Transcript Treatment Options for Adolescent Idiopathic Scoliosis Mandy Phelps

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
Digestive, Hormonal, Muscular, Skeletal and
Neurological effects
A Cobb angle greater than 10
degrees
A descriptive term; not a diagnosis
Terminology
Cobb angle
a measurement of
the degrees of
curvature present
in the spine
Terminology
Risser sign
a tool used to
assess skeletal
maturity
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
Magnitude of the curve
Risser sign
Young age at presentation
Gender (females greater than males)
Large Cobb angle
Menarchal status in females
Treatment Options
Depend on the severity of the spinal
curvature and on the age of the
patient.
Treatment Options
Do Nothing
Physically mature patient
Curve less than 40 degrees
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 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
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
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
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
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
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
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)
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
Conclusion
Surgery comparison is not possible
Surgery is the only truly effective way
to CORRECT scoliosis.
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