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When the Brace Goes Travelling: Tips and Hints to Enjoy Your Holidays

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At some point during treatment, every young person wearing a brace finds themselves asking the same questions:

“What should I do with my brace while I’m on holiday or a school trip? Should I bring it with me or can I leave it at home? I’ve always worn it consistently and followed my prescribed hours – surely missing a few days won’t hurt…”

Let’s start by repeating a golden rule:
Brace treatment should be followed with the same precision and consistency throughout the year, whether you’re at home or away for a few days or even several weeks.

Why? There are several reasons.
First of all, taking the brace off for many more hours than usual — or not wearing it at all for a few days — could undo the hard-earned results achieved in the previous months.

Secondly, your back relies on the daily brace break to gradually learn how to support itself actively. Suddenly being left unsupported for much longer than usual could lead to back pain, and those long-awaited holiday days might not be quite so enjoyable after all.

The next questions usually are:
“Alright, I’ll take it with me… but where do I put it? Can I take it on the plane?”

The best way to bring your brace with you is also the simplest: wear it.

There are several advantages to this. First of all, it saves space — no need to worry about which suitcase or bag to squeeze it into, and there’s also less risk of damaging it in transit.

What’s more, wearing your brace during the journey means you won’t lose valuable treatment hours, and once you arrive at your destination, you can take it off and be freer to enjoy your time.

A handy tip if you’re travelling by train or plane: try to sit in an aisle seat, so you can get up from time to time, stretch your legs and change position.

Feeling reassured, the final question inevitably pops up — and often with the hope that there’s no comeback:
“But what if the metal detector goes off? How do I explain what I’m wearing? Surely they’ll make me take the brace off…”

No need to worry. Simply ask your doctor in advance for a certificate explaining the importance of wearing the brace during travel, so you can show it if necessary to the security staff during checks.

Safe and smooth travels to all of you! 

Scoliosis Through the Centuries: From Galen to Modern Rehabilitation

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Scoliosis, now recognised as a complex three-dimensional deformity of the spine, is a condition known since antiquity.
The first documented accounts date back to the 5th century BCE, when Hippocrates, the father of medicine, described various spinal anomalies — including scoliosis — and attempted rudimentary therapeutic approaches involving traction, manual manipulations, and mechanical devices such as the so-called Hippocratic ladder.

In the 2nd century CE, Galen coined the term scoliosis, from the Greek skolios, meaning “curved” or “twisted.” Galen continued the classification of spinal deformities, introducing the concepts of kyphosis and lordosis, and investigated their possible causes, suggesting links to trauma, systemic illnesses, and congenital abnormalities. For centuries, however, scoliosis was considered solely as a structural orthopaedic condition to be “straightened”, with no development of preventive strategies or targeted rehabilitation treatments.

It was only in the Middle Ages that the first rudimentary corrective tools began to appear. In the 7th century CE, references were made to wooden sticks used to support the back, and by 1575, in France, the first metal corrective brace had been designed. The 19th century marked another step forward with French surgeon Jules René Guérin, who was the first to attempt surgical correction of the scoliotic curve — though with limited success.

A true turning point occurred in 1921, when Katharina Schroth, a German scoliosis patient, developed a rehabilitation method based on postural and breathing exercises. Her insight — using three-dimensional breathing to address spinal rotation and trunk asymmetry — opened the way for the concept that scoliosis could be managed conservatively, not solely through surgery or bracing.

In the 1950s, American surgeon Paul Harrington developed a system of metal rods (the Harrington rod) for surgical implantation in young patients, aimed at halting the curve’s progression. While revolutionary for its time, this method often resulted in rigidity and reduced functionality. To refine surgical treatment, French specialists Cotrel and Dubousset introduced a dual-rod system in the 1980s, offering a more stable and harmonious correction of spinal deformities.

Today, the management of scoliosis has evolved into a multidisciplinary and individualised approach. While no definitive cure exists, effective intervention is possible to prevent progression and minimise the condition’s impact on quality of life. Early diagnosis, physiotherapeutic scoliosis-specific exercises (PSSE)  such as SEAS – Scientific Exercise Approach to Scoliosis-, targeted use of braces, and, in severe cases, surgical treatment, are the primary therapeutic strategies.

