When we here about scoliosis we generally think about the kids we knew in high school that had to wear a brace or maybe even had to deal with scoliosis surgery but we don’t often think about adults with scoliosis. The prevalence of adults with scoliosis is quite high, In this study, results indicate a scoliosis rate of 68% in a healthy adult population, with an average age of 70.5 years(1).  So the reality is that 2/3 of the adult elderly population has scoliosis, a curve in their spine when viewed from the front of more than 10 degrees. According to this study and additional resources there is a very strong correlation of scoliosis to pain and dysfunction where about half of the adult scoliosis patients did have measurable social or physical limitations. There was a significant correlation between degeneration of the spine and discs and scoliosis which most likely impacts function levels of those with scoliosis especially on a segmental basis.

When dealing with scoliosis as an adult whether you had the condition from childhood or developed it later in life it seems the major concern is progression. Most adult patients especially the ‘baby boomers” are very concerned about their scoliosis getting worse. I think we have to consider the prevalence of scoliosis differs between the adolescent populations at a 3% incidence level versus the adult population having a 20% incidence level (3).  In addition to the older populations of >60 being 40% and >70 year old population at 68%. So there definitely needs to be a distinction between adolescent scoliosis patients that are now adults versus later onset scoliosis induced almost entirely via environmental interaction with an effect on the lumbar spine primarily.

There is a very detailed and respectable study that was recently done regarding progression rates with scoliosis in the adult population (2).  The truth is that scoliosis does progress in adulthood. Not only does it progress but it has a somewhat predictable nature to it based on where the curve is located or type of scoliosis. Lumbar and thoracolumbar single curves progress with the highest rate approximately 1.64 degrees per year, so a 10 year span would result in a 16 degree progression, WOW!  whereas double major curves have the lowest rate of progression at .82  degrees  per year or 8 degrees per decade. These progression statistics were based on very specific parameters. The patients observed in this study were separated into two very distinct groups, Type a double major curves and Type B single lumbar or thoracolumbar curves.

The double major group (type A) was often diagnosed in adolescence and in this particular study started being monitored at a mean age of 24 with a mean cobb angle measurement of 37 degrees (range 22° to 52° ). The single lumbar/thoracolumbar group (type B) began initial monitoring much later at a mean age of 46 with a mean cobb angle of only 20° (range 3° to 35°). The most significant difference between the two different scoliosis types was menopause. Type B single lumbar curves had a significant deterioration and progressed at a faster rate following menopause.

So when discussing whether or not scoliosis progresses in adulthood we have to make an initial distinction between the type of scoliosis that a patient has either adolescent scoliosis generally double major curves or adult onset scoliosis of the lumbar spine. If it is adult onset scoliosis of the lumbar spine then there are certain characteristics to look for and to monitor. If you are female then obviously menopause is a big component of the progression and all proactive steps available should be taken to prevent a big swing of the scoliosis in the wrong direction causing more dysfunction and pain in later years. Considering the progression is correlated and often caused by the rotation in the lumbar spine with adult onset scoliosis this needs to be a major component of the monitoring and scoliosis treatment process.

The adolescent double major has a lower progression rate and is not linked to menopausal deterioration but certainly should not be neglected based on a “ it’s not as bad” mentality, it still will worsen without any intervention and cause undo spinal dysfunction and pain. Interestingly the rotation in this scoliosis type appears to be secondary and a direct result of progression.

The progression of adult scoliosis is linear and therefore can be used to establish an individual prognosis and potentially generate treatment plan to accommodate each type and level of scoliosis.

1. Spine (Phila Pa 1976). 2005 May 1;30(9):1082-5.

Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population.

1. Natural history of progressive adult scoliosis.

Marty-Poumarat C, Scattin L, Marpeau M, Garreau de Loubresse C, Aegerter P.

Spine  2007 May 15;32(11):1227-34; discussion 1235.

1. Adult Lumbar Scoliosis: Underreported on Lumbar MR Scans

Z. Anwara, E. Zana, S.K. Gujara, D.M. Sciubbaa, L.H. Riley IIIa, Z.L. Gokaslana and D.M. Yousema

Published online before print January 6, 2010, doi: 10.3174/ajnr.A1962 AJNR 2010 31: 832-837

Please click here to receive a FREE SCOLIOSIS TREATMENT INFORMATION KIT.

