At what age does adolescent scoliosis typically stop worsening?

When Does Adolescent Idiopathic Scoliosis Stop Worsening?

Adolescent idiopathic scoliosis typically continues to progress until skeletal maturity, but curves greater than 50 degrees may continue to progress at approximately 1 degree per year even after skeletal maturity is reached. 1, 2, 3

Progression Patterns Based on Skeletal Maturity

• Curve progression is most rapid during periods of accelerated growth, particularly during the adolescent growth spurt 4
• Skeletally immature patients (Risser stages 0-3) are at highest risk for curve progression, with >70% likelihood of progression for curves >20° 2
• The risk of progression decreases significantly once skeletal maturity is reached (Risser stages 4-5), typically around age 14-16 in females and 16-18 in males 4
• Patients with thoracic curves exceeding 50° may continue to progress at approximately 1° per year into adulthood, even after skeletal maturity 2, 3

Risk Factors for Continued Progression

• Larger curves at the time of skeletal maturity have higher risk of continued progression into adulthood 1
• Female patients have a higher risk of progression, with a female-to-male ratio of 10:1 for larger curves (>40°) 1
• Thoracic curves >50° and lumbar curves >30° are most likely to continue progressing after skeletal maturity 3
• Patients who are diagnosed at a younger age generally have worse prognosis, with juvenile idiopathic scoliosis (ages 3-10) showing more aggressive progression patterns than adolescent scoliosis 5

Monitoring Recommendations

• The American College of Radiology recommends limiting spine radiographs to once every 12 months for patients at Risser stages 0-3 and every 18 months for patients at Risser stages 4-5 2
• After skeletal maturity, patients with curves <30° typically do not require continued monitoring unless symptoms develop 6
• Patients with curves >50° should continue monitoring into adulthood due to the risk of continued progression 1, 2

Clinical Implications

• Curves exceeding 50° in the thoracic region can lead to pulmonary functional deficits if they continue to progress 3
• Progressive scoliosis can lead to increased pain, reduced quality of life, and potential cardiopulmonary complications in adulthood 7
• Early identification of high-risk patients allows for timely intervention with bracing or surgery to prevent long-term complications 8

Common Pitfalls to Avoid

• Assuming that all curves stop progressing after skeletal maturity, when larger curves may continue to worsen 1, 3
• Discontinuing monitoring too early for patients with significant curves (>50°) 2
• Failing to recognize that the pattern of curvature may change over time, with extension of primary curves or development of secondary structural curves 5