What is the recommended management for an adult with adolescent idiopathic scoliosis of the cervicothoracic region?

Patient Education for Adults with Adolescent Idiopathic Scoliosis of the Cervicothoracic Region

For adults with adolescent idiopathic scoliosis (AIS) of the cervicothoracic region, management should focus on regular radiographic monitoring, physical therapy, pain management, and surgical intervention only for curves greater than 50° or with documented progression.

Understanding Your Condition

• AIS is the most common type of scoliosis, occurring in 1-2% of otherwise healthy children and constituting 75-80% of all scoliosis cases 1
• Although diagnosed during adolescence (10-18 years), AIS persists into adulthood and is considered a lifetime condition 2
• AIS is more common in females, with a female-to-male ratio of 10:1 for larger curves (>40°) 1

Monitoring Recommendations

• Regular radiographic monitoring is essential to track potential curve progression 1
• For adults with stable curves, radiographic evaluation every 12-18 months is typically recommended 3
• Skeletally mature patients with thoracic scoliosis greater than 50° may continue to progress at approximately 1° per year, requiring more vigilant monitoring 1
• MRI evaluation should be considered if you develop new neurological symptoms or if your curve shows unexpected progression 3

Non-Surgical Management Options

• For curves less than 40-45°, observation is generally recommended rather than surgical intervention 4
• Physical therapy focusing on core strengthening and postural awareness can help manage symptoms 5
• Pain management strategies may include:
  • Regular stretching exercises to relieve pain after prolonged sitting 3
  • Non-steroidal anti-inflammatory medications for acute pain episodes 5
  • Physical modalities such as heat or massage for muscle spasm 5

When to Consider Surgical Intervention

• Surgical treatment should be considered for:
  • Curves greater than 50° due to risk of continued progression into adulthood 4
  • Documented curve progression despite skeletal maturity 1
  • Significant pain not responding to conservative measures 5
  • Significant cosmetic concerns affecting quality of life 4

Red Flags Requiring Urgent Evaluation

• Development of new neurological symptoms such as weakness, numbness, or changes in bowel/bladder function 5
• Rapid curve progression (more than 1° per month) 1
• Development of functionally disruptive pain 1
• Focal neurological findings on examination 5

Long-Term Outlook

• Most adults with untreated AIS function at or near normal levels compared to non-scoliotic controls 2
• There may be increased pain prevalence, though severity varies between individuals 2
• Self-image may be affected, particularly with larger curves 2
• Mental health is usually not significantly affected by the condition itself 2
• Shortness of breath is not typically increased unless curves exceed 50° at maturity or 80° during adulthood 2

Common Pitfalls to Avoid

• Excessive radiation exposure from too-frequent radiographs - follow recommended monitoring intervals 1
• Assuming that absence of symptoms means no progression - regular monitoring is still necessary 1
• Delaying evaluation of new or worsening symptoms - prompt assessment is important for optimal management 5
• Underestimating the importance of core strengthening exercises in managing symptoms 5