From the Guidelines
Treatment Options for Severe Scoliosis
The primary treatment options for severe scoliosis are surgical intervention and bracing, with the choice of treatment depending on the severity of the curvature, the patient's age, and the presence of any underlying conditions.
- Surgical Intervention: This is typically recommended for patients with a Cobb angle of more than 50°, as the likelihood of curve progression is high in these cases 1. Surgical decision-making and planning are influenced by the flexibility of the curves, which can be assessed using various radiographic techniques.
- Bracing: This is often used for patients with a Cobb angle between 20° and 40°, particularly in skeletally immature individuals, to prevent further curvature progression 1.
- Monitoring: Regular monitoring with radiographs is essential to detect scoliosis progression and initiate early treatment. The frequency of monitoring depends on the patient's age, curve severity, and Risser stage, with the SOSORT suggesting limiting spine radiographs to once every 12 months for those at Risser stages 0 to 3 and every 18 months for patients at Risser stages 4 to 5 1.
- MRI: This is utilized selectively to assess for neural axis abnormalities in patients with congenital scoliosis, early onset idiopathic scoliosis, and adolescent idiopathic scoliosis with certain risk factors, such as a left thoracic curve or rapid curve progression 1.
It is essential to note that the treatment of scoliosis should be individualized, taking into account the patient's specific condition, age, and overall health. A multidisciplinary approach, including orthopedic surgeons, radiologists, and physical therapists, is often necessary to provide optimal care for patients with severe scoliosis.
From the Research
Treatment Options for Severe Scoliosis
The treatment options for severe scoliosis include:
- Surgical treatment, which can be performed in stages, including anterior release and posterior fusion 2, 3
- Halo-gravity traction, which can be used to provide better and safer correction, and minimize complications related to forceful intra-operative maneuvers 4
- Posterior fusion only, which may cause the crankshaft phenomenon in skeletally immature patients 3
- Anterior fusion only, which may lead to low correction and screw plowing 3
Surgical Techniques
Different surgical techniques can be used to treat severe scoliosis, including:
- Two-stage surgery, which involves less invasive internal distraction followed by posterior correction and instrumentation 2
- Single-stage anterior release and posterior fusion, which can result in higher correction rates and better curve stability 3
- Halo-femoral traction with posterior fusion, which can be used to treat severe scoliosis, but may result in lower correction rates and higher loss of correction 3
Non-Surgical Treatment
Non-surgical treatment options for severe scoliosis are limited, but may include:
- Physiotherapy, which can be used to treat mild idiopathic scoliosis, and comprises general training of the trunk musculature and physical capacity 5
- Corrective bracing, which can be used to treat moderate but progressive idiopathic scoliosis in skeletally immature adolescents, and can prevent more severe deformity and avoid the need for surgical treatment 5
Considerations
When treating severe scoliosis, it is important to consider the individual course of the disease in a given patient, and to avoid overtreatment or undertreatment 5. The treatment of severe scoliosis requires cooperation within a professional team, which includes the entire therapeutic spectrum, extending from simple watchful observation of nonprogressive mild deformities through to early surgery for rapidly deteriorating curvature 5.