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 The University of Texas Health Science Center at San Antonio |
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©2002 UTHSCSA Last update For suggestions, comments, and concerns about this site, e-mail us at: webteam@uthscsa.edu |
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Overview of Surgical Treatment of Adolescent Idiopathic Scoliosis |
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NON-OPERATIVE MANAGEMENT OF IDIOPATHIC SCOLIOSIS With the advent of school screening, which is compulsory in Texas, and many other states as well, many children and adolescents with mild curves are identified. The issue faced in managing these patients is identifying those patients who have a stable curve and those who have a curve that will likely progress to the point that surgery will be required unless there is some intervention. Risser(4) described the iliac apophysis, a cap of bone at the top of the pelvis. He observed that when this completely covered the pelvis (Risser 4) the growth of the spine was complete and curves stabilized. |
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| Lonstein(2) showed that by using the Risser sign and the degree of the curve, the odds of the curve progressing could be determined. Patients who are at high risk of progression are those with growth remaining and a curve of 20 degrees or greater. These high risk patients may be candidates for bracing. | |
 2Lonstein |
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Blount(1), who developed the Milwaukee brace (photo) observed, "if the curve was not acceptable to begin with, satisfactory improvement was rarely obtained by conservative treatment." |
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Bracing for scoliosis is different from orthodontic bracing in that the braces for tooth deformities apply pressure directly to the deformity and can correct it. In scoliosis bracing, there is a layer of soft tissue between the brace and the spine and the function of the brace is to prevent the curve from progressing. Since bracing usually does not improve the appearance of the back, it is important that the patient be satisfied with their cosmesis, prior to starting a bracing program. This usually limits the use of the brace to curves of 40 degrees or less. To be effective the brace must be worn close to twenty-three hours each day until growth has stopped and the iliac apophysis has completed it’s excursion. This requires dedication on the part of the patient and their support needs to be obtained before fitting a brace. Fortunately it is usually possible to use a below the shoulders, Boston type brace (photo), which is not visible in clothing and is more acceptable to patients than the Milwaukee brace. |
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For many years there was controversy on the effectiveness of bracing. Recent studies confirm the usefulness of a brace. A multicenter study by the Scoliosis Research Society(3) compared bracing versus no treatment or electrical stimulation. There was only a 20% failure rate in the braced patients in comparison to a 50% failure rate in the patients not treated or receiving electrical stimulation. |
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1Blount, W.P., Schmidt, A.C., Keever, E.D., et al. The Milwaukee Brace in the Operative Treatment of Scoliosis. J. Bone and Joint Surg. 40-A (3): 511-525, 1958. 2Lonstein, J.E., Carlson, J.M. The Prediction of Curve Progression of Untreated Idiopathic Scoliosis During Growth. J. Bone and Joint Surg. 66-A (7): 1061-1071, 1984. 3Nachemson, A.L., Peterson, L.E., et al. Effectiveness of Treatment with a Brace in Girls Who Have Adolescent Idiopathic Scoliosis. J. Bone and Joint Surg. 77-A (6): 815-822, 1995. 4Risser, J.C. The Iliac Apophysis: An Invaluable Sign in the Management of Scoliosis. Clinical Orthopaedics and Related Research 11: 111-119, 1958. |
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