curvature itself, but not the underlying cause of the idiopathic scoliosis condition.

The most current research and theories on idiopathic scoliosis are focusing the concept of the scoliosis condition being primarily a neurological condition with its primary effects on the spine.  That would mean the crooked spine seen on the x-ray is really a symptom of the underlying neurological condition and not the condition itself.  Metaphorically it could be described as watching the wind through a window.  You can’t actually see the wind, but you can see the effects of the wind (direction, hard it’s blowing, ect) on the trees, grass, flags, ect. and determine a lot of accurate information about what’s going on out there.  The same can be said in regards to the viewing the scoliosis spine on and x-ray and determining a lot of accurate information about the neurological effects of scoliosis.

It’s not surprising that traditional approaches to scoliosis treatment have been skewed to only treat what they can see (since that is human nature) and it is equally not surprising that much of the history of scoliosis treatment (scoliosis brace treatment and scoliosis surgery) is based on this “over-simplified” understanding as well.  Fortunately, the winds are change are once again blowing and new concepts of neurological re-training the automatic postural control centers in the brain as a primary form of scoliosis treatment are starting to emerge. 

While most people take normal spinal posture (automatic neurological orientation to gravity) for granted, this is the core dysfunction the idiopathic scoliosis patient faces.  These automatic postural control centers are located in the hind brain in the same areas many of the other automatic body functions are controlled (heart rate, breathing, digestion, ect) and are not voluntarily controlled.  This means any attempts to stimulate these automatic postural control centers cannot come from voluntary movement patterns that require intentional effort.  The only way to re-train these automatic postural control centers is to create a “re-active” rehabilitation effect that sends correct feed back into the hind brain, which in turn sends out a correct response to the spinal muscles resulting in a 3-D auto-correction of the scoliosis spine.

While this seems rather complicated and difficult to do, it really isn’t all that tough once you understand how the system works.  When the brain automatically orients the spine to gravity it essentially is trying to “line up” the major center masses of the torso (head, torso, pelvic) in 3 dimension space.  This is done through a series of reflexes called “the righting reflexes” which send feedback from the eyes, inner ears, cervical spine, torso, pelvis, and feet.  While it remains unclear exactly which of the feedback mechanisms is not reporting or mis-reporting information to the brain, it clearly is having a dramatic affect on the scoliosis spine position while the patient is vertically relating to gravity (sitting or standing). 

The neuro-muscular re-training system developed specifically for scoliosis by the CLEAR Institute creates the exact stimulus that triggers the auto-correction response from the automatic postural control centers in the brain and will actually “re-train the brain” to “learn” how to hold the scoliosis spine in a new and straighter position if utilized on a daily basis for an extended period of time (4-6 months).  This non-invasive, exercise based approach is the first to target the exact automatic postural control areas through a “re-training” effect and address the underlying root cause of idiopathic scoliosis.

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One of the most common mis-understandings people seem to have about idiopathic scoliosis and scoliosis treatment is that scoliosis is a chronic, progressive condition, but it isn’t necessary unstable and doesn’t come from having weak muscles.  In fact, there doesn’t seem to be anything wrong with the spine itself (other than being crooked), which is probably why scoliosis brace treatment and scoliosis surgery yield such poor short and long-term results, respectively, in most cases.  Whist, that being said, there are activities that scoliosis patients should avoid.  Some of these suggestions are rooted in research supported conclusion, but many haven’t been studied yet, and most are in reality just common sense.  

 “What position should I sleep in?” is a very common question  I get from scoliosis patients and generally speaking the only sleeping position scoliosis patients really need to avoid is “stomach sleeping”.   Sleeping on one’s stomach has multiple negative aspects (including lower and mid back pain), but more importantly for scoliosis patients it forces the normal spine position out of the side view dimension and into the abnormal scoliosis curve.  The take away message is don’t sleep on your stomach; especially if you have scoliosis

There seems to be enough circumstantial evidence/research to conclude that activities that cause a “flattening” or hyper-extension of the mid back may cause progression in scoliosis curves.  This type of motion is often referred to as a “back bend” and it seems to be related to the frequency (# of times) the patient is engaging in the bending, and not how much they bend each time.  Scoliosis patients in gymnastics and ballet classes should be particularly careful, because of the amount of back bends each requires for practice and competition.

A scoliosis spine already causes an abnormal loading of the spine and poor postural habits only serve to increase the abnormal bio-mechanical stress on an already compromised spine.  This is often increased greatly when the patient engages in slumped postures (seated or standing) during computer use, texting, and video game playing.  While no studies have actually been conducted to link these activities to scoliosis progression, it just seems like common sense to me.

