From the Guidelines
The recommended approach for treating scoliosis in adolescents depends on the curve severity, with observation being appropriate for mild curves (less than 25 degrees), bracing for moderate curves (25-45 degrees), and surgery for severe curves (greater than 45-50 degrees). This approach is based on the most recent evidence from the American College of Radiology 1, which emphasizes the importance of curve severity in determining the treatment plan.
Key Considerations
- For bracing, the most common option is the thoracolumbosacral orthosis (TLSO) or Boston brace, which should be worn 16-23 hours daily until skeletal maturity is reached.
- Surgical intervention typically involves posterior spinal fusion with instrumentation to correct and stabilize the spine.
- Physical therapy, while not proven to prevent curve progression, can help maintain flexibility and core strength.
- Early intervention is crucial as curves tend to progress during growth spurts, particularly in girls who have not yet reached menarche.
Monitoring and Follow-up
- Regular monitoring with physical exams and X-rays every 4-6 months during growth periods is essential for all adolescents with scoliosis.
- The Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) suggests limiting spine radiographs to once every 12 months for those adolescent patients at Risser stages 0 to 3 and every 18 months for patients at Risser stages 4 to 5, unless there are objective clinical changes in the appearance of the scoliosis 1.
Additional Considerations
- Up to 2% to 4% of adolescents with scoliosis have an intrinsic anomaly of their spinal cord or spinal contents that can only be identified with MRI 1.
- Several risk factors for neural axis abnormalities have been suggested, including left thoracic curve, short segment curve, absence of apical segment lordosis/kyphosis, rapid curve progression, functionally disruptive pain, focal neurologic findings, male sex, and pes cavus.
- Detecting these anomalies before scoliosis surgery may influence management, although there is no consensus on the indications for selective use of MRI 1.
From the Research
Treatment Approaches for Adolescent Idiopathic Scoliosis
The treatment of adolescent idiopathic scoliosis (AIS) can vary depending on the severity of the curvature and the patient's overall health. Some common approaches include:
- Observation: For mild curvatures, regular check-ups with a doctor to monitor the progression of the curve 2
- Scoliosis-specific exercises (SSE): Exercises designed to help improve posture, reduce curvature, and prevent progression 2, 3
- Bracing: The use of a brace to help prevent curvature progression and reduce the need for surgery 4, 2, 3, 5, 6
Bracing Options
There are several types of braces that can be used to treat AIS, including:
- Thoracolumbosacral orthosis (TLSO): A rigid brace that is worn for 22 hours a day 4, 5
- Providence orthosis: A brace that is worn for 8-10 hours a night 4
- SpineCor: A non-rigid brace that uses dynamic bracing concepts 5
- Lyon brace: A type of brace that can be used in conjunction with exercises 6
Effectiveness of Bracing
The effectiveness of bracing in treating AIS can vary depending on the type of brace used and the severity of the curvature. Some studies have shown that:
- The Providence orthosis can be more effective than the TLSO in preventing curvature progression and reducing the need for surgery when the initial curve is 35 degrees or less 4
- The SpineCor brace can be as effective as the TLSO in preventing curvature progression 5
- High-quality bracing can reduce curvatures exceeding 45 degrees in over 70% of growing adolescents 2
- A complete conservative treatment approach, including bracing and exercises, can be effective in preventing curvature progression and reducing the need for surgery 6
Indications for Bracing
Bracing is typically indicated for patients with AIS who have: