Do I need to visit an Orthopedic doctor?The short answer is, maybe. Clinics that offer the Scoliscore™ AIS prognostic test may in fact be a better starting point when initially diagnosed since Orthopedic doctors don't treat scoliosis until it progresses beyond 20 degrees at which point the patient is referred to a orthotist. This saliva collection test can compare the patient's genetic predisposition against 53 known genetic markers to produce a high, intermediate, or low risk determination of whetehr their spine curvature will progress to the point where surgical intervention is recommended. This does not predict if their scoliosis curvature will continue to increase, potentially causing significant spinal and postural deformity, but only if the curve will progress to the level of surgical threshold (40-45 degrees). However, this information is an invaluable tool in determining the level and intensity of treatment the patient may require.
It is important to note that a low or intermediate risk determination does not mean the patient should not be concerned about their condition and be proactive with an early stage scoliosis intervention program. A 10 degree curvature with a low Scoliscore™ could still see significant progression in their curvature producing irreversible postural deformity, a spinal rib hump, and significant quality of life concerns in adulthood (back pain, pre-mature spinal arthritis, spinal disc disease).
High Risk Classification Score: 181-200 (High risk of severe spinal curvature progression reaching surgical threshold by skeletal maturity)
This represents only 1% of idiopathic adolescent scoliosis patients; however these patients must have their condition and treatment managed by a team of experts including a orthopedist, an early stage scoliosis specialist, and possibly even a orthotist (brace maker). Early Stage Scoliosis Intervention may be the patients only real opportunity to avoid surgical intervention since rigid bracing has been shown in multiple studies not to reduce the number of patients who still reach surgical threshold.
Intermediate Risk Classification Score: 51-180 (Intermediate risk of severe spinal curvature progression by skeletal maturity)
This represents approximately 24% of idiopathic adolescent scoliosis patients. This classification score covers a wider range and the score is reflective of the increased or decreased risk within the range. For example, a patient with a score of 160 (intermediate risk) has a significantly increased risk of the curvature reaching surgical threshold than a patient with a ScoliScore™ of 60 (also intermediate risk). Early stage scoliosis intervention is a critical first step to combating the curves progression and preventing irreversible body distortion. Continued monitoring also will be necessary to provide ongoing treatment and assessment until the patient has reached skeletal maturity. Coordinated care with an orthopedic doctor may be recommended depending on the ScoliScore™ risk classification.
Low Risk Classification Score: 0-50 (Low risk of spinal curvature progressing to surgical threshold)
Approximately 70% of adolescent idiopathic scoliosis cases will have a scoliscore in the range of 0-50. This means there is a 99 % probability scoliosis will not progress to a severe curve that will require surgery. However, this does not indicate the curvature will not progress to the level that creates irreversible body distortion, rib humping, or interfere with the patient's quality of life as an adult. Early stage scoliosis intervention is still the indicated, preferred, and appropriate treatment choice to reduce the spinal curvature and prevent further curve progression.
Creating a "village of experts" is a great strategy when treating scoliosis.The diagnosis can create a lot of anxiety and fear, mostly fear of the unknown and uncertainty in the origins and process of treating the condition. It is important for the parent and patient to develop a comprehensive and realistic outlook in terms of the condition and its treatment at the time of initial diagnosis. Developing a working relationship and consistent treatment plan with the patient's orthopedist and an early stage scoliosis intervention specialist may provide the patient with the best opportunity to reduce, stabilize, and minimize the risk of further progression.
The risk of curve progression is the primary concern in patients with early (0-25 degrees) and intermediate (26-40 degrees) stage scoliosis; especially through periods of rapid growth. The rapid rate of increasing curve progression generally does reduce significantly as the patient reaches skeletal maturity (ages 16-17 in females/ ages 18-20 in males).
It is extremely important for the parent and child with scoliosis to develop a vision and comprehensive treatment plan that will provide them with a consistent plan course of treatment from the point of initial diagnosis (age 8-14) to the onset of skeletal maturity (age 16-17 in females/ ages 18-20 in males).
What you would expect during the visit to the orthopedic doctor should also be provided by an office providing treatment alternatives for scoliosis as well.
Much of the data and tests performed will be similar to a routine physical exam including:
- Case history
- Age of initial scoliosis diagnosis (if known)
- Size of initial curvature (if known)
- Curve development pre or post menses (if known)
- Physical examination
- Bend forward test to evaluate rib protrusion
- Posture evaluation
- Radiographic examination (x-ray) Full spine x-ray of the curvature measured by the Cobb angle system.Cobb's angle measures the size of the curvature by how much it is bending to the side.Risser's sign is the measurement of the growth plate on the crest of the hip. It is used to help determine where a patient is in terms of the skeletal maturity process. It is rated 0-5 with "5" being skeletally mature.
X-ray Safety Concerns are common with children and scoliosis evaluation so here are a couple of relevant statistics. One of the larger and newer studies published in the 2000 edition of the Journal of Pediatric Orthopedic was conducted over the course of 13 years and measured the total amount of x-ray exposure in surgically treated scoliosis patients (considered the most total x-ray exposed group).
The final conclusion of the study was the increase risk of carcinogenesis or hereditary defects in these patients is minimal.
"The risk of carcinogenesis from radiographs to pediatric orthopedic patients." Journal of Pediatric Orthopedics. 2000; 20(2): 251-4
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