Patient and Family Participation in Scoliosis Treatment  Making Right Choices for the Treatment of Idiopathic Scoliosis: A Patient Guide by Dr. Sigurd H. Berven. Sigurd H. Berven, M.D. Assistant Professor in Residence UC San Francisco, Department of Orthopaedic Surgery San Francisco, CA, USA

The purpose of this article is to provide basic information about the treatment of Adolescent Idiopathic Scoliosis (AIS).Scoliosis is a disease that causes the spine to curve to the left or right. AIS, also termed Adolescent Scoliosis, occurs between age 10 and maturity. AIS may start at the onset of puberty or become apparent during an adolescent growth spurt. This information will help patients and family to be active participants in the medical and surgical management of AIS. In managing AIS, the judgment of the surgeon and the participation of informed patients and families are as important in determining treatment outcome as surgical techniques. Decision-making in the management of AIS remains complex despite the availability of data on natural history, prognosis of different curve patterns, brace treatment factors, and surgical innovations. The management of AIS includes several steps and treatment options: screening and early detection of deformity, observation of changes in deformity over time with informed judgment regarding prognosis, orthotic and non-operative interventions, surgical planning and operating, post-operative care, and long-term follow-up. Surgical treatment of idiopathic scoliosis varies throughout the country. As with many elective surgical procedures, the decision may be determined by factors such as the surgeon's or the institution's training, experience, and preferences, instead of the decision being based on the disorder and the patient's individual preference. Such variability in treating idiopathic scoliosis reflects uncertainty. In the setting of uncertainty, an informed patient and family should be empowered to participate actively in treatment decisions, and participation will positively influence the outcome of orthopaedic care. Patients and family members should consider the next sections of this article when evaluating treatment options for AIS. Patients and families should seek further information on these topics from their care providers. Continue this article...
Management of Idiopathic (Adolescent) Scoliosis Surgical Management of Scoliosis Deformity and Scoliosis Thoracoscopy in the Treatment of Scoliosis Idiopathic Scoliosis Spine Chat Video Chiropractic Patient Case Study: Cervical Bulging, "Slipped", Herniated and Ruptured Discs	Article written 09/20/2000 Published online 11/16/2000 Last updated 02/13/2008

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. Thomas G. Lowe, M.D. 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. Baron S. Lonner, MD

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