What is the management for a patient with 19 degrees of levoscoliosis?

From the Guidelines

Management for a patient with 19 degrees of levoscoliosis typically involves observation and non-surgical approaches. Regular monitoring with clinical examinations and X-rays every 6-12 months is recommended to track curve progression, especially in skeletally immature patients. Physical therapy focusing on core strengthening exercises, postural training, and specific scoliosis-targeted exercises like the Schroth method can help manage symptoms and potentially slow progression. Pain management may include non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-600mg three times daily as needed) for occasional discomfort. Bracing is generally not indicated for curves under 25 degrees in growing children unless there's evidence of rapid progression. Patients should maintain normal physical activity and sports participation as tolerated. This conservative approach is appropriate because a 19-degree curve is considered mild (curves under 25 degrees rarely progress significantly after skeletal maturity) and typically doesn't cause functional limitations or significant health problems. However, if the patient experiences worsening pain, noticeable progression, or respiratory symptoms, more aggressive intervention may be warranted.

Some key considerations in managing scoliosis include:

• Regular monitoring to track curve progression
• Physical therapy to manage symptoms and potentially slow progression
• Pain management with NSAIDs as needed
• Maintenance of normal physical activity and sports participation
• Consideration of bracing for curves under 25 degrees only if there's evidence of rapid progression

It's also important to note that the provided evidence 1 does not directly address the management of levoscoliosis, but rather provides general guidance on the management of scoliosis and other related conditions. However, the principles of observation, physical therapy, and pain management can still be applied to the management of levoscoliosis.

In terms of specific treatment recommendations, physiotherapy and dental examination are considered important components of management 1. Additionally, short courses of oral prednisolone or local glucocorticoid injections may be considered as bridging management options 1. However, these recommendations are not specific to levoscoliosis and should be considered in the context of the individual patient's needs and circumstances.

Overall, the management of levoscoliosis should prioritize a conservative approach, with regular monitoring and physical therapy, and consideration of pain management and bracing as needed.

From the Research

Management of 19 Degrees of Levoscoliosis

• The management of a patient with 19 degrees of levoscoliosis depends on various factors, including age, curve magnitude, and risk of progression 2.
• According to the study by 2, a child should be referred to a specialist if the curve is greater than 10 degrees in a patient younger than 10 years of age, or greater than 20 degrees in a patient 10 years of age or older.
• Since the patient's curve is 19 degrees, which is less than 20 degrees, the treatment approach may involve observation, orthotic management, or physiotherapy scoliosis-specific exercises (PSSE) 3.
• PSSE is a therapeutic intervention that can be used alone or in combination with bracing or surgery, and its goal is to stabilize the curve, improve posture, and reduce the risk of progression 3.
• The study by 4 found that levoscoliosis can progress rapidly, particularly in women older than 69 years with lateral listhesis of more than 5 mm, and that small curves can progress and should be individualized in the context of other risk factors.
• The use of PSSE methodologies, such as the Schroth, SEAS, and BSPTS methods, has been shown to be effective in stabilizing spinal deformity and improving patients' quality of life 5.
• However, the available evidence is insufficient to confirm the advantage of one specific physiotherapy technique over others, and more research is needed to determine the most effective treatment approach for patients with 19 degrees of levoscoliosis 5.

Treatment Options

• Observation: regular follow-up appointments to monitor the curve and prevent progression 2.
• Orthotic management: the use of braces to stabilize the curve and prevent progression 2.
• Physiotherapy scoliosis-specific exercises (PSSE): a therapeutic intervention that aims to stabilize the curve, improve posture, and reduce the risk of progression 3.
• Surgical correction with fusion: may be considered for patients with curves greater than 40-50 degrees, or for those who have not responded to conservative treatment 2.

Important Considerations

• The patient's age, curve magnitude, and risk of progression should be taken into account when determining the treatment approach 2.
• The use of PSSE methodologies should be individualized and tailored to the patient's specific needs and goals 3.
• Regular follow-up appointments are necessary to monitor the curve and prevent progression, regardless of the treatment approach 2.