Scoliosis screenings in middle schools find thousands of teenagers with curved spines each year.
Treatment for scoliosis hasn't changed in five decades — if the spine is curved to a certain degree, the teenager gets a back brace. But research has not conclusively proved the benefits of the braces.
Some young people who don't wear a brace never have any problems and their curves never worsen. Others wear the braces for years and still end up needing back surgery.
A long-term study at Washington University and more than 20 other research centers hopes to figure out why.
"If we can say that bracing doesn't change (the progression of a spinal curve) then it's a treatment regimen that we shouldn't offer," said Dr. Matthew Dobbs, a pediatric orthopedic surgeon and lead investigator at Washington University. "Why do school screenings? Why identify a child with a small curve and put them through years of bracing if it's not going to alter natural curve?"
Half of the participants in the study will receive back braces to wear at least 18 hours a day, and the other half won't wear braces. Both groups will receive regular X-rays to check their spinal curves.
Braces aren't thought to correct the curves but to prevent progression.
"But again we have no data to support that, despite all of us doing this for years and years and years," Dobbs said. "We don't know what the best treatment is; we don't know who's going to progress."
Curves that progress to 50 degrees — about 10 percent of cases — are generally thought to require spinal fusion surgery.
Dobbs predicts the research will show that certain patients benefit from bracing and others don't, depending on the type of spinal curve.
Adolescent idiopathic scoliosis occurs in about one in 1,000 teenagers, and is 10 times more common in girls. It can cause back pain, and in severe cases can affect heart and lung function.
The cause is unknown, although Dobbs and other researchers are studying the disorder's genetic factors.
Smaller spinal curves are typically monitored by a doctor, but patients whose curves reach between 20 and 40 degrees are usually recommended for back braces.
If it's found that fewer teens need braces, the research could save money on treatments plus spare some teenagers the psychological stress of wearing a brace.
Braces are "mostly put on young teenage girls who are very concerned about appearance in general and don't want anything that makes them look different," Dobbs said.
That's why patients in the study are also monitored psychologically to see how they're handling the brace.
"If we see a child in the study who dips on their mood and mental health during the study, we need to figure out what's going on," Dobbs said.