1 / 21

Treatment Options for Adolescent Idiopathic Scoliosis

Treatment Options for Adolescent Idiopathic Scoliosis. Mandy Phelps March 24, 2006 Advisor Bill Grimes D. Min., PA-C. What is Scoliosis?. A lateral curvature of the spine that is often accompanied by axial rotation A multi-system disorder

eyad
Download Presentation

Treatment Options for Adolescent Idiopathic Scoliosis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Treatment Options for Adolescent Idiopathic Scoliosis Mandy Phelps March 24, 2006 Advisor Bill Grimes D. Min., PA-C

  2. What is Scoliosis? • Alateral curvature of the spine that is often accompanied by axial rotation • A multi-system disorder • Digestive, Hormonal, Muscular, Skeletal and Neurological effects • A Cobb angle greater than 10 degrees • A descriptive term; not a diagnosis

  3. Terminology • Cobb angle • a measurement of the degrees of curvature present in the spine

  4. Terminology • Risser sign • a tool used to assess skeletal maturity

  5. Terminology • Adam’s forward bend test • done with the patient standing in front of the examiner and then slowly bending forward as if they are going to touch their toes

  6. Risk factors for curve progression • Magnitude of the curve • Risser sign • Young age at presentation • Gender (females greater than males) • Large Cobb angle • Menarchal status in females

  7. Treatment Options • Depend on the severity of the spinal curvature and on the age of the patient.

  8. Treatment Options • Do Nothing • Physically mature patient • Curve less than 40 degrees

  9. Treatment Options • Bracing • Prevent progression • Children and adolescents with expected rapid progression of the curvature • Curves between 20 and 35 degrees • Compliance issues • Less effective in overweight patients

  10. Treatment Options • Surgery • Teens and pre-teens • Curvature of 40 degrees or greater • Reduces curvature and deformity • Adults to decrease pain • Types of Surgery…

  11. Posterior Spinal Fusion • Most common surgery for idiopathic adolescent scoliosis or any thoracic curvature • Used with instrumentation and bone grafting • May be performed as young a 3 years • Long lasting • May be accompanied by endoscopic discectomy surgery to get maximum correction

  12. Anterior Approach • Lumbar spine curvature • Less fusion, better correction and greater ROM than posterior approach • Average of 2.5 lumbar levels are saved • Disadvantage is the large scar • Endoscopic techniques now being used

  13. Combination Anterior and Posterior • May be necessary to achieve maximum correction of a double major curvature • Option to correct thoracic curve and see if lumbar corrects naturally

  14. Costodesis and Contralateral Rib Release • Less commonly used • Ribs are fixed along the convexity and released on the opposite side • Less favorable outcome in congenital and adolescent patients • Diminished spirometric volume • Contraindicated in patients with diminished respiratory function

  15. Non-Surgical; Non-Bracing Strategies • Often used with bracing • Address other body systems affected by scoliosis • Re-educate mind-body system • Examples: • Ocular vestibular therapy • Electrical muscle stimulation • Flexion Distraction • Exercise therapy • Nutritional Support

  16. Conclusion • No clean cut rules for scoliosis treatment • Non-Surgical; Non-Bracing therapies have little or no value in the treatment of scoliosis esp. as monotherapy • Bracing is controversial • 23 hours a day is effective for skeletally immature patients with mild to moderate curvatures • Full-time (23 hr/day) bracing may not be more beneficial than part-time bracing (8-16 hr/day)

  17. Conclusion (Statistics) • Weighted mean proportion of success • 0.39 for Lateral Electrical Surface Stimulation • 0.49 for Observation only • 0.60 for Bracing 8 hr/day • 0.62 for Bracing 16 hr/day • 0.93 for Bracing 23 hr/day

