The paper reviews the current imaging methods in the diagnosis and monitoring of patients with adolescent idiopathic scoliosis. Radiography is generally used in the initial diagnosis of the condition. Postero-anterior erect full spine radiograph is generally prescribed, and is supplemented by lateral full spine radiograph when indicated. To reduce the radiation hazard, only the area of interest should be exposed, and follow-up radiographs should be taken with as few projections as possible. When available, EOS® stereoradiography should be used. The radiation of the microdose protocol is 45 times less than that of the conventional radiography. Surface topography offers another approach to monitoring changes of curvatures in AIS patients. Recently, 3D ultrasound has been found to be able to measure the Cobb angle accurately. Yet, it is still in the early developmental stages. The inherent intrinsic and external limitations of the imaging system need to be resolved before it can be widely used clinically. For AIS patients with atypical presentation, computed tomography (CT) and/or magnetic resonance imaging (MRI) may be required to assess for any underlying pathology. As CT is associated with a high radiation dose, it is playing a diminishing role in the management of scoliosis, and is replaced by MRI, which is also used for pre-operative planning of scoliosis.The different imaging methods have their limitations. The EOS® stereoradiography is expensive and is not commonly available. The surface topography does not enable measurement of Cobb angle, particularly when the patient is in-brace. The 3D ultrasound scanning has inherent intrinsic technical limitation and cannot be used in all subjects. Radiography, however, enables diagnosis and monitoring of the adolescent idiopathic scoliosis (AIS). It is thus the gold standard in the evaluation and management of scoliosis curves.

Study design: This is a pilot prospective cohort study.Objectives: To investigate if outpatient Schroth exercises (SBP) affect thoracolumbar or lumbar curves in adult scoliosis patients.Background: Adult scoliosis tends to progress and is associated with an increased prevalence of low back pain. The outcome of conservative treatment is not satisfactory, as treatment is not directed towards spinal deformity. This study investigates if SBP influences the thoracolumbar and lumbar curves in patients with adult scoliosis. Materials and methods:Adult patients with thoracolumbar and lumbar curves ≥ 20 o were taught SBP exercises once weekly for 4 weeks. They then performed the exercises at home three times a week, for 9 months. Baseline measurements included Cobb angles, coronal offset, sagittal vertical axis (SVA), T4-12 kyphosis, L1-S1 lordosis, sacral slope, pelvic incidence and pelvic tilt. They were compared to post-intervention measurements, using paired t tests.Results: SBP exercises statistically significantly decreased the Cobb angle (p = 0.0032), improved the ATR (p = 0.012), increased the sacral slope (p = 0.03), decreased the pelvic tilt (p = 0.0032) and the SVA (p = 0.032). Conclusion:The SBP exercises improved the Cobb angles and SVA in adult scoliosis patients with thoracolumbar and lumbar curves.

Introduction:Physiotherapeutic Scoliosis-Specific Exercises (PSSE) and bracing have been found to be effective in the stabilization of curves in patients with Adolescent Idiopathic Scoliosis (AIS). Yet, the difference among the many PSSEs and braces has not been studied. The present review attempts to investigate the role of curve correction in the outcome of treatment for PSSEs and braces.Material and Methods:A PubMed manual search has been conducted for studies on the role of correction in the effectiveness of PSSE and bracing. For the PSSEs, the key words used were “adolescent idiopathic scoliosis, correction, physiotherapy, physical therapy, exercise, and rehabilitation.” For bracing, the key words used were “adolescent idiopathic scoliosis, correction and brace”. Only papers that were published from 2001-2017 were included and reviewed, as there were very few relevant papers dating earlier than 2001.Results:The search found no studies on the role of correction on the effectiveness of different PSSEs. The effectiveness of different PSSEs might or might not be related to the magnitude of curve correction during the exercises. However, many studies showed a relationship between the magnitude of in-brace correction and the outcome of the brace treatment.Discussion:The role of correction on the effectiveness of PSSE has not been studied. In-brace correction, however, has been found to be associated with the outcome of brace treatment. An in-brace correction of < 10% was associated with an increased rate of failure of brace treatment, whereas an in-brace correction of >40-50% was associated with an increased rate of brace treatment success (i.e. stabilization or improvement of curves). Thus, in the treatment of AIS, patients should be advised to use highly corrective braces, in conjunction with PSSE since exercises have been found to help stabilize the curves during weaning of the brace. Presently, no specific PSSE can be recommended.Conclusion:Braces of high in-brace correction should be used in conjunction with PSSEs in the treatment of AIS. No specific PSSE can be recommended as comparison studies of the effectiveness of different PSSEs are not found at the time of this study.

Scoliosis is prevalent in elderlies over the age of 60. Of the different curve types, the thoracolumbar curve is the most common curve type operated upon, as it is associated with marked trunk shift and disability. Current physiotherapy treatments consist of electrotherapy, aquatic exercises, core-strengthening exercises, and dry needling. Outcome of these treatments has not been satisfactory. Longterm successful rate of conservative treatment of symptomatic adult scoliosis is low, as the treatment addresses symptoms but not the biomechanics involved in adult scoliosis. Recent studies have shown that physiotherapeutic scoliosis-specific exercises (PSSE) and bracing stabilized the curves in 80% of the subjects. Thus PSSE and bracing should be added to the standard physiotherapy care in the management of symptomatic adult scoliosis. For asymptomatic patients with thoracolumbar curve that has an increased risk of progression, PSSE should be considered as preventative exercises. Patients who do not respond to conservative treatments and have significant spinal stenosis should be referred for surgery.curves progressed 3° per year [13] and that apical vertebral rotation ≥ III (according to the Nash-Moe classification), a Cobb angle >30°, lateral vertebral translation >6 mm, and L5 above the intercristal line predict curve progression [13,14]. Osteoporosis, a coronal Cobb angle <30°, lumbar lordosis, and degenerative spondylolisthesis are not risk factors for curve progression [14].With increase in life expectancy of the population [2,15], it follows that the prevalence of adult scoliosis increases [2,15] and with it the morbidity.