From the Guidelines
The treatment for marked thoracolumbar scoliosis and rotoscoliosis should be based on the severity of the curve, patient age, and skeletal maturity, with surgical intervention being the most effective option for curves exceeding 45-50 degrees or rapidly progressing curves, as recommended by the most recent guidelines 1.
Treatment Options
The treatment approach for marked thoracolumbar scoliosis and rotoscoliosis can be categorized based on the severity of the curve:
- For curves less than 25 degrees, observation with regular follow-up X-rays every 4-6 months is typically recommended.
- For curves between 25-40 degrees in growing children, bracing is the standard treatment, with the Boston brace or Cheneau brace worn 16-23 hours daily until skeletal maturity.
- For curves exceeding 45-50 degrees or rapidly progressing curves, surgical intervention is usually necessary, with posterior spinal fusion with instrumentation being the gold standard surgical approach.
Surgical Approach
The surgical approach for marked thoracolumbar scoliosis and rotoscoliosis may involve:
- Posterior spinal fusion with instrumentation, which involves placing rods, screws, and hooks to straighten the spine and fuse the vertebrae together.
- Anterior approaches or combined anterior-posterior procedures may be required, especially for rigid curves or those with significant rotation (rotoscoliosis).
Additional Treatments
Additional treatments that can complement the main treatment approach include:
- Physical therapy, including specific exercises like Schroth method, to improve spinal mobility and reduce pain.
- Pain management, including NSAIDs like ibuprofen (400-800mg three times daily) for short-term relief.
Importance of Early Detection and Treatment
Early detection and treatment of marked thoracolumbar scoliosis and rotoscoliosis are crucial to prevent progression, correct deformity, maintain spinal balance, and preserve neurological function while minimizing complications and maintaining as much spinal mobility as possible, as highlighted in the guidelines 1.
From the Research
Treatment for Marked Thoracolumbar Scoliosis and Rotoscoliosis
- The treatment for marked thoracolumbar scoliosis and rotoscoliosis can involve surgical correction, including posterior spinal fusion, hemivertebra resection, and short-segment fusion with pedicle screw fixation 2, 3, 4, 5.
- Posterior spinal fusion using a unilateral convex segmental pedicle screw technique can achieve a mean scoliosis correction of 80% 3.
- Hemivertebra resection and short-segment fusion with pedicle screw fixation can achieve significant correction of the segmental main curve, total main curve, and compensatory curves, with an average correction of 60-70% 4, 5.
- The choice of treatment depends on the severity of the curve, the patient's age, and the presence of any underlying conditions or complications 6.
Surgical Outcomes and Complications
- Surgical outcomes for marked thoracolumbar scoliosis and rotoscoliosis can include significant improvements in curve correction, trunk shift, and sagittal balance 2, 3, 4, 5.
- Complications can include implant migration, postoperative curve progression, proximal junctional kyphosis, and adding-on phenomena 4, 5.
- Neurological, pulmonary, and mechanical complications can also occur, with some cases requiring revision surgery 5.
Predictive Radiological Factors
- Pre-operative radiological parameters, such as the size of the thoracolumbar/lumbar curve, lowest instrumented vertebra angle, apical vertebra translation, and Cobb angle on lumbar convex bending, can correlate with the need for distal extension of the fusion 3.
- An equation incorporating these parameters can be developed to reliably inform the selection of the lowest instrumented vertebra 3.