The journey of medicine over the past two millennia reveals how knowledge and awareness of scoliosis have evolved, transforming what was once a poorly understood condition into a field of ongoing scientific advancement, where research, prevention, and rehabilitation play a central role.

Annasofie, a Champion in a Brace: Determination on Ice

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Annasofie began skating at the age of just four, inspired by admiration for her older sister. From her very first steps on the ice, she showed remarkable balance and a deep passion for figure skating — a passion she now pursues with six training sessions a week, both on and off the rink. Her commitment recently earned her a silver medal at the Italian Championships, despite being diagnosed with congenital scoliosis at the age of eleven.

Figure skating demands great dedication and intense training — qualities Annasofie has demonstrated from a very young age. She tackles each day with courage, following a tailored physiotherapy programme that includes specific exercises and wearing the Sforzesco brace (ISICO) full-time, except during on-ice training.

This brace, designed to fit seamlessly into daily life, allows her to move freely, study, and continue training without compromise.

Her perseverance has paid off: after two years of consistent effort, she has seen improvement not only in her posture but also in her control and balance on the ice. This year has brought great success for Annasofie — she placed second in the final of the Italian Gold Division Championship, confirming her status as a rising star in figure skating.

Congratulations to our young patient — a truly exceptional athlete!

Below is a video where we can admire Annasofie engaged in a competition on ice:

https://youtu.be/eajmaaxDLws

From Natural History to IS-GROWTH: ISICO’s New Tool to Predict and Communicate the Evolution of Idiopathic Scoliosis

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Understanding the natural history of idiopathic scoliosis—how the condition evolves in the absence of treatment— is the starting point for any effective care pathway. But to truly guide clinical practice, this knowledge must be translated into reliable predictions and into tools that facilitate communication with patients and their families. 

This is precisely the aim behind IS-GROWTH, the focus of our study entitled “The Idiopathic Scoliosis Graphical Representation Of Worsening Trend of Natural History (IS-GROWTH) communication tool provides a reliable prediction useful to manage long-term treatment during growth”, which was awarded the 2025 SOSORT Award just a few weeks ago during the international conference held in Dubrovnik.

Today, IS-GROWTH is freely available to everyone through its dedicated website.  

Step One: Mapping Natural History through a Meta-Analysis

Until just a few years ago, the natural history of idiopathic scoliosis was described in a fragmented and inconsistent way. To address this, ISICO conducted a meta-analysis, published in 2018 (Di Felice et al., Am J Phys Med Rehabil), that reviewed 13 studies. This work clearly showed the lack of solid and coherent data, making it difficult to guide long-term treatment decisions.

To bridge this gap, ISICO launched a large-scale research project involving thousands of untreated patients. The goal was to build reliable prediction models based on real-world, untreated progression data.

Step Two: From International Collaboration to a Clinical Model

The next milestone was a study we published in 2023 in collaboration with Dr. Eric Parent from the University of Alberta (Canada).
Titled “Prediction of future curve angle using prior radiographs in previously untreated idiopathic scoliosis: natural history from age 6 to after the end of growth”, this research aimed to predict curve progression based solely on X-rays taken before the start of any treatment.

The study won the 2022 SOSORT Award, confirming the feasibility of predictive modelling. However, while statistically robust, the model’s limitation was that it only allowed for short-term projections.

The recently awarded study builds directly on that work, transforming a retrospective analysis into a dynamic, visual, customizable tool for use in everyday clinical practice.

Step Three: IS-GROWTH

IS-GROWTH (Idiopathic Scoliosis Graphical Representation Of Worsening Trend of natural History) is a visual model that illustrates the expected progression of a scoliosis curve in each patient, segmented across the different growth phases (pre-pubertal, pubertal, post-pubertal).

Developed using 3,184 radiographs from 1,818 untreated patients, it was later validated on another 552 cases, achieving 95% accuracy after adjusting for radiographic measurement error. The resulting graph displays a range of expected progression (between minimum and maximum scenarios), into which the patient’s real-time clinical data is gradually added.

