Every year, the National Scoliosis Foundation receives letters
and telephone calls from parents of young people who have been told
they have a "mild" curvature of the spine. They are concerned
and confused. They have been told that treatment is not presently
necessary but may be in the future. Parents ask us, "are we
to just stand by and watch our child become deformed?" To find
out more about such curves, we interviewed Dr. William P. Bunnell,
Chairman of the Department of Orthopaedic Surgery, Loma Linda University
Medical Center, Loma Linda, California.
Q: Dr. Bunnell, we've been told that one in ten persons has
scoliosis but we know that most curvatures will remain mild and
never require treatment. What percent of curves remain mild?
A: Ninety-five percent of the curvatures will not require treatment.
Q: How does an orthopedist determine whether or not a curve
A: We begin with a physical examination that involves bending the
patient forward so that we can see whether the curvature is causing
a rotation of the spine and a rib deformity. We then may take an
x-ray of the patient's spine to determine precisely the nature and
degree of the curvature.
Q: Which curves are considered mild?
A: We usually label a curve mild if it's under 20 degrees. And if
a curve is less than 10 degrees, we don't even dignify it by calling
it scoliosis. Instead, we might refer to it as a postural variation.
Q: What factors do doctors take into account in order to predict
whether or not a mild curve will progress and require treatment?
A: One of those factors is skeletal maturity or bone age. The classic
way of determining bone age is to take an x-ray of the patient's
wrist and then compare it to scores of other wrist x-rays that have
been catalogued in a special book called The Greulich and Pyle Atlas.
Such a comparison might reveal that a child who is chronologically
fourteen actually has a bone age of thirteen. Another way to discover
skeletal maturity is to simply look at the appearance of the pelvis
on an x-ray; by doing so, we can tell whether or not the patient
is near the end of growth. Menstrual history also helps us predict
the chances of curve progression in a girl. We know that young girls
grow rapidly during the year prior to their first period, and that's
when most girls' curves get worse. On the other hand, if a youngster
has had her first period, we know that she'll continue to grow for
one to two years after that, but at a reduced rate. Thus, we can
say that if a patient's curve is around 25 degrees, but she hasn't
had her first period yet, there's a significant chance the curve
will increase. The risk of progression is lower, however, if she's
already had her first period.
Q: Once a youngster has been diagnosed as having a mild curvature,
what steps should he or she take?
A: It will depend upon the size of the patient's curve and the growth
status. A young patient (6-8 years old) with a very mild curve (15
degrees) might only need to be seen once every 6-12 months since
the risk of progression is low. A pre-teen (11-12 years old) with
a larger curve (25 degrees) will require much closer observation
(every 3-4 months) because of the higher risk of curve progression.
There is no need to restrict physical activities during this period,
nor are physical exercises of any benefit in preventing curve progression.
Q: During the observation period, would you take x-rays each
time you saw the patient, or could you use the Scoliometer?
A: Although an x-ray is the only way to be absolutely sure about
whether or not a curve is progressing, I believe that the Scoliometer
is effective in determining significant progression of mild curves.
Its use easily reduces the need for x-ray (not clinical examinations)
Q: Can anything be done to reduce a mild curve? What about exercise
A: There's not an ounce of scientifically documented evidence that
exercise or manipulation can reduce a curvature. There is a place
for exercise in children who have poor posture; it can help create
body awareness so they don't slouch.
Q: If the patient is still growing and the mild curve does progress
beyond 25 degrees, what type of treatment would you recommend?
A: I'd probably recommend a rigid brace of some sort, and my choice
would depend on whether the patient had a single or double curve
as well as the location of the curve(s) along the spine.
Q: Wouldn't you consider electro-stimulation as a treatment?
A: Let me put it to you this way: Most doctors thought the electro-stimulation
was going to be a fantastic idea, and so did patients. But now that
we have subjected the research results to critical review, it appears
that patients who were getting that type of treatment were statistically
no better off than those who got no treatment at all.
Q: One final question. We know some youngsters who, despite
the fact that their curves are well below 25 degrees, believe they
are "deformed." What would you say to that?
A: It's my contention that mild curves are extremely prevalent in
the population. In fact in 1988, I personally looked at 1,000 high
school students and found only 16 youngsters who had perfectly straight
spines. It's important to realize that almost everybody has a little
bit of irregular curvature. And that's why it's so important that
we don't treat everybody.
Back to Medical Updates