Spontaneous regression of curve in immature idiopathic scoliosis - does spinal column play a role to balance? An observation with literature review

Abstract

Background: Child with mild scoliosis is always a subject of interest for most orthopaedic surgeons regarding progression. Literature described Hueter-Volkmann theory regarding disc and vertebral wedging, and muscular imbalance for the progression of adolescent idiopathic scoliosis. However, many authors reported spontaneous resolution of curves also without any reason for that and the rate of resolution reported is almost 25%. Purpose of this study was to question the role of paraspinal muscle tuning/balancing mechanism, especially in patients with idiopathic scoliosis with early mild curve, for spontaneous regression or progression as well as changing pattern of curves.

Methods: An observational study of serial radiograms in 169 idiopathic scoliosis children (with minimum follow-up one year) was carried. All children with Cobb angle < 25° and who were diagnosed for the first time were selected. As a sign of immaturity at the time of diagnosis, all children had Risser sign 0. No treatment was given to entire study group. Children were divided in three groups at final follow-up: Group A, B and C as children with regression, no change and progression of their curves, respectively. Additionally changes in the pattern of curve were also noted.

Results: Average age was 9.2 years at first visit and 10.11 years at final follow-up with an average follow-up of 21 months. 32.5% (55/169), 41.4% (70/169) and 26% (44/169) children exhibited regression, no change and progression in their curves, respectively. 46.1% of children (78/169) showed changing pattern of their curves during the follow-up visits before it settled down to final curve. Comparing final fate of curve with side of curve and number of curves it did not show any relationship (p > 0.05) in our study population.

Conclusion: Possible reason for changing patterns could be better explained by the tuning/balancing mechanism of spinal column that makes an effort to balance the spine and result into spontaneous regression or prevent further progression of curve. If this which we called as "tuning/balancing mechanism" fails, curve will ultimately progress.

Figure 1

Serial radiograms of a 6 year old boy with idiopathic scoliosis. Figure 1a) displayed initial Cobb angle of 15-degrees and curve was on left side; which Figure 1b) became right sided curve with regression of 6-degress after six months; and Figure 1c) again became left side curve after 19 months with Cobb angle of 11-degrees at final follow-up and became stable.

Figure 2

Serial radiogram of 11 years old male with idiopathic scoliosis. Figure 2a) showed left sided initial curve with Cobb angle of 8-degrees; which Figure 2b) became 5-degrees after 8 months; and Figure 2c) became right sided after 30 months with Cobb angle of 13-degrees and became stable.

Figure 3

Explains our proposed hypothesis of tuning/balancing mechanism of spinal column. Figure shows x is the onset time of scoliosis in growing spine; y is the time when curve will follow one of three pathway (A: regression; B: stabilization and C: progression); and z is the time of change in treatment approach. This figure explains that in growing spine for a short period of time (x-y), there is wavy pattern in Cobb angle that is the period during which spinal column makes an effort to balance the spine. When this effort fails, the curve will follow path C and show the progression; and if it gets balance curve will either stabilize (path B) or regress (path A).