Prognosis

Given a scoliotic curve, what about its destiny?
The concept of prognosis must be meant in the sense of an obliged potential worsening, for – except from a few unusual forms of childhood idiopathic scoliosis, which heal spontaneously (resolving), for all the other forms the forecast does not imply a healing and they all have a different evolutionary potential.
The most and most frequent observation of numerous cases of structured scoliosis, which represent slight radiographic curves and modest humps, induced Prof. Alberto Ponte to check (at the Centre of Vertebral Deformities of Santa Corona Hospital in Pietraligure – SV, in 6 years, from 1975 to 1980) if the from the fixed rotation and so from the measurement of the hump it was possible to deduce the evolutionary potential of a scoliotic curve; then he submitted several subjects suffering from structured scoliosis (approx. 5,000) to periodical measurements of the hump throughout the pubertal period.
The results of this study allowed establishing then maximum limits for a hump in the different types of curves exceeding which a scoliosis has – in a high percentage – a high evolutionary potential according to the vertebral skeletal maturity/immaturity.

Here are the relevant limits:

• 13 mm for a hump from a simple thoracic curve

• 12 mm for a simple thoracolumbar hump
  
  
• 11 mm for a lumbar hump
  
  
• 9 mm for a hump from one of the two double thoracolumbar curves
  
  
• 8 mm for a hump from a double or high thoracic curve

Once these limits are exceeded, in the pubertal period, the scoliosis always gets worse, regardless of the angular value of the curve.
For instance, a 20° simple thoracic radiographic curve – but with a 23 mm clinical hump – is highly susceptible of developing, needing an immediate treatment, while a 34° lumbar curve – but with a hump projecting only by 6 mm – only requires periodical tests.
In that study conducted by Prof. Ponte (and presented in several Conventions) we can find the most important and simple prognostic criterion for scoliosis: the hump is the main aspect of the deformity and represents the first symptom of the evolutionary potential; the indication of the bloodless treatment of the disease is no more established only on the basis of the angular value of the curve on the X-ray, but also on the basis of the clinical seriousness of the deformity, i.e. of the type and extent of the rotation and consequently of the height of the hump. This direction followed in the treatment of patients suffering from scoliosis has led us to confirm thoroughly the validity of the method, which has also allowed a clear limitation to the exposure to X-rays in patients submitted to a check-up (fig. 15).

Fig 15 - A careful clinical observation allows avoiding useless exposures to X-rays.