Treatment Options for Adolescent Idiopathic Scoliosis

Mandy Phelps

March 24, 2006

Advisor Bill Grimes D. Min., PA-C

What is Scoliosis?

A lateral curvature of the spine that is often accompanied by axial rotation

A multi-system disorderDigestive, Hormonal, Muscular, Skeletal and Neurological effects

A Cobb angle greater than 10 degrees

A descriptive term; not a diagnosis

Terminology

Cobb angle a measurement of the degrees of curvature present in the spine

Terminology

Risser signa tool used to assess skeletal maturity

Terminology

Adam’s forward bend test

done with the patient standing in front of the examiner and then slowly bending forward as if they are going to touch their toes

Risk factors for curve progression

Magnitude of the curve

Risser sign

Young age at presentation

Gender (females greater than males)

Large Cobb angle

Menarchal status in females

Treatment Options

Depend on the severity of the spinal curvature and on the age of the patient.

Treatment Options

Do NothingPhysically mature patient

Curve less than 40 degrees

Treatment Options

BracingPrevent progression

Children and adolescents with expected rapid progression of the curvature

Curves between 20 and 35 degrees

Compliance issues

Less effective in overweight patients

Treatment Options

SurgeryTeens and pre-teens

Curvature of 40 degrees or greater

Reduces curvature and deformity

Adults to decrease pain

Types of Surgery…

Posterior Spinal Fusion

Most common surgery for idiopathic adolescent scoliosis or any thoracic curvatureUsed with instrumentation and bone graftingMay be performed as young a 3 yearsLong lastingMay be accompanied by endoscopic discectomy surgery to get maximum correction

Anterior Approach

Lumbar spine curvature

Less fusion, better correction and greater ROM than posterior approach

Average of 2.5 lumbar levels are saved

Disadvantage is the large scarEndoscopic techniques now being used

Combination Anterior and Posterior

May be necessary to achieve maximum correction of a double major curvature

Option to correct thoracic curve and see if lumbar corrects naturally

Costodesis and Contralateral Rib Release

Less commonly used

Ribs are fixed along the convexity and released on the opposite side

Less favorable outcome in congenital and adolescent patients

Diminished spirometric volumeContraindicated in patients with diminished respiratory function

Non-Surgical; Non-Bracing Strategies

Often used with bracingAddress other body systems affected by scoliosisRe-educate mind-body systemExamples:

Ocular vestibular therapyElectrical muscle stimulationFlexion DistractionExercise therapyNutritional Support

Conclusion

No clean cut rules for scoliosis treatment

Non-Surgical; Non-Bracing therapies have little or no value in the treatment of scoliosis esp. as monotherapy

Bracing is controversial23 hours a day is effective for skeletally immature patients with mild to moderate curvatures

Full-time (23 hr/day) bracing may not be more beneficial than part-time bracing (8-16 hr/day)

Conclusion (Statistics)

Weighted mean proportion of success0.39 for Lateral Electrical Surface Stimulation

0.49 for Observation only

0.60 for Bracing 8 hr/day

0.62 for Bracing 16 hr/day

0.93 for Bracing 23 hr/day

Conclusion

Surgery comparison is not possible

Surgery is the only truly effective way to CORRECT scoliosis.

References

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References

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References

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