What is the treatment for scoliosis in a 14-year-old girl?

Treatment for Scoliosis in a 14-Year-Old Girl

The treatment for scoliosis in a 14-year-old girl should be based on curve severity, with observation for curves <20°, bracing for curves 20-50° with documented progression, and surgical intervention for curves >50° or those progressing despite conservative treatment. 1

Initial Assessment and Classification

• Scoliosis is defined as a lateral curvature of the spine greater than 10° on standing posteroanterior (PA) radiographs, typically associated with trunk rotation 2, 1
• For initial evaluation, standing PA and lateral radiographs of the complete spine should be obtained, including visualization of the iliac crests for Risser staging 1
• Risser staging (0-5) helps determine skeletal maturity and risk of progression:
  • Patients at Risser stages 0-3 have significantly higher risk of progression (up to 70% likelihood with curves >20°)
  • Girls have a 10:1 ratio compared to boys for developing larger curves (>40°) 1

Treatment Algorithm Based on Curve Severity

1. Mild Curves (<20°)

• Observation and monitoring:
  • Regular clinical assessment at least twice yearly 1
  • Radiographic monitoring every 12 months for patients at Risser stages 0-3
  • Radiographic monitoring every 18 months for patients at Risser stages 4-5 1
• Physical therapy:
  • Core strengthening exercises
  • Postural training
  • Maintaining spinal flexibility
  • Promoting symmetrical muscle development 1

2. Moderate Curves (20-50°) with Documented Progression

• Bracing is indicated when:
  • Documented progression of ≥5° on serial radiographs
  • Curve between 20-50° in a skeletally immature patient 1
• Bracing protocol:
  • Full-time bracing (23-24 hours/day) initially
  • Gradual weaning (1-2 hours every 6 months)
  • Continue until skeletal maturity (Risser 4-5) 1

3. Severe Curves (>50°) or Progressive Despite Treatment

• Surgical intervention is recommended when:
  • Curve exceeds 50° in adolescents
  • Documented progression despite conservative treatment
  • Significant pain, cosmetic concerns, or respiratory compromise 1
• Surgical approach:
  • Typically involves spinal fusion with instrumentation
  • Correction of deformity and stabilization to prevent further progression 1

Special Considerations

• Referral criteria: Refer to a spine specialist if:

  • Curve >10° in patients younger than 10 years
  • Curve >20° in patients 10 years or older
  • Presence of atypical features, back pain, or neurological abnormalities 1, 3

• Monitoring frequency:

  • More vigilant monitoring is required in patients with neuromuscular disease, as scoliosis may progress more rapidly 1
  • Regular assessment of respiratory function is recommended, especially in cases with neuromuscular involvement 1

• Lifestyle modifications:

  • Maintain normal physical activity while avoiding activities that increase asymmetric loading on the spine 1
  • High-impact activities should be limited in patients with progressive curves 1

Treatment Outcomes

The goals of treatment include:

• Preventing further curve progression
• Correcting existing deformity when possible
• Improving trunk balance and cosmesis
• Preventing potential long-term complications of untreated severe scoliosis
• Improving pain and self-image 1

Common Pitfalls to Avoid

1. Delayed referral: Curves may progress rapidly during growth spurts; timely referral to specialists is crucial
2. Inadequate monitoring: Skeletally immature patients (Risser 0-3) require more frequent monitoring due to higher progression risk
3. Inconsistent brace wear: Effectiveness of bracing depends on compliance with prescribed wear time
4. Overlooking non-idiopathic causes: Ensure proper evaluation to rule out congenital, neuromuscular, or syndrome-related causes that may require different management approaches 2, 3
5. Neglecting psychological impact: Adolescents may experience body image concerns and psychological distress related to both the condition and treatment (especially bracing)