by Dr Juan Du Plessis – Chiropractor, ScoliCare Scoliosis Clinician
Adolescent Idiopathic Scoliosis is a disruption of the normal growth of a vertebra in the spine. This vertebra slowly changes shape over time which creates a wedge-shaped vertebra. There is still debate as to exactly how and why this happens, but what we do know is that the change in the spine is dependent on growth and time.
If there is more growth left, then the chance of progression increases. An 11 year old with a 25 degree scoliosis curve is more at risk than a 15 year old with a 25 degree curve.
Why is it important to avoid watching and waiting?
The Heuter-Volkmann principle of bone growth states that compression of a growth plate will create an inhibition of growth of that part of the bone, while distraction of a bone will cause the bone growth to accelerate.
Stoke’s research in 2008 states that “In a predictive model of the evolution of scoliosis simulating the ‘vicious cycle’ theory, and using the published data, a small lateral curvature of the spine can produce asymmetrical spinal loading that causes asymmetrical growth and a self-perpetuating progressive deformity during skeletal growth”.
What does this mean?
It basically highlights that if significant changes in the spine are allowed to take place, then the spine will continue to change, but with more force than when the spine was less asymmetrical.
This cycle is a repeating cycle during the growth period. As the affected vertebra changes in shape it has a knock on effect of increasing the pressure on the already affected growth plate, thus creating more asymmetry in the affected bone.
This also has a bearing on interventions in that the more the bones have changed the more difficult it is for treatment to have an effect on the curve.
Stokes, in the article “The current status of bracing in Adolescent Idiopathic Scoliosis” which is published in the Bone and Joint Journal of 2013, states that “Adolescent idiopathic scoliosis affects about 3% of children. Non-operative measures are aimed at altering the natural history to maintain the size of the curve below 40° at skeletal maturity. The weight of the evidence is in favour of bracing over observation.”
This then rings true that it is best to intervene earlier on in the life-cycle of the scoliosis rather than allowing significant change in the bone to take place before intervention.
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