With adults the situation can be more problematic. I see adult patients, particularly women, who fall into one of several categories:
Often I see young women with very large curves who have no pain. I tell them that statistically the probability of the disease progressing is 80 or 90 percent, and that untreated they may well have problems in later life. With these women we discuss their treatment options on a case by case basis.
I also see young women who have a history of scoliosis who were told their curves would not progress in adulthood. And the story goes something like this: "My curve was stable. I had no back pain. My first pregnancy wasn't terribly complicated, but after my second pregnancy something happened." Now pregnancy is a very complicated physiologic state. The hormone of pregnancy is progesterone, and what we believe is that women who have curves that were otherwise reasonably well compensated may progress under the influence of progesterone. That is, the ligaments become somewhat lax as they need to be for pregnancy and for the pelvis to develop appropriately for delivery. At the same time, the curve starts to progress, and so I'll see these young women who've had several children and they'll say, "You know, my body is changing. Something's happened." Some of those women are now experiencing pain.
Finally, there are women who come in and say, "You know, I had a small curve, and it has continued to progress throughout adulthood. Didn't seem to be related to pregnancy, but now I'm 50, 52, 55, and I really have become deformed. The trunk has become deformed. My dresses are different. I don't have a waistline anymore. My ribs are actually resting on my hip bones, and there's really been a dramatic change in what I look like. But I'm here not because I'm worried about my cosmetics. It's because I hurt. Because I have pain. It's limiting my ability to live effectively."