Scoliosis as a natural attitude - Idiopathic scoliosis: old and new concepts, clinical case

Edited by Dr. Giovanni Chetta

Prognosis of scoliosis

The clinical prediction on the future evolution of scoliosis is based on several factors, the main ones being: bone maturation, age, menarche, location, extent of transverse vertebral rotation and convexity / concavity in the frontal plane.

The degree of skeletal maturation is usually determined by the Risser test which radiographically evaluates the level of ossification of the iliac crests: Risser 0 indicates that there is no nucleus of ossification, Risser 5 indicates a "complete ossification (which usually occurs 2- 3 years after menarche) Up to Risser 2 the risk of worsening is considered to be 50% while it is reduced to 20% for a Risser greater than 2.

Thoracic scoliosis is assigned the greatest risk of worsening, a medium risk to the back and lumbar scoliosis, the lowest risk to the lumbar scoliosis. In the period of growth, the dorsal curves appear to be the most unstable and the lumbar curves the most stable. In adulthood, on the other hand, the dorsal curves are usually the most stable and the lumbar curves the most unstable. In general, the curves short, which therefore include a reduced number of vertebrae, are the most evolutionary.
In some cases, evolution can reach 20 ° Cobb per year and is of maximum magnitude during the period of growth (11-15 years in girls and 13-17 years in boys). In adulthood, very severe scoliotic curves (Cobb greater than 40 °) can worsen to varying degrees (on average 0.5-1 ° Cobb / year).

% Risk of worsening scoliosis based on age and Cobb °

Age (years)

10-12

13-15

Cobb

25%

10%

Cobb20 ° -30 °

60%

40%

10%

Cobb30 ° -60 °

90%

70%

30%

Cobb> 60 °

100%

90%

70%

Source: www.my-personaltrainer.it

The situations described can obviously show considerable variations from case to case. The importance of a more complete and exact diagnosis is more than evident in order to develop both a prognosis as probabilistic as possible and a rehabilitation plan of maximum effectiveness. The possibility of carrying out precise, repeatable and therefore comparable checks over time, with minimal side effects, is vital for evaluating the evolutionary trend of scoliosis as well as the effectiveness of the treatment in progress.