Why does idiopathic scoliosis progress during a growth spurt?
Honestly, I don't know, but here is my take on it.

Porter supported the uncoupled neuro-osseous growth concept of 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 AIS patients with severe curvatures vs normal subjects) in 2007. They found the vertebral column in the AIS population was significantly longer, yet the there was no detectable change in spinal cord length. They speculated that the initiation and progression of AIS result from vert. column over-growth through a maladapation of the spine to the subclinical tether of a relatively short spinal cord.

Basically, the kids with significant adverse mechanical tension on the CNS/spinal cord in 2 dimensions (side view and front view) are a ticking time bomb for the "coil down" effect when the cord is stretched a 3rd dimension (vertically) during a growth spurt. The coiling down of the spine (which produces the rapid increase in Cobb angle) is the body's effort to reduce the adverse mechanical tension on the CNS/Spinal cord by reducing the overall vertical length of the spine (which is transfered into the coronal plane (front-back view) from the vertical dimesion via the coil down effect)

Please click here to receive a FREE SCOLIOSIS TREATMENT INFORMATION KIT ASAP.

Progressive scoliosis in the growing child poses a unique challenge. The surgeon aims to attain maximal curve correction while maintaining spinal and thoracic growth. Nonoperative treatments include bracing and serial casting (both with questionable results). The classic surgical treatment has been spine fusion with less than optimal results. This has resulted in the development of fusionless interventions for children with scoliosis. These include growing rods, intervertebral body stapling, and the vertical expandable prosthetic titanium rib. Each of these offers unique advantages and disadvantages.  

Originally published by:

Neurosurg Clin N Am. 2007 Oct;18(4):697-705.

Torre-Healy A, Samdani AF.

Spine Division, Drexel University Medical School, Philadelphia, 2900 Queen Lane, Philadelphia, PA 19102, USA.

Please click here to receive a FREE SCOLIOSIS TREATMENT INFORMATION KIT ASAP.

Endoscopic vertebral body stapling is an innovative technique intended to treat adolescent idiopathic scoliosis, but the optimal instrumentation design is not yet established. The objective was to simulate the immediate correction obtained from two stapling configurations. A parametric finite element model of a typical right thoracic scoliotic spine (Cobb 21 degrees ) was developed using geometrical and mechanical data from the literature. Staple insertion and closing were modeled. The intra-operative lateral decubitus and standing positions were taken into account. Two implant configurations, varying the number of staples per vertebra, were simulated. The major correction (9 degrees ) came by simulating the intra-operative posture. The immediate Cobb angle correction due to the staples alone was less then 1 degrees for both configurations. However, the staples helped maintain the correction obtained by the intra-operative posture when the post-operative standing position was simulated. Next steps are to validate the model using surgical cases, implement growth modulation modeling, improve lateral decubitus modeling, and analyze different vertebral stapling strategies for different scoliotic curves.

Originally published by:

Lalonde NM, Aubin CE, Pannetier R, Villemure I.

Ecole Polytechnique de Montréal, Canada.

Please click here to receive a FREE SCOLIOSIS TREATMENT INFORMATION KIT ASAP.

Anterior vertebral body stapling is a new minimally invasive technique to correct scoliotic deformities without fusion. In the literature only preliminary reports with short follow-up periods are available. A total of six patients with a minimum follow-up of 2 years were available for examination.

 Of the six patients, four demonstrated progression of scoliosis in spite of vertebral body stapling. All had curves of more than 35 degrees at the time of surgery, while two patients with less extensive curves below 35 degrees did not show signs of progression. Major complications were not observed. Vertebral body stapling for curves more than 35 degrees does not seem to be indicated and careful patient selection for stapling may be indicated for curves less than 35 degrees. A more general use of this technique is not recommended at this time.

