Global InformationManagement of scoliosis information
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The management of scoliosis is complex and is determined primarily by the type of scoliosis encountered: syndromic, congenital, neuromuscular, or idiopathic.[1] Treatment options for idiopathic scoliosis are determined in part by the severity of the curvature and skeletal maturity, which together help predict the likelihood of progression. Non-surgical treatment (conservative treatment) should be pro-active with intervention performed early as "Best results were obtained in 10-25 degrees scoliosis which is a good indication to start therapy before more structural changes within the spine establish."[2] Treatment options have historically been categorized under the following types:
- Observation
- Bracing
- Specialized physical therapy
- Surgery
For adults, treatment usually focuses on relieving any pain,[3][4] while physiotherapy and braces usually play only a minor role.[5]
- Painkilling medication
- Bracing
- Exercise
- Surgery[6]
Treatment for idiopathic scoliosis also depends upon the severity of the curvature, the spine’s potential for further growth, and the risk that the curvature will progress.
Mild scoliosis (less than 30 degrees deviation) has traditionally been treated through observation only.[7] However, the progression of adolescent idiopathic scoliosis has been linked to rapid growth,[8] suggesting that observation alone is inadequate as progression can rapidly occur during the pubertal growth spurt. Another study has further shown that the peak rate of growth during puberty can actually be higher in individuals with scoliosis than those without, further exacerbating the issue of rapid worsening of the scoliosis curves.[8] Moderately severe scoliosis (30–45 degrees) in a child who is still growing requires bracing. A 2013 study by Weinstein et al.[9] found that rigid bracing significantly reduces worsening of curves in the 20-45 degree range and found that 58% of children receiving "observation only" progressed to surgical range. Recent guidelines[10] published by the Scientific Society of Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) in 2016 state that “the use of a brace is recommended in patients with evolutive idiopathic scoliosis above 25º during growth” based on a review of current scientific literature. Severe curvatures that rapidly progress may be treated surgically with spinal rod placement. Thus, early detection and early intervention prior to the pubertal growth spurt provides the greatest correction and prevention of progression to surgical range.[11] In all cases, early intervention offers the best results. A growing body of scientific research testifies to the efficacy of specialized treatment programs of physical therapy, which may include bracing.[12]
- ^ Menger RP, Sin AH (2019). Adolescent and Idiopathic Scoliosis. StatPearls Publishing. PMID 29763083. Retrieved 2019-04-30.
{{cite book}}:|work=ignored (help) - ^ Białek M (November 2011). "Conservative treatment of idiopathic scoliosis according to FITS concept: presentation of the method and preliminary, short term radiological and clinical results based on SOSORT and SRS criteria". Scoliosis. 6: 25. doi:10.1186/1748-7161-6-25. PMC 3286410. PMID 22122964.
- ^ "Scoliosis – Treatment in adults". NHS Choices. 19 February 2013. Retrieved 14 May 2014.
- ^ "Idiopathic Scoliosis – Adult Nonoperative Management". Scoliosis Research Society. Archived from the original on 1 July 2014. Retrieved 14 May 2014.
- ^ Trobisch, P; Suess, O; Schwab, F (December 2010). "Idiopathic scoliosis". Deutsches Ärzteblatt International. 107 (49): 875–83, quiz 884. doi:10.3238/arztebl.2010.0875. PMC 3011182. PMID 21191550.
- ^ "Idiopathic Scoliosis – Adult Surgical Treatment". Scoliosis Research Society. Archived from the original on 1 July 2014. Retrieved 14 May 2014.
- ^ Choudhry MN, Ahmad Z, Verma R (2016-05-30). "Adolescent Idiopathic Scoliosis". The Open Orthopaedics Journal. 10: 143–54. doi:10.2174/1874325001610010143. PMC 4897334. PMID 27347243.
- ^ a b Loncar-Dusek M, Pećina M, Prebeg Z (September 1991). "A longitudinal study of growth velocity and development of secondary gender characteristics versus onset of idiopathic scoliosis". Clinical Orthopaedics and Related Research (270): 278–82. PMID 1884550.
- ^ Dolan LA, Wright JG, Weinstein SL (February 2014). "Effects of bracing in adolescents with idiopathic scoliosis". The New England Journal of Medicine. 370 (7): 681. doi:10.1056/NEJMc1314229. PMID 24521128.
- ^ Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, Diers H, Grivas TB, Knott P, Kotwicki T, Lebel A, Marti C, Maruyama T, O'Brien J, Price N, Parent E, Rigo M, Romano M, Stikeleather L, Wynne J, Zaina F (2018). "2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth". Scoliosis and Spinal Disorders. 13: 3. doi:10.1186/s13013-017-0145-8. PMC 5795289. PMID 29435499.
- ^ DiMeglio A, Dimeglio A, Canavese F, Charles YP, Charles P (January 2011). "Growth and adolescent idiopathic scoliosis: when and how much?". Journal of Pediatric Orthopedics. 31 (1 Suppl): S28-36. doi:10.1097/BPO.0b013e318202c25d. PMID 21173616.
- ^ Negrini S, Fusco C, Minozzi S, Atanasio S, Zaina F, Romano M (2008). "Exercises reduce the progression rate of adolescent idiopathic scoliosis: results of a comprehensive systematic review of the literature". Disability and Rehabilitation. 30 (10): 772–85. doi:10.1080/09638280801889568. PMID 18432435. S2CID 13188152.