Treatment Options for Adolescent Idiopathic Scoliosis
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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

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Treatment Options for Adolescent Idiopathic Scoliosis

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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

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


Terminology

Terminology

  • Cobb angle

    • a measurement of the degrees of curvature present in the spine


Terminology1

Terminology

  • Risser sign

    • a tool used to assess skeletal maturity


Terminology2

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


Risk factors for curve progression

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


Treatment options

Treatment Options

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


Treatment options1

Treatment Options

  • Do Nothing

    • Physically mature patient

    • Curve less than 40 degrees


Treatment options2

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


Treatment options3

Treatment Options

  • Surgery

    • Teens and pre-teens

    • Curvature of 40 degrees or greater

    • Reduces curvature and deformity

    • Adults to decrease pain

  • Types of Surgery…


Posterior spinal fusion

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


Anterior approach

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


Combination anterior and posterior

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


Costodesis and contralateral rib release

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


Non surgical non bracing strategies

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


Conclusion

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)


Conclusion statistics

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


Conclusion1

Conclusion

  • Surgery comparison is not possible

  • Surgery is the only truly effective way to CORRECT scoliosis.


References

References

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  • 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

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  • Blackman Ronald, Estep Mary Ellen. Minimally Invasive Surgery for Scoliosis. 2005 [online] 16 Oct. 2005. http://www.spineuniverse.com/displayarticle.php/article506.html

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  • Deutchman Gary A. Scoliosis Affects the Entire Body. 2005 [online] 16 Oct. 2005. http://www.nonsurgicalscoliosistreatment.com/scoliosis.html.

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References1

References

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  • Dunn Harold, Smith John. Risser Sign. 2005 [online] 9 Nov. 2005. http://medlib.med.utah.edu/scoliosis/risser.htm.

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  • 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.

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  • 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.


References2

References

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  • 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.

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