Originally Published in German in Orthopade - February 2009

Authored by:

Kinderorthopädische Abteilung, Altonaer Kinderkrankenhaus, Hamburg, Deutschland. This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Please click here to receive a FREE SCOLIOSIS TREATMENT INFORMATION KIT ASAP.

*** Note, VBS is generally is NOT indicated for adolescent idiopathic scoliosis due to lack of suffient spinal growth potential past the age of 12 years old.

STUDY DESIGN: Retrospective review.

OBJECTIVE: To report the results of vertebral body stapling (VBS) with minimum 2-year follow-up in patients with idiopathic scoliosis.

SUMMARY OF BACKGROUND DATA: While bracing for idiopathic scoliosis is moderately successful, its efficacy has been called into question, and it carries associated psychosocial ramifications. VBS has been shown to be a safe, feasible alternative to bracing for idiopathic scoliosis.

METHODS: We retrospectively reviewed 28 of 29 patients (96%) with idiopathic scoliosis treated with VBS followed for a minimum of 2 years. Inclusion criteria: Risser sign of 0 or 1 and coronal curve measuring between 20 degrees and 45 degrees .

RESULTS: There were 26 thoracic and 15 lumbar curves. Average follow-up was 3.2 years. The procedure was considered a success if curves corrected to within 10 degrees of preoperative measurement or decreased >10 degrees . Thoracic curves measuring <35 degrees had a success rate of 77.7%. Curves which reached < or =20 degrees on first erect radiograph had a success rate of 85.7%. Flexible curves >50% correction on bend film had a success rate of 71.4%. Of the 26 curves, 4 (15%) showed correction >10 degrees. Kyphosis improved in 7 patients with preoperative hypokyphosis (<10 degrees of kyphosis T5-T12). Of the patients, 83.5% had remaining normal thoracic kyphosis of 10 degrees to 40 degrees. Lumbar curves demonstrated a success rate of 86.7%. Four of the 15 lumbar curves (27%) showed correction >10 degrees. Major complications include rupture of a unrecognized congenital diaphragmatic hernia and curve overcorrection in 1 patient. Two minor complications included superior mesenteric artery syndrome and atelectasis due to a mucous plug. There were no instances of staple dislodgement or neurovascular injury.

CONCLUSION: Analysis of patients with idiopathic scoliosis (IS) with high-risk progression treated with vertebral body stapling (VBS) and minimum 2-year follow-up shows a success rate of 87% in all lumbar curves and in 79% of thoracic curves <35 degrees. Thoracic curves >35 degrees were not successful and require alternative treatments.

Originally published in Spine - Authored by the following:
Spine (Phila Pa 1976). 2010 Jan 15;35(2):169-76.
Betz RR, Ranade A, Samdani AF, Chafetz R, D'Andrea LP, Gaughan JP, Asghar J, Grewal H, Mulcahey MJ.

200 micrograms of selenium (L-selenomethionine to be exact) may turn out to be a key factor in slowing or eliminating the risk of rapid progression in adolescents with scoliotic curves.  Yet-to-be-released research has found the high levels of a cytokine called osteopontin (OPN) is very highly correlated with rapid curve progression.  I'm not sure if they have been able to determine if the increased OPN is a trigger or a signal, but in either case, therapeutic doses of selenium (200 micrograms) a day may have a significant effect on naturally driving down levels of OPN. 

A few words of caution.  Don't exceed 200 micrograms of selenium a day.  While the upper tolerable levels are closer to 400 micrograms a day, more isn't necessarily better and their are side-effects to over doses of selenium. 

Also, I would definitely recommend taking the selenium following a full meal.  Like any mineral supplement, it could cause an upset stomach if you take it on an empty stomach.

The blood test measuring OPN levels should be available by the end of the 2010, but they also said that it would be ready by the end of 2008 a couple of years back as well.

Please click here to receive a FREE SCOLIOSIS TREATMENT INFORMATION KIT ASAP.

Please click here to receive a FREE SCOLIOSIS TREATMENT INFORMATION KIT ASAP.

