Treatment Options for Adolescent Idiopathic Scoliosis

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.

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