Growth Spurts and Levoscoliosis Development
Yes, growth spurts are a critical contributor to the development and progression of levoscoliosis (and scoliosis in general), as curve progression is directly linked to periods of rapid skeletal growth, particularly during puberty. 1, 2, 3
The Growth-Scoliosis Relationship
Rapid growth periods represent the highest risk window for scoliosis development and progression. The biomechanics are straightforward: during growth spurts, asymmetrical forces act on the vertebral growth plates (over 130 in the spine), and any slight imbalance in these forces can lead to progressive spinal curvature. 3
Critical Growth Periods
The spine experiences three distinct growth phases, with varying risk profiles: 3
- Birth to 5 years: Initial rapid growth phase
- 5 to 10 years: Slower, steady growth
- 10 years to skeletal maturity: Peak growth velocity period with highest progression risk 3, 4
Peak growth velocity during puberty is the most critical period for curve progression. 4 This is when idiopathic scoliosis progresses most rapidly and aggressively.
Quantifying Progression Risk During Growth
The data on progression during growth spurts is striking: 4
- Curves ≤20° at puberty onset: 15.6% progress beyond 45° requiring surgery
- Curves 21-30° at puberty onset: 75% surgical rate
- Curves >30° at puberty onset: 100% surgical rate 4
Curves that progress 6-10° per year during growth spurts have a 70.9% fusion rate, while those progressing >10° per year have a 100% fusion rate. 4 This underscores how growth acceleration directly drives surgical necessity.
The Younger, The Worse
The younger the child at scoliosis onset, the higher the progression risk and the more severe the ultimate deformity. 3 Remaining growth is the single most determining factor for curve worsening—more growth time equals more opportunity for progression.
Clinical Implications for Monitoring
In skeletally immature patients with active growth, follow-up intervals must be shortened to as little as 4 months during rapid growth phases. 2 The standard annual monitoring is insufficient during peak growth velocity.
For systematic monitoring: 5
- Risser stages 0-3 (active growth): Radiographs every 12 months maximum
- Risser stages 4-5 (near maturity): Radiographs every 18 months acceptable 5
However, during documented rapid growth or puberty, more frequent assessment is warranted despite radiation concerns. 2
Why Growth Spurts Matter for Treatment Timing
Bracing is only effective during active growth in curves between 20-45° that are documented to be progressive. 1 Once skeletal maturity is reached, bracing loses its mechanical advantage since there's no growth to redirect.
The window for conservative intervention is narrow: 1, 4
- Must have remaining growth potential
- Curve must be flexible enough to respond
- Intervention must occur before curve becomes too severe (>45°)
Delaying treatment during active growth phases allows irreversible anatomical modifications that cannot be corrected later. 3 The abnormal growth pattern becomes self-perpetuating as asymmetric forces compound with each growth increment.
Post-Growth Progression
Even after skeletal maturity, thoracic curves >50° continue progressing at approximately 1° per year. 5, 6, 7 However, this is dramatically slower than the 6-10° per year (or more) seen during active growth spurts. 4
Only curves >30° require monitoring after skeletal maturity is achieved. 2 Smaller curves stabilize once growth plates close.
Common Pitfall to Avoid
Never assume a curve is stable simply because symptoms are absent—curves progress silently during growth spurts, and by the time pain or visible deformity appears, surgical thresholds may already be exceeded. 5, 7 Vigilant monitoring during all growth phases is mandatory, with heightened surveillance during puberty when growth velocity peaks. 4