Adolescent idiopathic scoliosis: Indications and efficacy of nonoperative treatment

Abstract

The strategy for the treatment of idiopathic scoliosis depends essentially upon the magnitude and pattern of the deformity, and its potential for progression. Treatment options include observation, bracing and/or surgery. During the past decade, several studies have demonstrated that the natural history of adolescent idiopathic scoliosis can be positively affected by nonoperative treatment, especially bracing. Other forms of conservative treatment, such as chiropractic or osteopathic manipulation, acupuncture, exercise or other manual treatments, or diet and nutrition, have not yet been proven to be effective in controlling spinal deformity progression, and those with a natural history that is favorable at the completion of growth. Observation is appropriate treatment for small curves, curves that are at low risk of progression, and those with a natural history that is favorable at the completion of growth. Indications for brace treatment are a growing child presenting with a curve of 25°–40° or a curve less than 25° with documented progression. Curves of 20°–25° in patients with pronounced skeletal immaturity should also be treated. The purpose of this review is to provide information about conservative treatment of adolescent idiopathic scoliosis. Indications for conservative treatment, hours daily wear and complications of brace treatment as well as brace types are discussed.

Serial elongation, derotation and flexion (EDF) casting under general anesthesia and neuromuscular blocking drugs improve outcome in patients with juvenile scoliosis: preliminary results

“…Although good results can be achieved in patients with JS treated conservatively, there is no known conservative technique able to completely arrest curve progression and to erase the potential need for surgery for this patients population [16][17][18][19][20][21][22]. In particular, Tolo and Gillespie [3] found 27.2 % of their patients treated with the Milwaukee brace needed surgery.…”

“…Coillard et al in 2010 using a SpineCor orthosis reported 37.1 % of patients needed surgery [20]. Other authors have reported higher percentages of patients who needed surgery despite bracing [21][22][23].…”

“…Our hypothesis is that complete muscle relaxation, allows the surgeon to better derotate the spine while straightening it. Both rib vertebral angle difference and apical vertebral degree improved [17,[19][20][21][22][23][24]. Canavese et al showed that rib vertebral angle difference and apical vertebral degree are expression of vertebral rotation and can be used to better characterize the spinal deformity and/or to evaluate effects of brace or surgical treatment [24].…”

Manipulative and rehabilitative therapy as a treatment of idiopathic scoliosis without psychological sequelae: a case report

“…Patients, usually young, have to wear the brace for 18 to 23 hours a day for several years; the brace is often visible and can be uncomfortable to wear. 26 This type of treatment can be rather bothersome 26 and may significantly impact patients' psychological well-being and negatively affect their QoL. 9,21 Bracing may have psychological impacts at the beginning of treatment, including reduced self-esteem.…”

The Effects of the Core Muscle Release Technique on Scoliosis

“…Typical nonsurgical treatments include wearing orthotics, stretching and massage, therapeutic exercises, ultrasound or electric stimulation therapy and manual therapy [7][8][9] . Among these methods, therapeutic exercise, strengthening the paraspinal muscles, is recommended as an effective treatment, and is now frequently conducted for the prevention and treatment of scoliosis [10][11][12] .…”