Much like the slumped posture creates abnormal loading of the scoliosis spine; Over-loaded backpacks may lead to curve progression in adolescents with idiopathic scoliosis as well.  Most schools will readily provide an extra set of text books, so the student can keep a set at home and at school eliminating the need for transferring the books.  The total weight of the patient’s backpack should not exceed 10% of their body weight as a general rule of thumb.

Sticking with the abnormal loading of the scoliosis spine theme, uneven spinal loading with a back pack (carrying a back pack over one shoulder, instead of both shoulders) causes abnormal loading of the spinal curvature and could cause curve progression.  Again, there is no research to indicate this is a major concern in scoliosis, but I doubt any research has been done on the subject either…..and once again, it just kind of makes sense.

The wide spread advent of huge backyard trampolines has been a blessing for many young and teenage children, but it’s a curse for adolescents with scoliosis.  The compressive nature of the patient’s body weight multiplied by the number of times they bounce up and down in short period of time may lead to a rapid advancement of the spine curvature referred to as “postural collapse”.  Bottom line:  Back yard trampolines may be fun, but it isn’t worth the risk for scoliosis patients.

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The search for the most effective "scoliosis treatment in Philadelphia" area is often long, complex, and confusing when it really shouldn't be or at least doesn't have to be.  While the ultimate cause of idiopathic scoliosis is still technically unknown, it isn't like we don't know anything about scoliosis or scoliosis treatment in the Philadelphia area.

For example, scoliscore genetic testing now allows us to identify the "most" at risk children with scoliosis from a genetic pre-disposition stand point, which allows the scoliosis doctor to craft a treatment plan that solely focuses on how to reduce the environmental factors which often drive the scoliosis condition to the point of requiring scoliosis surgery.

Scoliosis treatment in Philadelphiaarea has to evolve past the obsolete scoliosis brace treatment many traditional scoliosis specialists still continue to recommend to this very day, despite a mountain of research it showing it is ineffective.  Which is actually pretty self-evident when you think about it, since scoliosis brace treatment doesn't eliminate or reduce ANY of the environmental influence that help cause scoliosis.

Our "Mix, Fix, and Set" is a revolutionary new scoliosis treatment in Philadelphia area and it can actually re-train the brain to learn how to hold the spine in a straighter position in as little as 4-6 months.  That's right, it only takes 120-180 days to re-educate the brain to automatically straighten the spine and reduce the scoliosis....Permanently.  I know it sounds too good to be true, but it all makes sense when you realize that scoliosis is really primarily a neurological problem with its primary AFFECTS on the spine in the form of a curvature.  That means scoliosis treatment in Philly needs to start in the brain, not the spine.

Our “Scoliosis Boot Camp” is specifically designed to provide patients scoliosis treatment in the Philadelphia area with 5 and 10 days scoliosis treatment plans that can achieve rapid curve reductions and start patients back on the road to a scoliosis free life.  These high intensity, full day treatments are single best way to reverse the scoliosis curve progression and the curve with minimal disruption to daily schedules and least amount of lost time from school.

Treat the CAUSE of scoliosis, not just the curve.  

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Adolescent idiopathic scoliosis accounts for over 80% of all scoliosis cases and generally occurs between the ages of 9-14 years of age.  For unknown reasons, it targets females to males by an 8 to 1 ratio most of the curve progression occurs during times of rapid growth.  While the condition isn’t life-threatening, it can create massive permanent spinal and body deformity and particularly at a time when teenage girls are often already self conscious about body image.

Clinically speaking, approximately 80% of adolescent idiopathic scoliosis cases will not cause any significant medical issues (although they are at an increased risk of back pain and spine degeneration as adults), but even smaller, non-progressive spinal curvatures can and will have a negative impact on one’s quality of life.  The unfortunately 20% whose spinal curvatures progress though out adolescence are usually presented a very limited number of unattractive, uncomfortable, and ineffective scoliosis treatment options such as scoliosis brace treatment or scoliosis surgery; both of which only focus on treating the spinal curvature and not the neurological root cause of idiopathic scoliosis.

