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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

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
  • Cobb angle
    • a measurement of the degrees of curvature present in the spine
  • Risser sign
    • a tool used to assess skeletal maturity
  • 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
  • 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
  • Surgery comparison is not possible
  • Surgery is the only truly effective way to CORRECT scoliosis.
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