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When to “Watch and Wait”

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Your child is diagnosed with scoliosis and your parental instincts kick in: you want to make it better and make it better right away. Delaying any sort of treatment just does not seem like a viable option. Your clinician’s advice of “watch and wait” goes against every parental instinct that you may have. But, in certain cases, inaction may be the best course of action, at least for the time being.

Not all scoliosis spinal curvatures are created equal. If your child’s curvature is 20º or less then a “watch and wait” approach may be recommended. You should first understand that “watch and wait” is not the same as doing nothing at all. Your child’s clinician will be watching and closely monitoring him or her through X-rays and other protocols to determine if the curve progresses.

You may ask: why not go ahead and treat a smaller, non-progressive curve just to be on the safe side? What can it hurt? While that may seem to make sense in the treatment of certain conditions, intervening at this point to treat scoliosis would actually be an over-treatment. Moreover, it could unnecessarily impact your child’s life by requiring him or her to wear a brace and possibly participate in therapy he or she doesn’t need.

When should your child’s scoliosis be treated with a back brace? Curves that remain small – generally below 20º do not require bracing. However, if the curve is between 20 º to 50 º, your watch and wait window is over and you should engage in seeking bracing treatment to halt or reduce curve progression. Here’s why:

• In curves over 21º, more rotational deformity occurs in the spine, resulting in asymmetries in appearance.
• In curves between 50º and 70º, respiratory impact can take place.
• In curves over 70º, cardiac and lung function are potentially affected.

So, with those smaller curves, you can rest easy with a “watch and wait” approach. Stay engaged with your clinician and remember that watching and waiting is doing something.

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Author Luke Stikeleather is the President of the National Scoliosis Center (NSC), where he serves as the Chief Orthotist exclusively specializing in scoliosis treatment. Luke is internationally recognized as an expert in his field. He is an Associate Fellow with the Scoliosis Research Society, a founding member and president of SOSORT, the International Society of Spinal Orthopaedic and Rehabilitation Treatment. Additionally, he serves on the editorial board for the Scoliosis Journal and is a member of the BRAIST Bracing Evaluation Committee. He earned his bachelor’s degree from James Madison University and is a graduate of the post-graduate certificate program in orthotics from Northwestern University in Chicago.

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