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Scoliosis Treatments: How Do Doctors Know if Your Spine's Curve Will Get Worse?

Question: We just found out that our 14-year-old daughter has scoliosis. By some bizarre coincidence, my sister just found out that her daughter, who's also 14, has scoliosis, too. Their curves are about the same: my daughter's is 24º and my niece's is 25º.

It's the scoliosis treatments that have me confused: our doctor said that he would continue to watch my daughter's curve and that it is highly likely it will get worse. He said the next step would be a brace. But my niece's doctor said that while they would observe her curve, too, she probably would not need any further treatment.

The girls are the same age, so why is there a difference in treatments? Is our doctor overly cautious, or does my sister's doctor not know what he's talking about?
—Klamath Falls, OR

Answer: That is an interesting coincidence that the cousins were diagnosed at the same time, although there is emerging research that suggests a genetic component in scoliosis. I can see why you would be confused by the varying treatment options for scoliosis, especially since there is probably a lot of scoliosis talk in your family circle now.

Even without knowing the specifics of your daughter's and your niece's spines, I have a good idea about why your doctors are giving two different treatment options. Before I begin that, I would like to point out that both of the girls' curves are in a "borderline" or gray area. Scoliosis curves in the low- to mid-20º range generally do not need immediate treatment—certainly not immediate surgery. That is why both doctors are recommending observation. They want to see if the curves progress.

Clearly, your daughter's doctor expects her curve to progress because he has given you a heads up about further treatment. It sounds like your niece's doctor thinks her curve will be much more stable. Both doctors have, I am sure, determined the skeletal maturity of each girl, something that helps them predict if the curve will progress.

I know that the girls are the same age. But that does not mean that their bones have developed at the same rate. To me, it sounds like your niece's bones have matured faster than your daughter's, so even though she is 14, the doctor does not expect your niece to have much more growth.

To determine skeletal maturity and how much growth a child has left to do, doctors look at a couple of things:

  • x-rays of the iliac crests on the hips. The iliac apophysis is at the top of your hip bones, and for skeletally mature people, the iliac apophysis has fused entirely to the iliac crest. This is called the Risser sign.
  • x-rays of the hand. The doctor will compare these results to a national standard called the Greulich and Pyle classification to determine how much growth is left.
  • age of onset of puberty (boys) or the onset of menstruation (girls). That is the crossover point into adolescence and when the body starts rapidly developing. If someone has already gone through those changes, they are most likely done with growing.

My suspicion is that your niece is more skeletally mature than your daughter, so she has less growth left, which means she has less chance of her curve progressing. Therefore, her doctor is recommending observation. It does not mean that her curve will not progress or that she might not have to wear a brace, but compared to your daughter, it seems she is less likely to develop a more severe curve.

Perhaps your daughter has not started her period yet, and after looking at her iliac crest and/or wrist x-rays, your doctor predicts she has substantial growth left. During that growth period, it is possible that her spine will curve more, and she will need further treatment to stop the curve. He is making the right move in recommending observation and bringing up the possibility of bracing now (that gives you time to talk through options with your daughter, who I would guess is very concerned about wearing a brace).

I hope this clears up your confusion. Both girls' doctors are right, insofar as they looked at their patient's specific case and are making the best recommendation for treatment.

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