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The treatments for scoliosis are not always straightforward. Some young people do not need treatment at all -- only careful observation. When treatment is necessary, several options, including braces and various surgical procedures, can help.
The general rule of thumb for treating scoliosis is to monitor the condition if the curve is less than 20 degrees. Curves greater than 25 degrees, or those that progress by 10 degrees while being monitored, may require treatment. Whether scoliosis is treated immediately or simply monitored is not an easy decision, however. The percentage of cases that will progress more than 5 degrees can be as low as 5% or as high as 50 - 90%, depending on the severity of the curve or other predisposing factors:
Age. In general, the older the child the less likely it is that the curve will progress. Scoliosis in a child under 10, for example, is more likely to progress than scoliosis in an adolescent. Experts estimate that curves less than 19 degrees will progress 10% in girls ages 13 - 15 years and 4% in children older than 15. Therefore, a young man of 18 who has a curvature of 30 degrees may require no treatment because his growth has probably almost stopped, and his gender puts him at lower risk. A young girl of 10, however, with the same curvature requires immediate treatment.
In some rare, severe cases, however, a curve may worsen even after a child has received treatment and stopped growing because of the weight of the body pressing against the abnormal curve.
Gender. Girls have a higher risk for progression than boys.
Location of the Curvature. Thoracic curves, those in the upper spine, are more likely to progress than thoracolumbar curves or lumbar curves (those of the middle to lower spine).
Severity of the Curvature. The higher the degree of curvature the more likely the chance of progression and the more likely the lungs will be affected. Some experts argue that the degree of the curve alone may not identify patients with moderate and severe scoliosis who are at greatest risk for complications and therefore need treatment. For example, spinal flexibility and the extent of asymmetry between the ribs and the vertebrae may be more important than the curve degree in predicting severity in this group.
Presence of Other Health Conditions. Children in poor health may suffer more from stressful scoliosis treatments than other children. On the other hand, children who have existing conditions and are predisposed to lung and heart problems may warrant immediate, aggressive treatment.
In general, the following criteria are used to determine whether a patient should receive braces and conservative treatments or surgery:
The choice may not be so straightforward in certain cases, and patients should discuss all options with their doctor.
In Children and Adolescents. After a mild curve is detected, a more difficult step is required: predicting whether the curve will progress into a more serious condition. Although as many as 3 in every 100 teenagers have a condition serious enough to need at least observation, progression is highly variable and individual.
Doctors cannot rely on any definitive risk factors for curve progression to predict with any certainty which patients will need aggressive treatment. Some evidence suggests the following factors may help determine patients at lower or higher risk:
Curvatures may be less likely to progress in girls whose scoliosis was low in the back and whose spine was out of balance by more than an inch. Height also comes into play. For example, a shorter-than-average girl of 14 with low-back scoliosis of 25 - 35 degrees but whose spine is imbalanced by over an inch would have almost no risk. The same degree of curvature in the chest region of a tall 10-year old girl whose spine was in balance, however, would almost certainly progress.
In Adults. In rare cases, unrecognized or untreated scoliosis in youth may progress into adulthood, with the following curvatures posing low-to-high risk:
Aebi M. The adult scoliosis. Eur Spine J. 2005;14(10):925-948.
Akbarnia BA, Marks DS, Boachie-Adjei O, Thompson AG, Asher MA. Dual growing rod technique for the treatment of progressive early-onset scoliosis: a multicenter study. Spine. 2005;30(17 Suppl):S46-S57.
Budweiser S, Moertl M, JÃrres RA, et al. Respiratory muscle training in restrictive thoracic disease: a randomized controlled trial. Arch Phys Med Rehabil. 2006;87(12):1559-65.
D'Astous JL, Sanders JO. Casting and traction treatment methods for scoliosis. Orthop Clin North Am. 2007;38(4):477-484.
Everett CR, Patel RK. A systematic literature review of nonsurgical treatment in adult scoliosis. Spine. 2007;32(19 Suppl):S130-134.
