ROWAN BERKOWITZ BLOG

The Importance of Correcting the Coronal Balance in Scoliosis Treatment

When it comes to conservative scoliosis management, the goals are to retard or prevent the progression of Scoliosis and to get as much correction as possible in all three aspects of the 3D deformity: frontal (coronal), lateral (sagittal) spine, and trunk rotation (transverse plane).

However, it is crucial not to overlook the importance of correcting the coronal balance in scoliosis treatment as well, as it can be a predictor of scoliosis progression after treatment. Statistics show that idiopathic Scoliosis can progress by 1 to 2 degrees per year after treatment. One of the most significant factors affecting this is the relationship between the head-over-pelvis balance of alignment. 

The coronal balance measures how far out of balance the head is in relation to the pelvis during, but more importantly, at the end of the treatment, when the patient has reached skeletal maturity. The asymmetrical growth and development of the vertebrae, being compressed on the concave side of the curve on the one hand and the vertebral body’s more rapid growth on the convex side of the curve, invariably leads to rapid progression during adolescent growth. If the coronal balance is not corrected, Scoliosis can progress rapidly due to gravity pulling the upper torso over to one side. 

The central-sacral line (CSL) is a helpful tool in assessing coronal balance. It shows whether the head is in line with the pelvis or not. The better the CSL balance at the end of the treatment (at skeletal maturity and brace wean-off), the less likely the curve is to progress. This is one of the main objectives of treatment for Scoliosis – to retard or stop curve progression during and after treatment.

Correcting coronal balance is not just important for preventing scoliosis progression. It also has functional and aesthetic benefits. Patients with uncorrected coronal imbalance may experience pain, fatigue, and difficulty standing or walking for prolonged periods. Furthermore, a noticeable coronal imbalance can have a negative impact on one’s self-esteem and confidence, affecting social and psychological well-being.

In conclusion, while the goals of conservative scoliosis management are to retard or prevent the progression of Scoliosis and to achieve correction in all three aspects of the 3D deformity, it is essential not to overlook the importance of correcting the coronal balance as well. The coronal balance can be a predictor of scoliosis progression after treatment and has functional and aesthetic benefits.

Rowan Berkowitz