A Tool to Understand, Decide, and Communicate

“We initially focused on building a scientifically solid foundation, based on rigorous data,” explains Professor Stefano Negrini, first author of the study and Scientific Director of ISICO.
“But we soon realized that wasn’t enough. We needed a tool that could support everyday clinical communication. In idiopathic scoliosis, the best outcome is often not improvement, but simply avoiding progression.
This is a hard concept to convey without something that clearly shows the natural course of the curve in the absence of treatment.
That’s why we developed IS-GROWTH—a model built using alternative methods, specifically designed to be shared with patients. From the beginning, we’ve clarified that it offers a plausible projection, not an absolute prediction.”

IS-GROWTH was designed to:

  • help clinicians understand the expected evolution of the curve;
  • motivate patients—especially adolescents—by showing how even stabilization can be considered a success;
  • visually demonstrate the impact of treatment over time, incorporating new data at every follow-up.

The model has proven especially useful in clinical follow-up: 79% of doctors in ISICO use it to motivate patients, and 84% consider it valuable for monitoring progression and interpreting outcomes

ISICO sets a record at the SOSORT Congress: here are the final two studies nominated for the AWARD

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Once again this year, ISICO stands out at the international SOSORT Congress, scheduled to take place in Dubrovnik from 23 to 26 April. Among the 12 studies accepted for the congress as oral or poster presentations, no fewer than four were selected among the 10 contenders for the SOSORT AWARD, the most prestigious recognition for research in the field of rehabilitative treatment of spinal disorders.

After presenting two of the finalist studies in the March newsletter, in this issue we introduce the other two studies in the running for the prize: 

“The Idiopathic Scoliosis Graphical Representation Of Worsening Trend of Natural History (IS-GROWTH) communication tool provides a reliable prediction useful to manage long-term treatment during growth” and “Wearing a brace for idiopathic scoliosis above 18 hours/day shows a dose-response effect on the outcomes improvement and end-of-treatment Cobb angle below 30 degrees”.

Two studies which, although very different from each other, focus on key themes for our daily practice: the effectiveness of bracing and communication with patients.

Over 18 hours a day: the “brace-effect” gets confirmed.

Our study “Wearing a brace for idiopathic scoliosis above 18 hours/day shows a dose-response effect on the outcomes improvement and end-of-treatment Cobb angle below 30 degrees” shows that wearing a brace for more than 18 hours a day leads to significantly better outcomes in the treatment of adolescent idiopathic scoliosis.
The findings of this research, conducted on 884 adolescent patients, reinforce what was already highlighted by the BrAIST (Bracing in Adolescent Idiopathic Scoliosis Trial) study, but also show that the benefit does not stop at 18 hours: the more the brace is worn, the greater the chance of ending treatment with a curve below 30°, thus reducing the risk of problems in adulthood.
Key findings include:

  • Wearing the brace for over 18 hours a day avoids surgery in 97-98% of cases.
  • With strong compliance, exceeding the 50° Cobb threshold is highly unlikely 
  • The more time the brace is worn, the higher the likelihood of ending with a curve below 30° Cobb.
  • In the most compliant patients, curve improvement exceeds 60%.

    “This study settles a debate that has gone on for years: wearing the brace for longer, if well tolerated, produces better results. The progression of scoliosis is avoided and the curve is improved, in a therapeutic path based on decisions shared with patients and families,” highlights Professor Stefano Negrini, one of the study’s authors. “Working with a personalised and collaborative approach with patients has enabled us to achieve very high compliance, even exceeding what is commonly reported in the literature. It demonstrates that it is possible to be effective even in everyday clinical practice,” concludes Negrini.

IS-GROWTH: a new ally to predict and communicate scoliosis progression 

How can we explain to an adolescent and their family that even a worsening outcome in the rehabilitative treatment of scoliosis can be a good result? 

The new IS-GROWTH model (analysed in the study “The Idiopathic Scoliosis Graphical Representation Of Worsening Trend of natural History”) was born to answer this challenge, improving communication and long-term treatment management.

When it comes to idiopathic scoliosis, communication is an integral part of treatment. For a rehabilitative pathway to succeed, it requires sharing, motivation, and awareness. 

It is precisely to support all this that ISICO has developed IS-GROWTH: a visual and predictive tool that graphically represents the natural progression of scoliosis during growth.