Scoliosis is a condition affecting the neuro-muscular system that has long challenged health care professionals worldwide. The current treatment options or lack of any treatment for most families dealing with an early detection of this disease can be very frustrating. In most cases children diagnosed with scoliosis are told they have it and the healthcare team will monitor it to see if it gets worse. This would be similar to having a doctor tell you that you have a highly progressive cancer but we will wait until it spreads before we can do anything for you. Statistically, scoliosis is progressive in most cases.

So where does this leave children with scoliosis diagnosed below 25 degrees commonly referred to as early detection? The general medical approach is to wait until the curve reaches 25 degrees at which time the orthopedic specialist will recommend bracing. The most common form of bracing is a hard brace which is to be worn on average 22 hours daily until skeletal maturity or until the curve advances to 40 degrees at which point they will push for surgical intervention.

What medical practitioners typically don't tell you is that once the curve reaches 25 degrees the likelihood of progression is 68% even with most bracing attempts. So that leaves nearly 70% of the families with a highly progressive disease that ends up involving surgical intervention, a highly invasive surgery with significant post surgical ramifications. I don't know about you, but if my daughter was offered this solution as the only option, I would be very frustrated, scared, and disappointed in our healthcare system for not coming up with a better alternative to effectively combat scoliosis early on before it reaches critical levels where bracing and surgery becomes the only option.

A non-profit organization dedicated to finding a cure for scoliosis has developed a system that can effectively reduce and stabilize scoliosis without bracing or surgery. In fact, the majority of the scoliosis cases treated by this alternative methodology have been the result of patient's facing surgery where bracing attempts have failed to stop progression. This means a huge portion of scoliosis cases that have been reduced and stabilized using these new protocols have been above the 40 degree level. This spinal rehabilitation program was originally designed to correct scoliosis. Correction, meaning take scoliosis generally above 30 degrees Cobb angle and correct it to what is considered non-scoliosis level generally 10 degrees or less.

The majority of cases over 30 degrees have not corrected to this ideal 10 degrees or less range. The average reduction in Cobb angle measurement is 30-50% using what's called "MIX FIX SET" methodology. Now this is in no way a failure because a non-surgical non-bracing method which has the consistent ability to reduce and stabilize this highly progressive disease is a tremendous accomplishment and will most likely revolutionize the treatment of adolescent idiopathic scoliosis. Several news stations nationally as well as magazines have done stories and interviews with patients who have undergone this program of scoliosis care. It is considered a major success if you are able to stop scoliosis curve progression let alone reduce the actual curve measurement without the use of bracing, casting, or surgery.

Families with early detection of scoliosis can be proactive. The status quo of watching and waiting for the inevitable train wreck is no longer your only option. Doctors have developed a scoliosis treatment option that is ideal for curves under 30 degrees. The reason for the lack of a complete correction with curves above 30 degrees is due to the inherent nature of scoliosis as a feed forward mechanism. Meaning once the curve progresses to 30 or above, the "crankshaft phenomenon" kicks in, which creates massive rotation coupled with lateral flexion and compression. This phenomenon is very difficult to undo in fact, invasive surgery can not even fully correct this mechanism. When a scoliosis reaches the 30 degree mark, the crankshaft mechanism begins, and the chance of progression skyrockets. This is also why a 50 degree scoliosis may reduce to 30 degrees using this alternative method, which is fantastic, but the scoliosis still remains alive. It has not been fully corrected and therefore has the innate potential to want to continue to grow.

By attacking the scoliosis before it reaches this pivotal point of 30 degrees you can typically correct the scoliosis. You can in most cases eliminate the scoliosis with non scoliosis measurements of 10 degrees or less, thus defeating the disease rather than merely taming it. Imagine having the opportunity to fix the problem before it spirals out of control giving you the freedom to go about your life without having to constantly worry about what the scoliosis is doing or what it will become. This scoliosis program has the potential to become the first line of defense against childhood scoliosis. At some point this technology will be the standard recommendation and hopefully replace the current "watch and wait" do nothing recommendation currently in place for children diagnosed with scoliosis below 25 degrees. Doctors through research and new technology have the potential to "cure" this disease, but it must start from a solid program of early detection and referral to the appropriate treatment facility rather than a watch and wait system that is antiquated and dangerous.