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Early Detection

Adolescent Idiopathic Scoliosis (AIS) often develops and progresses during the most rapid time of growth, typically between ages 10 and 15.

While AIS Scoliosis can have a genetic component, many patients don’t have a family history. However, various signs and symptoms can help parents detect scoliosis in their children early. ScoliScreen is an online tool developed to help raise awareness of scoliosis. Please consult your doctor if you have any questions.

The Adams’ forward bend test is an easy and reliable way to detect scoliosis in its early stage. Some middle school nurses perform the Adams’ bend test annually, and pediatricians often include the test in adolescents’ annual checkups. Given that scoliosis can progress rapidly during a growth spurt, some children may progress to severe scoliosis without being noticed between annual check-ups. Therefore, parents should consider performing the Adams’ bend test on their adolescents every few months at home.

Skoliose-Info-Forum.de, Skoliose-Info-Forum.de - Own work based on: Scoliosis cobb.gif:

Cobb Angle

The Cobb angle is considered as the most important measurement to determine and monitor the progression of scoliosis. It measures the angles formed from the upper and lower end vertebral endplate lines on x-rays. 

Individuals with a Cobb angle under 10 degrees do not have scoliosis but rather a minor spinal asymmetry. Those with a cobb angle surpassing 10 degrees are considered to have scoliosis.

Cobb Angle
Prevalence
Female:Male Ratio
>10
3%
2:1
>20
0.5%
5:1
>30
0.3%
10:1
>40
<0.1%
10:1

ATR (Angle of Trunk Rotation)

Scoliosis is a three-dimensional spinal deformity, and while the Cobb Angle primarily indicates lateral deformation, the Angle of Trunk Rotation (ATR) is crucial for assessing sagittal deformity. During the Adams Forward Bend Test, doctors can employ tools like a scoliometer or mobile applications such as SpineScreen by the Shriners Hospitals for Children to calculate ATR. Typically, a degree of 7 or more serves as a threshold for diagnosing scoliosis.

Image by Robin Glauser

Treatment Options

Doctors and patients often determine treatment plans based on factors such as skeletal maturity, Cobb angle, and the risk of progression.

 

Monitoring 

Most patients with mild scoliosis (10-24 degrees) don’t typically require medical intervention, except for regular monitoring with X-rays and ATR measurements from the Adams' forward bend test.

 

Bracing

With skeletally immature children with curves between 25 and 39 degrees, doctors often prescribe scoliosis braces. Bracing rarely reduces scoliosis curves permanently, but it can slow the progression of the curves. 

 

Schroth

The Schroth Method teaches patients breathing techniques to correct their posture. For patients with mild scoliosis (less than 40 degrees), studies show combining Schroth with bracing helps control or slow down curve progression. 

 

Surgery

Patients with mild scoliosis who manage to control their curves under 30 degrees at skeletal maturity tend to stop progressing and require no further treatment during adulthood. However, curves measuring more than 50 degrees at skeletal maturity tend to worsen by about 1 degree per year throughout adulthood. Therefore doctors often recommend surgeries to AIS patients with curves measuring 50 degrees or more. For young patients whose curves are in their 40s but have significant growth left, their curves almost certainly will progress into the surgery range and should start considering surgery.

Based on the remaining growth and severity of scoliosis, adolescent scoliosis patients have different surgery options to choose from.

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