“In idiopathic scoliosis, often the best result is not improvement but simply not worsening. This concept is difficult to convey without a tool that clearly shows what the natural curve evolution would be without treatment,” explains Professor Stefano Negrini, author of the study.

The model was built using over 3,000 X-rays from more than 1,800 participants, from infancy through adolescence, and validated on 552 patients, with 95% accuracy after adjustment for radiographic measurement error.

Its objective? To provide a personalised graphical representation of the expected curve progression, divided by growth phases and updated over time. This allows clinicians to:

  • better understand the individual case trend;
  • strengthen dialogue with patients;
  • motivate them throughout the treatment pathway.

The model has proven particularly useful during follow-ups: 79% of doctors use it to motivate patients, and 84% consider it valuable for monitoring progression and interpreting results achieved.

“IS-GROWTH is not just a predictive model; it is above all, an ally for everyday communication. It helps us make patients participate and to build a more conscious therapeutic path,” – concludes Negrini.

Adult scoliosis and fracture risk: a frequently overlooked connection

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In elderly patients, the fracture risk is often attributed solely to bone fragility. However, one frequently overlooked factor is the presence of adult scoliosis, which can significantly increase the risk of falls and, therefore, fractures.

This condition, which may stem from progressive juvenile scoliosis, arises as “de novo” scoliosis in adulthood or is degenerative — that is, related to arthritic, degenerative phenomena and metabolic alterations — often leads to changes in postural alignment, particularly in the sagittal plane. The trunk leans forward, lumbar lordosis is lost, and the pelvis rotates backwards; thus, it develops what is known as a flexed posture, a typical condition of pathological ageing, which heavily impacts balance and mobility.

These biomechanical changes are not only aesthetic or functional issues; they are determining factors for static and dynamic balance and, therefore, significantly increase the risk of falls. Scientific studies confirm this: hyperkyphotic posture, for example, has been associated with a higher incidence of falls and, in a 2004 study involving over 1,300 adults, was found to be an independent predictor of mortality.

For an older adult with bone fragility, falling may result in a fractured femur, vertebra, or wrist — events that often lead to hospitalisation, loss of independence, and, in many cases, irreversible functional decline.

Worsening the clinical picture is often the presence of sarcopenia, the progressive loss of muscle mass and strength, common among older adults with scoliosis, as documented in the 2017 study “Sarcopenia and falls in patients with adult scoliosis”. This condition further reduces stability and reaction capacity, creating a vicious circle: less balance → more fear of falling → less activity → more weakness → even greater risk.

Even surgery does not represent a definitive solution: as reported by Glassman et al. (2016), even after the operation, sagittal alignment alterations may persist, maintaining a high risk of falls.

In light of this evidence, the message is clear: adult scoliosis cannot be considered a “benign” condition simply because it has stabilised. On the contrary, it requires clinical attention, monitoring, and personalised interventions. During adulthood, particularly between the ages of 40 and 60,the overall trunk alignment must be carefully monitored to detect the first signs of postural changes and take action to correct them. At the same time, the spine is still sufficiently mobile. When ageing progresses further and the older adult begins to bend forward, full recovery becomes difficult, and treatment aims to prevent further deterioration.

Fortunately, physiotherapy can offer effective responses: specific programmes to restore sagittal alignment, exercises for stability and postural control, pain management and functional improvement. Muscle strengthening and balance training have proven useful in reducing fall risk and, therefore, in preventing fractures and hospitalisation.

In conclusion, considering adult scoliosis as an independent risk factor for fractures — on par with osteoporosis — means acknowledging the importance of a multidimensional approach.

Early and targeted treatment of scoliosis can serve as a key lever in reducing fracture events, hospitalisations, and loss of independence in older adults. Fall prevention also starts with the spine.

SOSORT AWARD 2025: two of the four competing ISICO studies

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Among the 12 studies submitted and accepted as oral presentations or posters for the upcoming SOSORT conference, scheduled to take place in Dubrovnik, Croatia, from April 23 to 26, four are competing for the AWARD, the most prestigious recognition in the field of rehabilitative treatment for spinal disorders. This marks a record for ISICO, which has already won 11 AWARDs over the years thanks to its research.
Below, we present two of these studies; the remaining two will be featured in the April newsletter.