  18. Conclusion • Surgery comparison is not possible • Surgery is the only truly effective way to CORRECT scoliosis.

  19. References • Allington Nanni J., Bowen J. Richard. Adolescent Idiopathic Scoliosis: Treatment with the Wilmington Brace. A Comparison of Full-Time and Part-Time Use. J Bone Joint Surg. 1996;78:1056-62. • Abitbol JJ, Albert T, An HS, Bennett DS, Benzel EC, Betz RR, et al. Spine Universe. An in Depth Review of Scoliosis: Clinical. 2005 [online] 16 Oct. 2005. http://www.spineuniverse.com/displayarticle.php/article1499.html. • Abitbol JJ, Albert T, An HS, Bennett DS, Benzel EC, Betz RR, et al. Spine Universe. An in Depth Review of Scoliosis: Idiopathic Scoliosis. 2005 [online] 16 Oct. 2005. http://www.spineuniverse.com/displayarticle.php/article1503.html • Abitbol JJ, Albert T, An HS, Bennett DS, Benzel EC, Betz RR, et al. Spine Universe. An in Depth Review of Scoliosis: Introduction. 2005 [online] 16 Oct. 2005. http://www.spineuniverse.com/displayarticle.php/article1498.html • Abitbol JJ, Albert T, An HS, Bennett DS, Benzel EC, Betz RR, et al. Spine Universe. An in Depth Review of Scoliosis: Treatment of Adolescent Idiopathic Scoliosis. 2005 [online] 16 Oct. 2005. http://www.spineuniverse.com/displayarticle.php/article1507.html • Baulot E, Trouilloud P, Ragois P, Giroux EA, Grammont PM. Anterior Spinal Fusion by Thoracoscopy. A Non-traumatic Technique. Rev Chir Orthop Reparatrice Appar Mot 1997;83(3):203-9. • Betz RR, Harms J, Clements DH 3rd, Lenke LG, Lowe TG, Shufflebarger HL, Jeszenszky D, Beele B. Comparison of Anterior and Posterior Instrumentation for Correction of Adolescent Thoracic Idiopathic Scoliosis. Spine 1999;24(3):225-39. • Blackman Ronald, Estep Mary Ellen. Minimally Invasive Surgery for Scoliosis. 2005 [online] 16 Oct. 2005. http://www.spineuniverse.com/displayarticle.php/article506.html • Blackman Ronald, Smith Jason. Scoliosis Treatment. 5 Oct. 2005 [online] 16 Oct. 2005 http://www.scoliosisrx.com/ • Carr WA, Moe JH, Winter RB, Lonstein JE. Treatment of Idiopathic Scoliosis in the Milwaukee Brace. J Bone Joint Surg Am. 1980;62(4):599-612. • Deutchman Gary A. Scoliosis Affects the Entire Body. 2005 [online] 16 Oct. 2005. http://www.nonsurgicalscoliosistreatment.com/scoliosis.html. • Deutchman Gary A. Scoliosis Systems: Non-Surgical Scoliosis Treatment Program. 2005 [online] 16 Oct. 2005. http://www.nonsurgicalscoliosistreatment.com/recovery.html.

