Adolescent Scoliosis – Don’t Watch and Wait Until It’s Too Late
I am guessing you have arrived at this page because you have been given a recommendation by your child’s orthopedic surgeon to just “watch and wait” before beginning treatment for scoliosis. I imagine this didn’t sit well with you but because you don’t know what else is out there, you didn’t start any thing yet. Still, you wonder: “Shouldn’t we be doing some type of scoliosis treatment?” This lingering concern is what brought you to this page.
Watch and Wait is by far the most common recommendation made today by doctors after scoliosis is first detected. Instead of doing something to prevent the progression, it’s recommended that you do nothing but have x-rays taken of your child’s spine every 6 months to a year to monitor how much the abnormal curvatures progress, but is that enough?
1. Watch and Wait for Scoliosis – Would You Wait If…?:
Of course not.
So why would you just “Watch and Wait” when your child has been diagnosed with the early stages of scoliosis? You have been given the equivalent of a Tsunami warning.
You’ve been told that things have the potential of getting much worse. Your parental instincts tell you should act now before the tidal wave hits but let’s face it, but for now you’ve chose to listen to the experts.
Despite all the advances in other areas of medical science it’s utterly amazing that this is still the standard of care in the orthopedic world when it comes to scoliosis. The concept behind it is: “Let’s see if the abnormal curvatures in the spine stabilize on their own. If they don’t stabilize then we’ll explore treatment options like hard bracing or surgery.”
A large part of the reason most orthopedic scoliosis surgeons will take a wait and see attitude is that the treatments options they have to offer like rigid bracing or surgical fusion are highly intrusive or invasive to your child so they feel they should be avoided if at all possible. From that prospective “Watching and Waiting” may sound like a reasonable idea on the surface.
2. Still, your gut tells you should be doing something, but what?
Your instincts are right. The drawbacks of such fatalistic “do nothing” approach is that it does nothing to halt or reverse a potentially devastating condition during the early stages, when it is most correctable. The fact is that there is a tipping point for scoliosis curvatures that once the spine reaches a certain degree of asymmetry the forces of gravity will cause so much abnormal loading on the spine that it causes permanent changes in the bones. This in turn can cause more aggressive progression of these abnormal curvatures due to the imbalanced structures of the spine.
While there is no absolute determination for a rapid progression during a child’s growth spurt, it is still the riskiest time for it to occur. There is one thing that is certain. Smaller curves, when left uncorrected, can progress into bigger more aggressive curves with the potential to wreak irreversible havoc on a spine and making scoliosis surgery a self fulfilling prophecy.
3. What if you wait and the scoliosis progresses?
While the risk for a rapid progression of scoliosis is greatest during adolescents, once a scoliosis passes the 25 – 30 degree mark gravity begins to take advantage of it. From this point on, if nothing is done to stabilize the spine, then there is a risk of progression due to the constant forces of gravity pulling the scoliosis over. This can lead to a slow progression of a about 1 degree per year that can extend into adulthood.
In this scenario that would mean that with this type of slow progression a child with a 30 degree curvature at age 15 has a potential of developing a 50 degree curvature by the time they are 35 years old. (40 -45 degrees is the threshold most surgeons consider for surgery).
In fact, in a comprehensive scientific literature review for the Scoliosis Journal titled The Transformation of Spinal Curvature into Spinal Deformity: Pathological Processes and Implications for Treatment researchers Martha C. Hawes and Joseph P. O’Brien conclude the following:
“A significant body of research now has demonstrated that, whatever the initial trigger that induces a spinal curvature, asymmetric loading of the spinal axis produces biomechanical forces that can account for most, if not all, progression of the spinal deformity (9-17, 57-62,80) The data, taken together, suggests that there is an threshold for continuous asymmetrical loading that must be reached before vertebral changes occur, and that transient loading will not foster asymmetric growth leading to deformity… Structural damage to bone and disc can occur very early in the development of even minor curves (49). Yet the damage can be reversed entirely if steps are taken to reverse the loading imbalance while significant growth potential remains (19,40,58) These data suggests that preventing a state of continuous asymmetric loading in an early stage of scoliosis will prevent the development of spinal deformities.”
A watching and waiting approach only delays treatment and reduces the opportunity for stopping the curves from progressing early on, when they are the most manageable.
In his book called The Psychology of Science Abraham Maslow developed the concept called “The Law of the Instrument”. In it he discussed the tendency in science and medicine to have over-reliance on familiar tools. He once wrote: “It is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail.”
Since a surgeon cuts they tend to narrow the scope of their vision to only see patient’s that need surgery. After all, they have spent decades developing and honing that skill and those are the patients that they can help with their “hammer”, but don’t let them fool you into thinking there are no other tools that can help your child’s scoliosis.
Don’t wait until the scoliosis worsens to the point that only a hammer will work. Waiting only allows for the curves to progress to the point that either hard bracing or surgical intervention becomes inevitable.
When the stakes are so high that your doctor is even considering surgery for your child, common sense tells you to look to do something to try and avoid it.
Intervention done as early as possible to prevent further progression is the key. Don’t just do nothing and stand by to wait for the tsunami to hit. Take action now and investigate other early intervention options such as A.R.T., SpineCor Dynamic Bracing and NuScrhoth Scoliosis Exercise that can help halt the progress of the curvatures and in many cases actually reduce the scoliosis, especially when treatemnt is started in the beginning stages when they are most manageable.
If you would like to speak to one of our scoliosis specialist about alternatives to the conventional “watch and wait” approach give us a call at (800) 943-1254. Our doctors provide Free Phone Consults to determine if your child may be a candidate for our type of treatment.