1. The Psychological Impact of Children’s Spinal Deformities on their Parents: How to Measure with a Rasch-validated Questionnaire

ISICO has developed a new questionnaire to assess the quality of life of parents of children with scoliosis undergoing conservative treatment. 

By analysing the content of the scoliosi.org blog, which has collected contributions and responses from 24 scoliosis experts over the years, an initial version of the questionnaire with 48 questions was created. 

This version was subsequently refined through repeated administrations to four different samples of parents and statistical analyses to improve its validity and reliability. After three revisions, the questionnaire was reduced to 18 questions, demonstrating good reliability and validity, with no significant differences based on the parent or child’s age or gender.

“Dealing with scoliosis is not just about the patient; it deeply involves the family as well,” explains Dr. Irene Ferrario, ISICO psychologist and one of the study’s authors. “Parents of children undergoing conservative scoliosis treatment can experience anxiety and stress, but until now, there were no specific tools to assess the impact of therapy on families. This new questionnaire represents an important step forward, offering a reliable means to better understand the difficulties faced by parents.”

The questionnaire will facilitate the identification of families’ emotional and practical needs, providing targeted support.
“At ISICO, we recognize how crucial family well-being is in the therapeutic journey of young patients. For this reason,” concludes Dr. Ferrario, “we continue to promote a comprehensive approach to scoliosis, considering not only the patient’s physical health but also their emotional balance and that of their loved ones.”

2. Geographic, Personal, and Clinical Determinants of Brace-Wearing Time in Adolescents with Idiopathic Scoliosis

Brace therapy is an effective treatment for adolescents with idiopathic scoliosis (AIS), and several studies have already investigated factors influencing treatment adherence using sensors. However, the role of variables such as geographic location (mountain vs. seaside, large city vs. small town, mountain vs. plain) or family income had not yet been explored.

“Through this study, we aimed to verify the influence of geographic, personal, and clinical variables—routinely recorded by doctors— on adherence to brace treatment,” explains Alessandra Negrini, ISICO physiotherapist and author of the research.

Researchers examined 1,904 adolescents with an average age of 13 years and an average scoliotic curve of 35° Cobb. Adherence was measured using a thermal sensor (iButton) applied to the brace, while the analysed factors included age, prescribed brace-wearing hours, geographic area (North, Central, Southern Italy), gender, skeletal maturity (Risser), curve type, presence of back pain, income level, altitude above sea level, and the distance of the residence from the sea.

The collected data showed that 90% of patients demonstrated good adherence to treatment (wearing the brace for more than 75% of the prescribed hours). Factors that positively influenced adherence included younger age, female gender, a prescription of more than 20 hours per day, and living in Northern Italy. The results suggest that climatic and social factors can influence treatment adherence.

“Understanding that certain factors can reduce adherence to treatment allows us to identify patients who may benefit from targeted strategies to improve compliance,” concludes Alessandra Negrini. “Thanks to this type of research, we can enhance the personalization of therapeutic interventions, adapting them to patient characteristics to maximize treatment effectiveness.”

Is scoliosis harmed by high-impact sports?

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Periodically, ISICO launches the “Concorsetto,” an initiative in the form of a competition in which patients share their experience with wearing a brace, demonstrating that they can do almost anything: horse riding, dancing, rhythmic gymnastics, skating, and much more. This proves that sports and scoliosis are not incompatible.

But what about high-impact sports? Can they make scoliosis worse?

When it comes to scoliosis, one of the most common questions we receive from parents and coaches concerns sports that involve impacts on the spine (shocks, falls, landings from jumps…). Activities such as horse riding, long jump, high jump, and running often raise concerns.

In the common imagination, it is believed that repeated shocks may generate compressive and torsional forces on the spine, worsening the scoliotic curve. In reality, the spine, thanks to its sagittal plane curves, joints, and tendon structures, has a highly efficient system for “absorbing” impacts and withstanding intense forces without negative effects on its three-dimensional structure.

A recent study of ours has shown that the more sports young people engage in, the lower the likelihood of scoliosis worsening and the greater the chances of improvement with physiotherapy treatment [source 1]. It is no coincidence that mild scoliosis is successfully treated with specific exercises aimed at improving posture and triggering corrective reactions in the curves—an effect similar to that of sports, albeit in a less specific and more global manner.

