Treatment Option For Scoliosis Research Articles

New and Traditional Treatment Options for Idiopathic Scoliosis in Children and Adolescents

Scoliosis is a medical condition common in children and adolescents, which causes an abnormal curvature of the spine in a “C” or “S” shape. Three main forms of scoliosis exist: neuromuscular, congenital, and idiopathic with idiopathic being most common. Traditional treatments include observation, rigid bracing (a corrective orthosis), casting, surgery, and physiotherapeutic scoliosis-specific exercises. Surgical corrections include spinal fusion or placement of traditional or growing rods. Treatment options for scoliosis have recently expanded, to include newer flexible bracing and surgical procedures such as tethering and posterior dynamic deformity correction. Providers should be screening for scoliosis, and all providers can benefit from knowing the latest options available to help their patients receive the best care before reaching skeletal maturity.

Scoliosis: Causes and Treatments

Scoliosis is an abnormal curvature of the spine, which generally develops during childhood or adolescence. It affects 2–4 percent of the global population and is more prevalent among girls. Scoliosis is classified by its etiology: idiopathic, congenital, or neuromuscular. Among these, the former is the most common. Treatment options for scoliosis vary depending on the severity of the curve. Most scoliosis diagnoses tend to be mild and only require monitoring. However, curves between 20 and 40 degrees require bracing, while 40 degrees and above require surgery. There are various bracings available, such as Boston, Charleston, and Milwaukee. In severe cases of scoliosis, either fusion or fusionless surgery may be required. This review aims to discuss etiologies and different treatment interventions for scoliosis.

Congenital Scoliosis: A Current Concepts Review

Context: Congenital scoliosis is a difficult condition for orthopedic surgeons. There are some influencing factors to choose the best treatment option for scoliosis. Objectives: Patients with congenital scoliosis may encounter different anomalies. There exist various surgical techniques with different indications. Methods: Electronic databases, such as Google Scholar, PubMed, and Scopus were searched for congenital scoliosis. Articles published from 1928 to 2020 were searched. A narrative review was conducted by focusing on treatment options. Results: Different methods are presented in the literature that consists of operative and nonoperative approaches. Nonoperative treatment methods are seldom a final choice. They are used to postpone the final surgery. There are different methods of surgeries in the literature; the best treatment strategy concerns the patients’ condition and the surgeon’s preference. Conclusions: The critical issue in the management of congenital scoliosis is to diagnose these patients’ curves before severe progression, i.e. mandatory to achieve desirable results. Usually, a course of nonoperative treatment can be started, but only to postpone the final surgery. The preferred surgical treatment depends on the type of congenital scoliosis and the age of the patient. The treatment of congenital scoliosis should be a multidisciplinary approach due to concomitant morbidity in these patients.

Nonoperative treatment for adolescent idiopathic scoliosis

Since scoliosis affects up to 3–4% of the population and is the most common spinal deformity among children and adolescents, many practitioners are faced with decision making regarding these patients. However, since only a fraction of patients with scoliosis have the severe, progressive form of the condition and require surgery, practitioners require a foundation of nonoperative treatment modalities and alternatives. The treatment of any condition should take into account the short- and long-term outcomes as well as the complications of that treatment modality. The 3 generally accepted (and evidence-based) treatment options for scoliosis are observation, use of a brace, and surgical stabilization. Others have proposed that treatment modalities such as electrical muscle stimulation, postural exercises, chiropractic manipulation, nutritional supplementation, and magnet therapy have a role in the care of scoliosis, but evidence to support these modalities is lacking. This article will focus on the evidence-based nonoperative modalities of scoliosis treatment such as school screening, observation, and bracing.

Swimming and Spinal Deformities: A Cross-Sectional Study

To compare the prevalence of spinal deformities and low back pain (LBP) in adolescent competitive swimmers and normal controls. This was a cross-sectional study with convenience sample of 112 adolescent competitive swimmers (62 females) compared with 217 students (106 females) of the same age (12.5 years). We designed a questionnaire to collect data on LBP and measured the angle of trunk rotation with a Bunnell scoliometer to screen for scoliosis, along with the plumbline distances for kyphosis and lordosis. Clinical cutoffs defined in the literature for detection of spinal deformities were applied. Analyses were performed using the t test and χ(2) test, and ORs and 95% CIs were calculated. Swimming was found to increase the risk of trunk asymmetries (OR, 1.86; 95% CI, 1.08-3.20). Swimming also increased the risk of hyperkyphosis (OR, 2.26; 95% CI, 1.35-3.77) and hyperlordosis (OR, 2.24; 95% CI, 1.06-4.73), and increased LBP in females by 2.1-fold (95% CI, 1.08-4.06). Swimming is associated with an increased risk of trunk asymmetries and hyperkyphosis. Although swimming has been considered a complete sport and a treatment option for scoliosis, our data contradict that approach, and also show a higher prevalence of LBP in females.

No effect of osteopathic treatment on trunk morphology and spine flexibility in young women with adolescent idiopathic scoliosis.

Brace treatment is the gold standard for patients with mild adolescent idiopathic scoliosis (Cobb angle 20°-40°). However, negative psychosocial impacts, physical constraints and incompliance cause many patients and parents to seek for so-called holistic and apparently less harmful approaches within the field of complementary and alternative medicine (CAM). Osteopathy-manual interventions on the viscera and locomotor system-is widely used for scoliosis. There is, however, a complete lack of evidence regarding its efficacy. We, therefore, tested the hypothesis that osteopathy alters trunk morphology, a prerequisite to unload the concave side of the scoliosis, and that it halts curve progression. This was a prospective, controlled trial of 20 post-pubertal young women (20°-40° idiopathic scoliosis) randomly allocated to an observation (group 0) or osteopathic treatment (group 1). The latter comprised three sessions (5weeks). Trunk morphology (clinical examination, video rasterstereography) and spine flexibility (MediMouse(®)) were assessed at a pre- and post-intervention with a 3-month interval (blinded examiner). We chose scoliometer measurement (rib hump, lumbar prominence) as the main outcome parameter. Two patients in the treatment group refused further treatment and the final examination, as they felt no benefit after two osteopathic treatments. Regression analysis for repeat measurements (independent statistician) revealed no therapeutic effect on rib hump, lumbar prominence, plumb line, sagittal profile and global spinal flexibility. We found no evidence to support osteopathy in the treatment of mild adolescent idiopathic scoliosis. Therefore, we caution against abandoning the conventional standard of care for mild idiopathic scoliosis. As for other CAM therapies, the use of osteopathy as a treatment option for scoliosis still needs to be clearly defined.