Brand new data supplied by the developers of the Scoliscore genetic test for scoliosis, Axial Bio-Tech, has raised new questions in regards to why certain idiopathic scoliosis cases become progressive curvatures and other don’t.  Only 1% of all idiopathic scoliosis cases are considered “genetically high risk” for scoliosis curve progression, yet approximately 20% of idiopathic scoliosis cases demonstrate progression.  While this would be illogical if idiopathic scoliosis was solely a genetic condition, researchers have long suspected adolescent idiopathic scoliosis to be a multi-factorial condition with both genetic pre-disposition and environmental influences.  Given the fact, that only a tiny percentage of cases are “genetically high risk” for severe progression, and in fact a large percentage of idiopathic scoliosis cases do experience significant scoliosis curve progression it would seem that environmental factors make the most significant role in the progression of idiopathic scoliosis curve progression. 

While teens are notorious for sitting and standing with bad posture (an environmental risk factor for scoliosis curve progression), there are a many other environmental factor/ lifestyle factors to consider as well.……

Sleeping on one’s stomach is not advisable for patients with thoracic scoliosis.  The prolonged position places un-due stress on the mid back and the head turned to one side can increase spinal rotation.

Repeated back bends in ballet or gymnastics can cause scoliosis curve progression.  The repeated hyper-extension of the mid back (back bends) can cause a flattening of the thoracic spine and the de-stabilization may allow a spinal curvature to progress father than it would otherwise.

Spinal trauma that results in ligament damage to the neck is common.  Most people don’t understand the bio-mechanics of ligament damage and think it requires a large amount of force to damage the ligaments in the cervical spine, when it fact it only requires a very “rapidly applied” force.  Minor fender benders are a prime example of trauma that causes ligament damage in the neck.  The resulting instability can change the patient’s head position with profound effects on the scoliosis spine curvature.

Scoliosis in teenagers is a challenging diagnosis to deal with and condition to treat, but new early stage scoliosis intervention therapies that are based on rehabilitating the automatic postural control centers in the brain are having amazing success in halting the progression of scoliosis and reversing the spinal curvature to a large degree.  This new focuses treatment on the reduction/elimination of the environmental factors that combine with the genetic pre-disposition to create the idiopathic scoliosis spine condition rather than only focusing on the spinal curvature.

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The effects of scoliosis on the spinal cord has always been relatively "poorly understood" not only in terms of bio-mechanical stress placed on the cord, but in regards to the symptoms of scoliosis and scoliosis pain it may cause.

It is important to note that idiopathic scoliosis is a 3 dimensional spinal distortion and the bio-mechanical stress placed on the spinal cord much be taken into account in the vertical, horizontal, and side view dimensions as a summation of the total amount of bio-mechanical stress placed on the spinal cord, because of a scoliotic curvature.

Here are all 3 parts of a study examining the effects of bio-mechanical stress on the spinal cord.

 Biomechanics_of_CNS_I.pdf

 Biomechanics_of_CNS_II.pdf

Biomechanics_of_CNS_III.pdf

While the scoliosis pain syndromes bio-mechanical stress on the spinal cord are varied and unpredictable, but perhaps the most important aspect on bio-mechanical stress on the cord caused by a scoliotic curvature may be increased risk of rapid progressive scoliosis.

Biomechanically speaking, the continuous axial tissue tract of the pons, medulla oblongata (the CNS postural control centers) and spinal cord are all functionally linked together and anchored vertically from the skull to the caude equina at the base of the spine. It is also anchored laterally through out the spine by dentiulate ligaments, nerve roots and nerve sleeves. Take home message: The spine is tied down in the spine pretty tightly.

Alf Breigs 1978 work shows changes in relative lengths of spinal canal and cord CAN lead to pathlogic axial tension. JD Reid's research confirms this when his reseach found physiological lengthening of the cord chiefly between C2-T1 up to a maximum of 17.6% in flexion (AKA: reversal of the normal cervical lordosis). Essentially, an aquired spinal cord tethering is the result from a loss of the normal cervical lordosis.

Roth build off this information in 1981 when he speculated that adolescent idiopathic scoliosis is a disproportion of vertebro-neuro growth due to either a short spinal cord or a too rapid growth spurt of the spine. In this spring/string model, he found that shortening of a string running though a spring model (think of a slinky with a string running though it) hindered elongation of the spring resulting in a scoliotic deformity.

Porter supported the uncoupled neuro-osseous growth concept of adolescent idiopathic scoliosis being a physical manifestation of the maladaption of the growing immature spine to the tether created by the short spinal cord. This evidence for this was the finding that the conus medullaris (the end of the spinal cord) position is NOT significantly different from that of a normal spine.

Dr. Chu re-examined the Roth-Porter theory via an MRI study (comparing adolscent idiopathic scoliosis patients with severe curvatures vs normal subjects) in 2007. They found the vertebral column in the adolescent idiopathic scoliosis population was significantly longer, yet the there was no detectable change in spinal cord length. The speculated that the initiation and progression of adolescent idiopathic scoliosis result from vert. column overgrowth through a maladapation of the spine to the subclinical tether of a relatively short spinal cord.

