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Management of Idiopathic (Adolescent) Scoliosis

Making the Right Choices in the Treatment of Idiopathic Scoliosis: A Patient's Guide

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The Management of Scoliosis

When an adolescent is identified with scoliosis, management should be guided by informed choices by the patient, family members, and the health care provider. Management options are determined by the:

  • degree of the deformity
  • location of the deformity
  • cause of the deformity
  • age of the patient
  • skeletal maturity of the patient
  • individual preferences of the patient and family

For AIS, natural history studies provide important information regarding the prognosis of the curve types that affect adolescents. Despite this knowledge, individual curves behave quite differently and should be managed by experienced judgment and expectant observation rather than rules or strict guidelines.

Non-Operative Treatment:

Non-operative treatment of AIS focuses on preventing curve progression during the growing years. Brace treatment of scoliosis remains the only documented effective non-operative treatment of progressive idiopathic scoliosis. Brace treatment often accompanies exercises to maintain low back flexibility, mobility of the chest cavity, and overall cardiovascular fitness. Exercises alone have not demonstrated a benefit to stop or slow the curve progression. Bracing may be appropriate for patients with:

  • bones still maturing
  • premenarchal, or less than one year postmenarchal
  • curves between 30-45 degrees

Curves less than 30 degrees should only be braced when they have demonstrated progression, while curves greater than 45 degrees may not be effectively managed with brace treatment.

Orthotists create brace options that may include a/an:

  • superstructure encompassing the neck
  • underarm orthoses
  • nighttime bending brace
  • derotational brace

Patient, family, physician and orthotist can decide on the brace type. A cooperative decision may benefit the patient's overall experience.

medium sized scoliosis idiopathic boy in brace rodts

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Updated on: 02/01/10
Thomas G. Lowe, MD
Dr. Berven has provided the reader with an overview of scoliosis developing in the skeletally immature adolescent. The important fact to remember is that only a small fraction of adolescent patients who develop a curvature of the spine will ever require treatment other than periodic observation during the growth period. It is however important, once scoliosis has been diagnosed or is suspected, to be seen by an orthopaedic surgeon, who specializes in spinal problems in children to determine the severity of the deformity by an examination and x-rays and what, if any, treatment is indicated.

Most of the time he/she will recommend periodic follow-up examination during the growth period until growth is complete. Exercises alone have never proven helpful in the treatment of scoliosis. A small number of patients (<0.5%) will require the use of a back brace combined with an exercise program during growth, however the brace, if needed can be removed for daily athletic activities and exercise. Braces are now available which are cosmetically acceptable and easy to wear. Braces often will control curves <40º but a few will increase and require surgery. An even smaller number (<0.25%) with curves greater than 40º- 45º may require surgical correction of their scoliosis. When surgery is necessary, the use of a brace is rarely needed and present surgical techniques are usually very successful.

As Dr. Berven suggested, always discuss treatment options with your orthopaedist so that you thoroughly understand his/her recommendations and seek other opinions if he/she is unable to explain recommendations.

Baron S. Lonner, MD
Dr. Berven provides an excellent review of the management of adolescent idiopathic scoliosis that emphasizes the importance of informed decision-making by the patient, family, and surgeon. New treatment options in AIS include the possibility of modulating or controlling growth of the spine by causing differential growth on one side of the spine more than the other to allow for gradual correction of the scoliosis with growth. This approach, utilizing "staples" or flexible tethers placed by minimally invasive techniques would be utilized in patients who continue to grow and in whom bracing has failed. Flexibility of the spine is preserved by theses techniques. This is currently an experimental area.

Results of surgery in the adolescent patient have been predictable and quite good. Goals of surgery include correction of deformity, preservation of pulmonary (lung) function, avoidance of long-term pain as a consequence of untreated curvature, and preservation of as many motion segments of the spine as possible. Studies assessing outcomes of surgery in patients have shown high rates of satisfaction and improvements in self image, pain, and even function.

Dr. Berven should be congratulated on his approach to patient care based on informed decision-making and inclusion of the patient and family in the process of devising a treatment plan.

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