From the Guidelines
The recommended treatment for minimal dextroconvex scoliosis at the thoracolumbar junction is conservative management, focusing on physical therapy and monitoring, rather than surgical intervention. This approach prioritizes minimizing morbidity, mortality, and optimizing quality of life. The primary goal is to prevent curve progression and manage any associated symptoms.
Conservative Management
Conservative management involves:
- Physical therapy focusing on core strengthening exercises, postural training, and flexibility
- Specific exercises such as pelvic tilts, cat-cow stretches, and rotational movements to improve spinal mobility and muscle balance
- These exercises should be performed 3-5 times weekly for at least 20-30 minutes per session
Pain Management
Pain management, if needed, can include:
- Over-the-counter medications like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) for short periods
- Regular monitoring with clinical examinations every 6-12 months is important to ensure the curve doesn't progress, especially in growing adolescents
Bracing and Monitoring
- Bracing is generally not necessary for minimal curves (typically less than 20 degrees)
- Regular monitoring is crucial to detect any potential progression of the curve, as identified by studies such as 1, which highlights the importance of early detection and management of vertebral fractures and deformities.
This conservative approach is recommended because minimal scoliosis often doesn't progress significantly and rarely causes functional limitations or pain, as suggested by the lack of emphasis on surgical intervention in the provided evidence 1. The exercises help maintain spinal flexibility and strengthen supporting muscles, potentially preventing progression and reducing any associated discomfort.
From the Research
Treatment Options for Minimal Dextroconvex Scoliosis
- The treatment for minimal dextroconvex scoliosis at the thoracolumbar junction may involve a combination of physical therapy and bracing 2, 3, 4.
- A global physiotherapy approach, such as the Mézières method, may be effective in reducing pain and improving posture and mobility in patients with thoracolumbar junction syndrome 5.
- Bracing has been shown to be effective in slowing down the rate of progression of scoliosis in adults 4 and may be used in conjunction with exercise treatment 3.
- The use of a scoliosis-specific exercise program, such as the Schroth exercise program, may also be beneficial in managing pain and improving functionality in patients with scoliosis 2.
Bracing as a Treatment Option
- Bracing may be prescribed for patients with scoliosis who have a Cobb angle of 20-40 degrees 6.
- The type of brace used may vary depending on the location and severity of the scoliosis, as well as the patient's age and activity level 6.
- Bracing may be worn for a minimum of 6 hours per day, and the patient may need to undergo regular follow-up appointments to monitor the progression of the scoliosis 4.
Exercise and Physical Therapy
- Exercise and physical therapy may be used in conjunction with bracing to manage pain and improve functionality in patients with scoliosis 2, 3.
- A scoliosis-specific exercise program, such as the Schroth exercise program, may be beneficial in improving posture and reducing pain in patients with scoliosis 2.
- Physical therapy may also involve the use of techniques such as the Mézières method, which may be effective in reducing pain and improving posture and mobility in patients with thoracolumbar junction syndrome 5.