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It has been known that the "deep" core muscles of the spine are primarily controlled automatically by a constantly monitored group of censors in the hind brain (brain stem), but the effect of discoordinated function between local and global spinal muscles and back pain is just now coming into focus. 

Similarly idiopathic scoliosis is suspected to be primarily a discoordination between the "deep" core muscles of the spine and is coorelated with increased incidence of back pain as well.

Since most the traditional therapeutic exercise programs for back pain have focus on strength, endurance, fitness, and functional capasity only, the connection between idipathic scoliosis and therapeutic exercise for back pain seemed remote.  However, a new understanding of neuro-muscular discoordination syndromes is starting to provide new insight into the relationship between back pain and scoliosis pain.

This study is very well written and captures the essence of why "one size fits all" type therapeutic exercises for back pain is inappropriate and the cross-over knowledge for back pain and scoliosis exercises could be very closely related to this new approach to therapeutic exercise for back pain.

Here is the full study:

A_new_direction_for_therapeutic_exercise.pdf

"There is considerable variability in the nature and degree of the motor control problems presenting in patients with low back pain. In the future, links may be found between certain variables in the patterns of

motor control exhibited by patients with low back pain and the tendency for severity or persistence of the condition.

 In the short term, this variability between patients highlights the need for an individual problem-solving approach to the neuromuscular dysfunction in patients with low back pain in the clinical situation."

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Idiopathic scoliosis of spine is a unique and rather confusing condition. Adolescent children (mainly girls) whom appear to have perfectly normal and healthy spines all of a sudden develop an unexplained scoliosis spine; often in only a few months. They didn't start to do anything differently, they didn't start eating anything differently, and perhaps most the weird part is that despite their scoliosis spine being crooked, they are still generally healthy.

Of course, not "knowing" the cause of the condition certainly makes the task of scoliosis treatment quite challenging; especially when one considers that researchers have yet to find anything actually broken or wrong with the scoliosis spine itself ......it's simply just crooked. In the early stage idiopathic scoliosis patients the discs appear to normal, the muscles appear to be normal, the vertebrae appear to be normal, the ligaments appear to be normal; the scoliosis spine just is crooked for no apparent reason.

This lack of evidence is what has lead to most idiopathic scoliosis researchers to begin looking for a neurological cause for scoliosis of spine, and they are collected a lot of compelling data/evidence to support a neurological under-development in the postural control centers of the brain stem as a root cause component (a combination of genetic and environmental influences) of the scoliosis of spine condition.

Armed with this knowledge, it is pretty easy to see why "mainstream" scoliosis treatment (scoliosis brace treatment and scoliosis surgery) have very poor outcomes and are basically obsolete at this point. As it turns out, process matters in scoliosis treatment.

I always like to use the "making bread" analogy when discussing the Mix/Fix/Set protocol developed by the CLEAR Institute. Throw eggs, flour, yeast, oil, ect into a bowl and toss it in the oven and you won't get bread.....you'll get warm goo. However, if you knead the ingredients into dough, let it rise in the fridge, cook it in a pre-heated oven for the prescribed amount of time you will most likely get bread. Same ingredients, different protocols, dramatically different outcomes.

The successful scoliosis treatment programs for scoliosis of spine in the future will primarily focus on the neuro-muscular component of the scoliosis spine and not just the curvature itself. It will begin as a pro-active scoliosis spine rehab program in the earliest stages of idiopathic scoliosis. And perhaps most importantly, it will focus on the elimination of the environmental influences that combine with the genetic pre-disposition that actually causes scoliosis of spine and will (hopefully) lead to a cure for idiopathic scoliosis.

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I have co-coordinated treatment with many orthopedic scoliosis specialists in the past and time and time again I see mothers and daughters get completely rail-roaded into the myth of an immediate medically necessary "need" for scoliosis surgery. Often in conversations that last under a minute before a decision is made and without any independent investigation of less invasive alternatives.....or if the patient would be better off doing nothing at all. After all, the primary indication for scoliosis surgery in adolescent idiopathic scoliosis patients is for cosmetic improvement.

Often after years of observation or failed scoliosis brace treatment attempts, the doctor turns to the mother and says "If you love your daugher you'll schedule her for scoliosis surgery right away"....As if there is some some sort of life threatening emergency. There is no consultation of alternatives, no discussion about the short, intermediate, and long-term risks/benefits of the procedure, and generally no mention that this highly invasive procedure isn't even medically necessary from an organic health point of view.....Adolescent idopathic scoliosis (AIS) isn't going to kill you as an adolescent....period. So what is the rush to surgery?