So, is there anything that can actually worsen scoliosis?

According to the available data, an asymmetrical load on the vertebrae promotes uneven spinal growth in individuals already predisposed to developing scoliosis, contributing to its progression in children and adolescents. This is known as Stokes’ vicious cycle.

What should be done, then?

It is essential to counteract these factors using the tools available. Combined with specific treatments such as physiotherapy exercises and/or a brace, sporthelps develop reflexive corrective automatisms, integrating them into daily life. All sports are suitable in these cases, but every case of scoliosis is unique. Since sport reduces the risk of curve progression, it is advisable to encourage young people to choose an activity they enjoy and are motivated to practise consistently.

Even asymmetrical activities, such as tennis, should not be demonised; in fact, they can be a valuable ally in preventing and managing scoliosis. Often, it is enough to combine them with targeted exercises that strengthen the spinal muscle groups under strain.

Sport and the brace: Can physical activity be practised while wearing a brace?

A recent study confirms that those who wear a brace and engage in sport more frequently achieve better results. Moreover, an ISICO study has shown that wearing a brace does not hinder physical activity.

We just remind you that, in case of doubt, it is important to consult your specialist doctor.

In conclusion

Sport should be experienced as a moment of relaxation and recharge. The impacts on the spine that are inevitable when practising sports should not be a cause for concern, as they do not worsen scoliosis. The brace should not excessively restrict the patient’s movement and freedom but should support them in counteracting spinal deformity.

With the guidance of a scoliosis specialist, each patient can find the best way to manage physical activity—whether with or without a brace—because the confidence and psychological well-being derived from engaging in sport are fundamental to the success of the therapy.

SEAS: A New Study Demonstrates Its Greater Effectiveness Compared to Other Methods

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The SEAS approach, developed over 20 years ago by ISICO in Italy, has emerged as the most effective in reducing the Cobb angle, according to a significant meta-analysis recently published by Wang et al., “Comparative efficacy of six types of scoliosis-specific exercises on adolescent idiopathic scoliosis: a systematic review and network meta-analysis” (2024).

This study compared six of the most widely used scoliosis-specific exercise methods worldwide for adolescent idiopathic scoliosis: SEAS (Italy), Schroth (Germany), DoboMed (Poland), Side-shift (United Kingdom), Active Self-Correction (Italy), and FITS (Poland).

It is important to note that various exercise-based scoliosis treatment methods and approaches originated in Europe in the last century and have since spread globally. While the effectiveness of bracing in preventing scoliosis progression and the need for surgery is well-documented, the definitive effectiveness of specific exercises has yet to be fully proven.

Out of 465 studies initially identified in the meta-analysis, only 24 met the rigorous inclusion criteria, analysing a total of 1,069 subjects. The meta-analysis highlights that SEAS achieves the best results in reducing the Cobb angle, while Active Self-Correction and the Schroth method are more effective in reducing the Angle of Trunk Rotation (ATR) and improving quality of life.

SEAS exercises themselves are based on an active form of self-correction, enabling SEAS to deliver positive results on multiple fronts: reducing both the Cobb angle and ATR, while also ensuring a good quality of life for the patient. This was confirmed by a study published a few years ago, “Specific exercises reduce the need for bracing in adolescents with idiopathic scoliosis: a practical clinical trial”, which also contributed to lowering the risk of requiring a brace and/or experiencing scoliosis progression.

“These results confirm the importance of the SEAS approach in the conservative management of adolescent idiopathic scoliosis,” says Alessandra Negrini, physiotherapist at ISICO. “However, for SEAS to be definitively recognised as a treatment capable of altering the natural progression of scoliosis, further high-quality studies with long-term follow-ups are needed.”

This study marks a significant step forward in research on the effectiveness of scoliosis-specific exercises. The findings are encouraging and reinforce the importance of an evidence-based approach in the conservative treatment of adolescent idiopathic scoliosis.

Degrees of curvature and height: is there a relationship?

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Our patients’ questions are often opportunities to provide useful information to them and others.

Francesco’s questions prompted us to examine the possible correlation between scoliosis, degrees of curvature, and height growth. 

