From the Guidelines
Scoliosis of the thoracic spine should be diagnosed and treated based on the severity of the curve, with treatment options ranging from observation to bracing or surgical intervention, and comprehensive evaluation is essential to exclude underlying conditions. The diagnosis of scoliosis is typically made through a combination of physical examination and radiographic imaging, with the Cobb angle measured on PA and lateral spine radiographs being a key factor in determining the severity of the curve 1. Mild cases (less than 25 degrees) typically require only observation with regular X-rays every 4-6 months to monitor progression, while moderate curves (25-45 degrees) may require bracing, such as the Boston brace, worn 16-23 hours daily until skeletal maturity 1. Severe curves (greater than 45-50 degrees) usually require surgical intervention, typically posterior spinal fusion with instrumentation 1. It is also important to note that scoliosis can sometimes indicate underlying conditions like neuromuscular disorders or congenital abnormalities, so comprehensive evaluation is essential for proper management 1. Some key points to consider in the diagnosis and treatment of scoliosis include:
- The Cobb angle is a key factor in determining the severity of the curve and guiding treatment decisions 1
- Bracing is typically recommended for moderate curves (25-45 degrees) and can be effective in preventing curve progression 1
- Surgical intervention is usually required for severe curves (greater than 45-50 degrees) and can help to correct the deformity and prevent further progression 1
- Comprehensive evaluation is essential to exclude underlying conditions that may be contributing to the scoliosis, such as neuromuscular disorders or congenital abnormalities 1
- Regular follow-up appointments with an orthopedic specialist are important to monitor the progression of the curve and adjust treatment as needed. Overall, the goal of treatment for scoliosis is to prevent curve progression, correct the deformity, and improve quality of life, and treatment should be individualized based on the severity of the curve and the presence of any underlying conditions.
From the Research
Diagnosis of Scoliosis
- Scoliosis is defined as lateral curvature of the spine which is also associated with a change in the curves in sagittal plane and vertebral rotation 2
- Diagnosis and patient evaluation is essential in the treatment model, looking at a patient-oriented decision according to clinical experience, scientific evidence and patient's preference 3
Treatment of Scoliosis
- Various types of conservative treatment approaches have been recommended for the patients with scoliosis, including orthosis, brace, exercise, and physical therapy 2
- Physiotherapy Scoliosis Specific Exercises (PSSE) is part of a scoliosis care model that includes scoliosis specific education, scoliosis specific physical therapy exercises, observation or surveillance, psychological support and intervention, bracing and surgery 3
- Bracing and individual physiotherapy can be used for the comprehensive treatment of idiopathic scoliosis in adolescents 4
- Conservative scoliosis therapy according to the FITS Concept can be applied as a unique treatment or in combination with corrective bracing 5
- Thoracoscopic techniques can be used for the treatment of scoliosis, with benefits including improved observation of the spine, enhanced access to the extremes of the curve, decreased operative times and blood losses, shorter hospital stays and recuperative periods, and decreased overall costs 6
Treatment Outcomes
- PSSE can temporarily stabilize progressive scoliosis curves during the secondary period of progression, and produce a temporary and significant reduction of the Cobb angle in non-progressive scoliosis 3
- Bracing and physiotherapy can improve the muscle strength and correction of the curve in adolescents with idiopathic scoliosis 4
- FITS therapy can improve the Cobb angle and clinical assessment in patients with idiopathic scoliosis, with best results obtained in 10-25 degrees scoliosis 5
- Thoracoscopic techniques can provide curve correction, axial derotation, and pain management, with decreased hospital stays and recuperative periods 6