  20. References • Deutchman Gary A. Scoliosis Systems. Treating Adult Scoliosis. Should Adults with Scoliosis be Braced?. 2005 [online] 16 Oct. 2005. http://www.nonsurgicalscoliosistreatment.com/adult.html • Dunn Harold, Smith John. Risser Sign. 2005 [online] 9 Nov. 2005. http://medlib.med.utah.edu/scoliosis/risser.htm. • Emans JB, Kaelin A, Bancel P, Hall JE, Miller ME. The Boston Bracing System for Idiopathic Scoliosis. Follow-up Results in 295 patients. Spine 1986;11(8):792-801. • Faciszewski T, Winter RB, Lonstein JE, Denis F, Johnson L. The Surgical and Medical Perioperative Complications of Anterior Spinal Fusion Surgery in the Thoracic and Lumbar Spine in Adults. A Review of 1223 Procedures. Spine 1995;20(14):1592-9. • Greiner Allen. Adolescent Idiopathic Scoliosis: Radiologic Decision-Making. Am Fam Physician 2002 May;65(9):1817-1822 • Grossfeld Stacie, Winter Robert, Lonstein John, Denis Francis, Leonard Arnold, Johnson Linda. Complications of Anterior Spinal Surgery in Children. J Pediatr Orthop 1997;17(1):89-95. • Kokosha ER, Gabriel KR, Silen ML. Minimally Invasive Anterior Spinal Exposure and Release in Children with Scoliosis. JSLS 1998;2(3):255-8. • Krasna MJ, Jiao X, Eslami A, Rutter CM, Lexine AM. Thoracoscopic approach for spine deformities. J Am Coll Surg. 2003 Nov; 197(5):777-9. • Lenke Lawerence G, Betz Randal R, Harms Jürgen, Bridwell Keith H, Clements David H, Lowe Thomas G, Blanke Kathy. A New Classification to Determine Extent of Spinal Arthrodesis. J Bone Joint Surg Am. 2001; 83:1169-1181. • Lonstein JE, Carlson JM. The Prediction of Curve Progression in Untreated Idiopathic Scoliosis During Growth. J Bone Joint Surg Am. 1984; 66(7):1061-1071. • Lonstein JE, Winter RB. The Milwaukee Brace for the Treatment of Adolescent Idiopathic scoliosis. A Review of One Thousand and Twenty Patients. J Bone Joint Surg Am. 1994;76(8):1207-21. • Mardjetko Steven. Adolescent Idiopathic Scoliosis: Treatment via Selective Anterior Thoracic Instrumentation and Fusion. Ballert Orthopedic 5 April 2005 [online] 16 Oct. 2005. http://www.ballert-op.com/newsleter_adolescent_idiopathic_scoliosis.htm.

  21. References • Noonan KJ, Weinstein SL, Jacobson WC, Dolan LA. Use of the Milwaukee Brace for Progressive Idiopathic Scoliosis. J Bone Joing Surg Am 1996;78(4):557-67. • O’Neill Patrick J, Karol Lori A, Shindle Michael K, Elerson Emily E, Brintzenhofezoc Karlynn M, Katz Donald E, et al. Decreased Orthotic Effectiveness in Overweight Patients with Adolescent Idiopathic Scoliosis. J Bone Joint Surg Am 2005;87:1069-1074. • Perdriolle R, Vidal J. Thoracic Idiopathic Scoliosis Curve Evolution and Prognosis. Spine 1985;10(9):758-91. • Reamy Brian V, Slakey Joseph B. Adolescent Idiopathic Scoliosis: Review and Current Concepts. Am Fam Physician 2001;64(1):111-116. • Rogala EJ, Drummond DS, Gurr J. Scoliosis: Incidence and Natural History. A Prospective Epidemiological Study. J Bone Joint Surg 1978;60(2):173-176. • Rowe Dale E, Bernstein Saul M, Riddick Max F, Adler Federico, Emans John B, Gardner-Bonneau Daryle, et al. A Meta-Analysis of the Efficacy of Non-Operative Treatments for Idiopathic Scoliosis. J Bone Joint Surg 1997;79:664-74. • Sucato DJ. Thoracoscopic Anterior Instrumentation and Fusion for Idiopathic Scoliosis. J Am Acad Orthop Surg 2003;11(4):221-7. • Taylor JF, Roaf R, Owen R, Bentley G, Calver R, Jones RS, Thorneloe M. Costodesis and Contralateral Rib Release in the Management of Progressive Scoliosis. Acta Orthop Scand 1983;54(4):603-12. • Weinstein Stuart L, Dolan Lori A, Spratt Kevin F, Peterson Kirk K, Spoonamore Mark J, Ponseti Ignacio V. Health and Function of Patients with Untreated Idiopathic Scoliosis. JAMA 2003;289:559-567. • Winter RB, Lonstein JE. Adolescent Idiopathic Scoliosis: Case Report with 63-Year Follow-up Postsurgery. Spine 2003;28(21):E441-4. • Winter Robert B, Lonstein John E. Congenital Scoliosis with Posterior Spinal Arthrodesis T2-L3 at Age 3 Years with 41-Year Follow-Up: A Case Report. Spine 1999;24(2):194-197.

More Related