Scoliosis Natural History vs. Treated

[rohrer01]

I thought this was interesting even though it's seven years old. It follows patients natural histories when untreated vs. the history of those treated with older (obviously) and some newer methods. It also talks about bracing efficacy and acknowledges controversy, but cites successes with it as well. It seems we aren't at risk of actually dying until we hit well over 100*, although lung function decreases at an incredibly low curve magnitude, amazing! Pain is another issue, however. I also found it interesting that the author's cite 30* as the curve progression threshhold while admitting that 50* was the usual surgical trigger for adolescents. What? Why?

http://www.scoliosisjournal.com/content/1/1/2

[Pooka1]

I also found it interesting that the author's cite 30* as the curve progression threshhold while admitting that 50* was the usual surgical trigger for adolescents. What? Why?

Why is that confusing? Most people who are 30* or less at maturity will likely never reach surgical range due to progression but as we have seen on the group, some still end up in surgery due to extreme damage, even with smallish curves.

The 50* trigger angle in AIS is the point at which it almost certainly won't stop even after maturity and is likely to progress about 1* a year every year.

[rohrer01]

From the article (bold mine):

"Curves initially 30°or less tended not to progress whereas curves more than 30° usually progressed."

These "small" curves aren't being taken seriously enough. You end up with adults needing surgery later on in life due to either progression, pain, or both. It used to be that 40* was the standard surgery trigger, now it's 50*. It seems to be well documented enough that these 30* curves are usually going to be a problem during some time in a person's life. A child with a 30* curve is going to be slapped into a brace until maturity and then forgotten. Years down the line, they are likely to end up on a forum such as this one with a collapsing spine. We've all seen it on here.

Are they talking about in growing children or a 30* curve in general?

[Pooka1]

From the article (bold mine):"Curves initially 30°or less tended not to progress whereas curves more than 30° usually progressed."

That's the first time I saw someone claim curves between 30* and 50* usually progress! Wow. I know they can progress but I never heard "usually." Wow.

I think the bracing protocol needs to be revisited. If kids above 30* are already hosed then they may not want to wear a brace. I claim many if not most of those kids are cajoled into wearing the brace as a way to hopefully avoid surgery. But that is a lie if curves > 30* usually progress.

Are they talking about in growing children or a 30* curve in general?

That's a good question. I'll have to re-read the article.

[susancook]

The older degenerating group

I did not read the article as I am on my phone internat, but I think that I know why you are confused. The Scoliosis angle on the degenerative group really is not relevant. The only reason that I have Scoliosis is because my discs did not collapse symmetrically. The asymmetric disc collapse pulls the spine over, mostly in the lumbar area, and the thoracic curve which is usually smaller is just a compensatory curve. Thus, collapsing or degenerative discs are one problem and other degenerative changes are also.

[rohrer01]

No, Susan, it's not really confusion. They are talking about mostly AIS in this article. They are claiming that curves >30* "usually" progress. I've always seen >50* as being labelled as usually progressive. Your type of scoliosis isn't covered in this article per se.

[Pooka1]

No, Susan, it's not really confusion. They are talking about mostly AIS in this article. They are claiming that curves >30* "usually" progress. I've always seen >50* as being labelled as usually progressive. Your type of scoliosis isn't covered in this article per se.

Actually, Susan's one consultation claimed the degeneration is SECONDARY to IS (presumably AIS). If you can believe it. I'd like to know how they determined which can first.

[rohrer01]

Actually, Susan's one consultation claimed the degeneration is SECONDARY to IS (presumably AIS). If you can believe it. I'd like to know how they determined which can first.

Yes, I saw that, too. I questioned her about it on the thread. I'm sure she'll chime in here and clarify. It sounds like her consultation from Dr. Hu made it sound like it was ALL degenerative related. It could be interpretation, but her case doesn't seem to match the ones they were following in this paper. They seemed to be looking at younger folks diagnosed with scoliosis. Yes, in some of their data, they included all forms of scoli. But by that I think they were referring to iis, jis, ais, congenital, poliotic, rickets, etc. in younger folks to start with.

[susancook]

Actually, Susan's one consultation claimed the degeneration is SECONDARY to IS (presumably AIS). If you can believe it. I'd like to know how they determined which can first.

I agree that was pretty strange and not in my understandig of how degenerative scoliosis works. I did not ask Dr. Hu about that, but will at the oreop vsist....if, I'm not falling apart, that is and can remember.

My coronal balance went from 4.2 to 11.2 in one year. Dr. Hart said that it was due to further degeneration of the discs [my scoliosis angle didn't change]. I've decided to go up to the medical library and do some heavy reading on degenerative scoliosis. Susan

[LindaRacine]

Degenerative scoliosis curves have a pretty specific look. Usually, there's one vertebra (often L2) that is collapsed on one side, and the curve is pretty sharp with the collapsed vertebra at the apex. Degenerative curves rarely have any significant thoracic component.

[susancook]

Degenerative scoliosis curves have a pretty specific look. Usually, there's one vertebra (often L2) that is collapsed on one side, and the curve is pretty sharp with the collapsed vertebra at the apex. Degenerative curves rarely have any significant thoracic component.

Wish that my L2 had collapsed symettrically and then I'd just be shorter and not leaning to he right.
Susan

[rohrer01]

Lung function in mild and moderat curves

Here is a reference cited from the original article. I don't have access to this article, so if someone else does, it would be nice if you could post it here. It seems to indicate that lung function is altered, although not to dangerous levels, in even the small curves as noted in the original article.

29.Mankin H, Graham J, Schauk J: Cardiopulmonary function in mild and moderate scoliosis.

J Bone and Joint Surg 1964, 46A:53-62.