Scoliosis: What treatments may lie ahead?

They check for scoliosis in school, examining the backs of young adolescents for signs of spinal curvature. Occasionally, because the incidence is 1 percent to 2 percent of the population worldwide, they find it.

The good news is that "the majority of scoliosis never reaches a level where it has to be treated," said Dr. John T. Braun, an orthopedic surgeon who is an assistant professor in the University of Utah School of Medicine's Department of Orthopaedics and principal Utah investigator on a number of scoliosis studies and clinical trials.

That's good, he said, because treatment can accomplish a lot — or very little. And it's nearly impossible to predict whether the curve will get bigger, whether bracing will be effective, whether surgery may turn out to be the best option. It's a medical problem with few clear answers, and making a prognosis early is murky business indeed.

Still, promising changes are near the horizon, he said, from a gene test to identify cases and perhaps indicate how severe the scoliosis will become as the patient grows, to better surgical techniques that still allow spine flexibility, something fusion surgery removes.

The U. Orthopaedic Center is one of 59 institutions across the world working together to unlock mysteries of scoliosis and improve treatment. Together, they are the Spinal Deformity Study Group, which meets twice a year and collaborates in between. Besides looking at what has happened to patients who have already been treated, they're focusing on the future, based on what works best now and what can be done to improve even that.

Do you operate on the front or the back of the spine? Do you use screws or hooks? This age or that? "Everyone has an opinion," Braun said. So researchers worldwide are entering data into a database to share and compare information. More than 50 different publications have come out of the group's work. And they're standardizing such things as how X-rays are taken or the use of force plates on the feet to see the center of body mass.

The collaboration also means there's an international pool of talent waiting to test and validate whatever any of them find.

One of the biggest current problems is that diagnosis is made only after scoliosis is severe enough to be seen. And no one can tell whether it will get worse. So when a child is diagnosed with scoliosis, at a minimum it will mean years of follow-up, with X-rays every six months to monitor spinal curvature.

That's how the future looks right now for Lily Clark, who has just been fitted with a brace that covers her entire torso. Although it's cute, patterned with little elephants and lions, it's still a brace that restricts her movement and sometimes pinches.