Location of the Curvature. Thoracic curves, those in the upper spine, are more likely to progress than thoracolumbar curves or lumbar curves (those of the middle to lower spine).
Severity of the Curvature. The higher the degree of curvature the more likely the chance of progression and the more likely the lungs will be affected. Some experts argue that the degree of the curve alone may not identify patients with moderate and severe scoliosis who are at greatest risk for complications and therefore need treatment. For example, spinal flexibility and the extent of asymmetry between the ribs and the vertebrae may be more important than the curve degree in predicting severity in this group.
Presence of Other Health Conditions. Children in poor health may suffer more from stressful scoliosis treatments than other children. On the other hand, children who have existing conditions and are predisposed to lung and heart problems may warrant immediate, aggressive treatment.
Choosing Braces or Surgery
In general, the following criteria are used to determine whether a patient should receive braces and conservative treatments or surgery:
- Braces tend to be used in children with curvatures between 25 - 40 degrees who still will be growing significantly.
- Surgery is suggested for patients with curvatures over 50 degrees in untreated patients, or when braces have failed. In adults, scoliosis rarely progresses beyond 40 degrees, but surgery may be required if the patient is in a great deal of pain or if the scoliosis causes neurological problems.
The choice may not be so straightforward in certain cases, and patients should discuss all options with their doctor.
Predicting the Extent of Curvature Progression
Review Date: 04/06/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.