Sixty years ago, people who suffered from scoliosis, a side-to-side curving of the spine that pulls it into an S or C shape, were given a bleak prognosis. Doctors told them they would have shortened lives, and wouldn't be able to have children or hold active jobs. Surgery was frequently recommended for almost everyone.

Now that doctors know more, they give their patients a much brighter picture.

?There's a very low chance of scoliosis causing a medical problem,? says Mark Spoonamore, MD, an orthopedic surgeon in the Keck School of Medicine of USC. ?Actually, most curves have a low chance of getting worse and don't require treatment.?

A study that tracked patients with scoliosis for 50 years found that even in people with a large curvature that goes untreated, researchers were unlikely to find any health effects other than an increase in back pain, Spoonamore says.

Only in cases that occur before or during adolescence, when a growth spurt causes faster bone growth, is treatment usually considered to keep a curve from getting worse. Plastic torso braces, which bend the spine into a straighter position, are commonly used to halt curves with a 20 degree bend or more.

While small curves occur with equal frequency among boys and girls, adolescent girls are about 10 times more likely to have a curve that would get worse without a brace. However, boys are much more likely to require surgery for curves of 45 degrees or more.

?One of the hardest things for a young adolescent girl is to wear the brace,? says Spoonamore. Doctors have made it easier with new options that allow patients to wear them all day outside of school or only at night, instead of all day.

Less than 10 percent of scoliosis patients have surgery to correct severe curvatures that can cause problems walking. Stronger, lighter titanium metal rods and screws have been developed that reduce the chance of complications, such as a rod breaking inside a patient after a hard impact, Spoonamore says.

?Most of the time, they never have to do any further surgery to change the rod,? he said. They can even participate in non-contact sports.

While birth defects, paralysis or other health problems can lead to scoliosis, doctors don't know what causes most cases, although they do know that the condition runs in families. Spoonamore recommends keeping tabs on a child's spine by having his or her pediatrician do a simple test for scoliosis during regular check-ups.

Kathleen O\'Neil
Health Sciences Public Relations
University of Southern California
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Los Angeles, CA 90033
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