IntroductionA major concern of orthopedic surgeons in managing children with idiopathic scoliosis with a minor curvature is identifying how many and which curves will progress to severe deformities requiring treatment [1, 3-12, 14, 15]. Accurate identification of curves destined to progress requires a clear understanding of the natural history of idiopathic scoliosis. In this regard, school screening has been a powerful tool for the identification of children who may have scoliosis, as well as for providing information on the course of the disease over time [10, 11, 15, 17-19, 21, 22]. The vast majority of the children, however, show no spinal deformity, and of the scoliotic curves detected through school screening, only a percentage are destined to progress to clinical significance. Various factors have been associated with curve progression, although it is not clear to what extent they can be used in predicting the course of the natural history of the scoliotic curve. As a Abstract In a 5-year prospective study on idiopathic scoliosis, an attempt was made to elucidate the natural history of the disease and to determine which factors contribute to curve progression. A total of 85,622 children were examined for scoliosis in a prospective school screening study carried out in northwestern and central Greece. Curve progression was studied in 839 of the 1,436 children with idiopathic scoliosis of at least 10°detected from the school screening program. Each child was followed clinically and roentgenographically for one to four follow-up visits for a mean of 3.2 years. Progression of the scoliotic curve was recorded in 14.7% of the children. Spontaneous improvement of at least 5°was observed in 27.4% of them, with 80 children (9.5%) demonstrating complete spontaneous resolution. Eighteen percent of the patients remained stable, while the remaining patients demonstrated nonsignificant changes of less than 5°in curve magnitude. A strong association was observed between the incidence of progression and the sex of the child, curve pattern, maturity, and to a lesser extent age and curve magnitude. More specifically, the following were associated with a high risk of curve progression: sex (girls); curve pattern (right thoracic and double curves in girls, and right lumbar curves in boys); maturity (girls before the onset of menses); age (time of pubertal growth spurt); and curve magnitude (≥ 30°). On the other hand, left thoracic curves showed a weak tendency for progression. In conclusion, the findings of the present study strongly suggest that only a small percentage of scoliotic curves will undergo progression. The pattern of the curve according to curve direction and sex of the child was found to be a key indicator of which curves will progress.

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This study identified factors associated with the prevalence of idiopathic scoliosis and curve evolution in schoolchildren from northwestern and central Greece. A total of 85,627 children aged 9-15 years were screened for scoliosis. A subset of children with curves of at least 1 0° underwent clinical and radiographic follow-up. The total population screened and the cohort followed for curve progression were evaluated according to factors associated with curve evolution. The prevalence of scoliosis was 1.7%, with most cases appearing at ages 13 and 14 years and small scoliotic curves (10°-19°) being most prevalent (prevalence 1.5%). Prevalence was associated with gender; age; and magnitude, apex, and direction of the curve. Progression of the curve occurred in 1 4.7% of 839 children, while 27.4% demonstrated spontaneous improvement of at least 5°. A high risk of curve progression was associated with the following: sex - girls, curve pattern - right thoracic and double curves in girls and right lumbar in boys, maturity - girls before the onset of menses, age - time of pubertal growth spurt, and curve magnitude - curves 2=30°. Although only a small percentage of scoliotic curves undergo progression, the pattern of the curve according to curve direction and the sex of the child plays a significant role in the ability to identify which curves will progress.