Optimal management of idiopathic scoliosis in adolescence

Tomasz Kotwicki, Joanna Chowanska, Edyta Kinel, Dariusz Czaprowski, Marek Tomaszewski, Piotr Janusz, Tomasz Kotwicki, Joanna Chowanska, Edyta Kinel, Dariusz Czaprowski, Marek Tomaszewski, Piotr Janusz

Abstract

Idiopathic scoliosis is a three-dimensional deformity of the growing spine, affecting 2%-3% of adolescents. Although benign in the majority of patients, the natural course of the disease may result in significant disturbance of body morphology, reduced thoracic volume, impaired respiration, increased rates of back pain, and serious esthetic concerns. Risk of deterioration is highest during the pubertal growth spurt and increases the risk of pathologic spinal curvature, increasing angular value, trunk imbalance, and thoracic deformity. Early clinical detection of scoliosis relies on careful examination of trunk shape and is subject to screening programs in some regions. Treatment options are physiotherapy, corrective bracing, or surgery for mild, moderate, or severe scoliosis, respectively, with both the actual degree of deformity and prognosis being taken into account. Physiotherapy used in mild idiopathic scoliosis comprises general training of the trunk musculature and physical capacity, while specific physiotherapeutic techniques aim to address the spinal curvature itself, attempting to achieve self-correction with active trunk movements developed in a three-dimensional space by an instructed adolescent under visual and proprioceptive control. Moderate but progressive idiopathic scoliosis in skeletally immature adolescents can be successfully halted using a corrective brace which has to be worn full time for several months or until skeletal maturity, and is able to prevent more severe deformity and avoid the need for surgical treatment. Surgery is the treatment of choice for severe idiopathic scoliosis which is rapidly progressive, with early onset, late diagnosis, and neglected or failed conservative treatment. The psychologic impact of idiopathic scoliosis, a chronic disease occurring in the psychologically fragile period of adolescence, is important because of its body distorting character and the onerous treatment required, either conservative or surgical. Optimal management of idiopathic scoliosis requires cooperation within a professional team which includes the entire therapeutic spectrum, extending from simple watchful observation of nonprogressive mild deformities through to early surgery for rapidly deteriorating curvature. Probably most demanding is adequate management with regard to the individual course of the disease in a given patient, while avoiding overtreatment or undertreatment.

Keywords: adolescence; idiopathic scoliosis; management.

Figures

Figure 1
Figure 1
Clinical signs of idiopathic scoliosis. (A) Trunk asymmetry and lateral deviation of the spine in the frontal plane, (B) trunk rotation in the horizontal plane, and (C) disturbances in physiological curvature in the sagittal plane (kyphosis flattening).
Figure 2
Figure 2
Surgical treatment of idiopathic scoliosis using posterior instrumentation. (A and C) Preoperative anteroposterior and lateral standing radiographs of an adolescent girl with progressive idiopathic scoliosis Lenke type 6CN. (B and D) Postoperative standing radiograph of the patient after hybrid-type posterior instrumentation. Satisfactory correction, increased trunk height, and a well balanced spine are seen in both the sagittal and coronal planes.

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