Intervention versus Observation in Mild Idiopathic Scoliosis in Skeletally Immature Patients

Shu Yan NG1, Ying Ling NG1, Ka Ping Cheng1, Wing Yan Chan1, Tsz Ki Ho1, *
1 Spine Technology Ltd, Wanchai, Hong Kong

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© 2020 Yan NG et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at Spine Technology Ltd, Rm 1101, 11/fl Methodist House, 36 Hennessy Road, Wanchai, Hong Kong; Tel: 852-25229673; Fax: 852-25273618; E-mail:



Observation is the treatment of choice for idiopathic scoliosis with Cobb angles between 15 degrees - 20 degrees in growing children. This passive approach does not address the anxiety of the patient and the stress of the parents. In this paper, we attempt to identify skeletally immature patients with mild scoliosis curvatures that are more at risk of progression and propose possible intervention for this group of subjects.


The literature was searched in Pubmed, and additional references were searched manually in the literature.


Many studies have shown that low serum 25[OH]D level, bone mineral density (BMD), and body mass index (BMI) are related to the curve severity or progression of the curve.

We suggest that skeletally immature patients (< Risser 2) with mild curves be divided into two groups, viz. Group O (observation) with a lower risk of progression, and Group I (intervention) with a higher risk of curvature progression. We propose early intervention for the latter group.

It is suggested that pre-menarcheal, skeletally immature patients with mild idiopathic scoliosis, and low vitamin D, BMD, and BMI should be treated. Also, asymmetric foot biomechanics should be addressed, although nutrition and foot orthoses are regarded to have no role in the management of idiopathic scoliosis. The outcome of early intervention may be utterly different from late treatment when the curvature becomes more structural, and the patient more skeletally mature.


Research is required to prove if the intervention is clinically indicated.

Keywords: Scoliosis, Foot orthosis, Exercise therapy, Observation, Spine, Early intervention.