Freeman III, BL. Scoliosis and Kyphosis. In: Canale ST, Beatty JH. (eds.) Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007.
Gao X, Gordon D, Zhang D, et al. CHD7 gene polymorphisms are associated with susceptibility to idiopathic scoliosis. Am J Hum Genet. 2007;80(5):957-965.
Guille JT. Fusionless treatment of scoliosis. Orthop Clin North Am. 2007;38(4:541-545.
Hedequist DJ. Surgical treatment of congenital scoliosis. Orthop Clin North Am. 2007;38(4):497-509.
Hell AK, Campbell RM, Hefti F. The vertical expandable prosthetic titanium rib implant for the treatment of thoracic insufficiency syndrome associated with congenital and neuromuscular scoliosis in young children. J Pediatr Orthop B. 2005;14:287-293.
Ilharreborde B, Morel E, Fitoussi F, et al. Bioactive glass as a bone substitute for spinal fusion in adolescent idiopathic scoliosis: a comparative study with iliac crest autograft. J Pediatr Orthop. 2008;28(3):347-351.
Latalski M, Fatyga M, Gregosiewicz A. The vertical expandable prosthetic titanium rib (VEPTR) in the treatment of scoliosis and thoracic deformities. Preliminary report. Ortop Traumatol Rehabil. 2007;9(5):459-466.
Lenssinck ML, Frijlink AC, Berger MY, et al. Effect of bracing and other conservative interventions in the treatment of idiopathic scoliosis in adolescents: a systematic review of clinical trials. Phys Ther. 2005;85(12):1329-1339.
Lonner, B. S. Emerging minimally invasive technologies for the management of scoliosis. Orthop Clin North Am. 2007;38(3): 431-440.
Luhmann SJ, Bridwell KH, Cheng I, Imamura T, Lenke LG, Schootman M. Use of bone morphogenetic protein-2 for adult spinal deformity. Spine. 2005;30(17 Suppl):S110-S117.
Motoyama EK, Deeney VF, Fine GF, et al. Effects on lung function of multiple expansion thoracoplasty in children with thoracic insufficiency syndrome: a longitudinal study. Spine. 200631(3):284-290.
Patil CG, Santarelli J, Lad SP, et al. Inpatient complications, mortality, and discharge disposition after surgical correction of idiopathic scoliosis: a national perspective. Spine J. 2008 Mar 19 [Epub ahead of print]
Richards BS, Vitale M. Screening for Idiopathic Scoliosis in Adolescents: Information Statement. AAOS-SRS-POSNA-AAP. Available online.
Rose PS, Lenke LG. Classification of Operative Adolescent Idiopathic Scoliosis: Treatment Guidelines. Orthop Clin N Am. 2007;38:521-529.
Sarwark J, Sarwahi V. New strategies and decision making in the management of neuromuscular scoliosis. Orthop Clin North Am. 2007;38(4): 485-496.
Shaughnessy WJ. Advances in scoliosis brace treatment for adolescent idiopathic scoliosis. Orthop Clin North Am. 2007;38(4):469-475.
Thompson GH, Akbarnia BA, Kostial P, Poe-Kochert C, Armstrong DG, Roh J, et al. Comparison of single and dual growing rod techniques followed through definitive surgery: a preliminary study. Spine. 2005;30(18):2039-2044.
U.S. Preventive Services Task Force. Screening for Idiopathic Scoliosis in Adolescents: A Brief Evidence Update for the U.S. Preventive Services Task Force. June 2004. Agency for Healthcare Research and Quality, Rockville, MD.
Waldhausen JH, Redding GJ, Song KM. Vertical expandable prosthetic titanium rib for thoracic insufficiency syndrome: a new method to treat an old problem. J Pediatr Surg. 2007;42(1):76-80.
Yuan N, Fraire JA, Margetis MM, Skaggs DL, Tolo VT, Keens TG. The effect of scoliosis surgery on lung function in the immediate postoperative period. Spine. 2005;30(19):2182-2185.
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