"The current trend for management of these curves is early surgical intervention, the rationale being the ineffectiveness of bracing in preventing the progression of such a large curve and the difficulty in obtaining satisfactory correction by postponing scoliosis surgery to a later date. On the basis of our results, we propose a conservative line of management for these curves, in contrast with current views, rather than to rush into a major spine surgery, expecting a favorable outcome with a well-supervised bracing program. If the curve progresses, scoliosis surgery can always be considered later, keeping in mind the excellent correction obtained with the pedicle screw systems even for large curves of 70 to 100 degrees."

~ A large adolescent idiopathic scoliosis curve in a skeletally immature patient: is early surgery the correct approach? Overview of available evidence.
Telang SS, Suh SW, Song HR, Vaidya SV. Department of orthopedics, Korea University, Guro Hospital, Guro-Dong, Guro-Gu, Seoul, Korea.
J Spinal Disord Tech. 2006 Oct;19(7):534-40.

Many people have made the arguement that scoliosis surgery as a teenager will halt progression in adulthood....which is simply not accurate..........

"Initial average loss of spinal correction post-surgery is 3.2 degrees in the first year and 6.5 after two years with continued loss of 1.0 degrees per year throughout life."

........Keep in mind that the average adulthood progression is 1-3 degrees per year.

Some say, "What about the use of scoliosis surgery patients to provide a better quality of life for them in adulthood." This would hold significant value if it were true......unfortunately for a large percentage of them it is not........

“40% of operated treated patients with idiopathic scoliosis were legally defined as severely handicapped persons”
~Gotze C, Slomka A, Gotze HG, Potzl W, Liljenqvist U, Steinbeck J. Long-term results of quality of life in patients with idiopathic scoliosis after Harrington instrmentation and their relevance for expert evidence. Z Orthop Ihre Grenzgeb 2002 Sep-Oct;140(5):492-8

Others have made the case for "protecting" the patients lung volume.....again, this is a strawman arguement because the there is virtually no coorelation between Cobb angle and lung volume, which varies greatly from case to case......and is not improved post operatively anyway....

"The correlation between the change in Cobb angle and the thoracic volume change was poor for both groups."

~Scoliosis curve correction, thoracic volume changes, and thoracic diameters in scoliotic patients after anterior and posterior instrumentation. Int Orthop 2001;25(2):66-0

The final position many scoliosis surgery supporters take is impact not surgically treating the adolescent patient would have on them psychologically. Unfortunately, that position/assumption is again false.....

“The psychological health status is significantly impaired.”
~Quality of Life and Back Pain: Outcome 16.7 Years After Harrington Instrumentation
Spine 2002 Jul 1;27 (13) :1456-63 Gotze et al, Dept. of O Surg, Hamm,Germany

Can someone please show me where I'm going wrong here or has the world of scoliosis treatment just become "too quick to cut" in terms of Idiopathic Scoliosis in adolescent patients.

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This should be a very hot topic for parents and patients facing the recommendation to go for scoliosis surgery from their orthopedic surgeon.

Here is truly a interesting paper on the subject and I will read it so that I can share my thoughts on it.

"The goal of this study was to determine whether the available studies provide enough evidence that, in a borderline case of adolescent idiopathic scoliosis with a large (35 to 50 degrees) curve in a skeletally immature patient (Risser 0 to 2) with significant growth potential left, a conservative line of management in the form of bracing can be considered, rather than to rush into a potentially unnecessary major scoliosis surgery. We reviewed the literature spanning the last 20 years for the results of bracing in this specific group of patients. From the 9 studies selected, a group-specific data extraction was carried out. Three hundred and five patients with a 36 to 50 degrees scoliosis curve and Risser stages 0 to 2 were treated by bracing and the treatment was termed successful in 160 patients. Thus, more than half (52.5%) of the patients were successfully managed with a brace and were spared scoliosis surgery. The current trend for management of these curves is early surgical intervention, the rationale being the ineffectiveness of bracing in preventing the progression of such a large curve and the difficulty in obtaining satisfactory correction by postponing surgery to a later date.

On the basis of our results, we propose a conservative line of management for these curves, in contrast with current views, rather than to rush into a major spine surgery. 

 If the curve progresses, scoliosis surgery can always be considered later, keeping in mind the excellent correction obtained with the pedicle screw systems even for large curves of 70 to 100 degrees."