“Let me start by describing my particular experience: at the age of 17 and a half, in a skiing accident, I injured my patellar tendon, which was operated on and then put in a brace for 30 days. Once I had recovered and regained full mobility, I had a physiatrist colleague of my father who examined me. During the examination, he measured my height (178 cm) and checked my back, remarking that I perhaps had very mild scoliosis (there was no talk of X-rays, much less of degrees of curvature and so on). Let’s just say that I took the information on board and left it at that.

This year, I had a checkup with the same physiatrist, who, upon seeing me, was immediately struck by how much taller I had grown: he measured me, and I was 184 cm.

I’m sure I’m not unique, but I would guess it’s rare for a boy of 17 and a half to gain another 6 cm.

He looked at my back and told me it was “a bit worse”. I was quite upset about that because, being completely ignorant on the subject (like anyone who has no direct experience of this deformity), I had imagined it was something that could be remedied by improving my posture or through physical activity. He reassured me that by now it should have stabilised (“stable until proven otherwise” as you say) and not to worry about it too much. This time, though, he recommended an X-ray. 

From the X-ray, I learned that my latest growth had done me more harm than good and had seemingly affected my scoliosis more than anything. Also, at the initial examination, I’d had a much chubbier, more child-like physique, which at the time might have helped to mask the scoliosis somewhat. Functionally, though, I have no pain (since, as you have told me, my curve is moderate), and fortunately, aesthetically, it is not too noticeable.

So, here are my two questions:

  • Given that the human body generally declines with age, does that mean I am at risk of becoming, in the future, one of those old men you see with a walking stick, bent over and crooked? In other words, even though my scoliosis shouldn’t get worse in adulthood, am I more likely than someone without scoliosis to end up like the kind of elderly person I just described?  
  • Is there a relationship, however approximate, between the number of Cobb degrees and the number of cm lost in height? I have read that you lose 1 cm in height for every 10° of Cobb angle, and therefore that you can divide your degrees of curvature by 10 to work out how much height you’ve lost”.

Here is our response.

First of all, it’s not unusual for males to gain a few more centimetres after reaching the age of 17. In fact, height growth is linked to skeletal maturation, a process that in boys begins and therefore also ends a few years later than in girls. Scoliosis is a pathology that, to worsen, exploits bone growth, accentuating the vertebral deformity; this could explain the clinical findings from your latest examination.

As regards height “lost” due to scoliosis, I would say that having reached around 1.85 m, you can’t really complain …! That said, to answer your question, with a 30° curve you lose 1–1.5 cm at most.

Some international scientific journals have published mathematical formulas for calculating centimetres lost due to scoliotic curvature(s) of the spine.-

These calculations also take into account the ratio between height when seated (trunk and head) and height when standing.

The studies published on this topic evaluated scoliosis cohorts (between 140 and 1500 subjects enrolled) and reported an average height loss of 3.38 cm for females and 2.86 cm for males.

The formulas providing the most valid estimates of height loss are those of Kono and Stokes, according to which a scoliotic curve of 80° seems to lead to a loss of between 3.5 and 5.5 cm, while one of 100° appears to correspond to between 4.5 and 8.5 cm in lost height. The greater the curve, the more the estimates produced by the two formulas differ; instead, they give comparable results for smaller curves.

Patients with severe curves also tend to ask surgeons about height, but in terms of gain, asking: “How many extra cm of height will this operation give me?” The answer to this question is less certain, because there are too many factors at play, so many in fact that no pre-surgical prediction can be considered reliable.

As for your concerns about adulthood and old age, you will understand that I can only reply in very general terms. With curves of around 30° at the end of growth, the risk of the condition worsening over future decades is very low.

It’s like someone with slightly raised cholesterol or high blood pressure asking me: am I going to have a heart attack in a few decades’ time? Although high cholesterol levels, systemic arterial hypertension, a sedentary lifestyle and other factors are associated with increased cardiovascular risk, it isn’t possible to translate estimates of the risks associated with a specific disease into a clear prediction for an individual case.  

In terms of prevention, in adults with scoliotic curves similar to yours, regular physical activity is recommended in order to maintain good general muscle tone, able to counteract the worsening effect that gravity would otherwise have on the curves over the years.