TREATMENT OF ADOLESCENT IDIOPATHIC SCOLIOSIS DURING GROWTH
Idiopathic scoliosis may develop at any time during childhood and adolescence but it is most common in periods of rapid growth spurts before puberty and skeletal (spinal) maturity. The growth spurt in adolescence occurs between 11 and 14 years of age when scoliosis can progress rapidly. The growth spurt in girls starts 12-18 mnoths before menarche (first period); boys begin their growth spurt 1 to 2 years later.
Orthopaedic specialists who treat adolescent idiopathic scoliosis use several indicators "that correlate with skeletal maturity to assist in treatment decisions including chronologic age, skeletal age, menarchal stage," The Risser stage classification is "perhaps the most widely used indicator for skeletal maturity.” Patients with curvatures of 45° and above are considered at risk of spinal fusion surgery.
The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) 2016 guidelines proposed a specific set of goals for an alternative non-invasive conservative treatment approach for idiopathic scoliosis during growth:
- Absolute goal, the minimum expected goal of conservative treatment is to avoid surgery, improve aesthetics, and improve quality of life
- Primary goal – best possible outcome for patients
- Secondary goal – compromised goal when it is evident the primary goal cannot be reached
Primary and Secondary goals are desired patient treatment outcomes defined by the degree of curvature:
Degree of Curve Primary Goal Secondary Goal
Low Remain below 20° Remain below 45°
Moderate Remain below 30° Remain below 45°
Severe Remain below 45° Postpone Surgery
Conservative Treatment of idiopathic scoliosis usually takes the following course:
- Observation, clinical evaluation with or without x-rays – 3, 6, 12, and up to 36 months
- Rigid Bracing - full-time; night-time; part-time; or specific soft bracing
- Physiotherapeutic scoliosis-specific exercises, such as provided by the Schroth Method of inpatient rehabilitation or outpatient therapy.
Observation is the most widely used treatment for scoliosis curves below 20°. Bracing is usually prescribed once a curve has progressed to 25° or greater, as are physiotherapeutic scoliosis-specific exercises.
Treatment of idopathic scoliosis ¹ should take into account the three dimensional (3D) nature of the condition and the risk of progression. "The main objective of physical therapy [such as the Schroth Method] should be to convert the ‘vicious cycle’ into a new ‘virtuous cycle’, where deforming forces are prevented, and reverted, not only during the exercise practice, but also during the activities of daily living ."
In 2017, a preliminary study conducted in Hong Kong focused on evaluating the effectiveness of Schroth scoliosis-specific exercises performed by idiopathic scoliosis patients with high-risk curves, whilst receiving brace treatment.
The primary outcome measure for the study for all major curves was an improvement/decrease in the Cobb angle of 6° or more; unchanged/stable as ± 5°; and progressed/worsened by 6° or more. Patients in the experimental group who were compliant with their exercise program had a higher rate of Cobb angle improvement. The study shows that the effectiveness of bracing can be improved with the addition of Schroth Method scoliosis-specific exercise program, providing there is a strong compliance to both.
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¹ For more information regarding specific physical therapy methods in the treatment of idiopathic scoliosis click on the citation below: