Optimal management of idiopathic scoliosis in adolescence

Figures & data

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).

Table 1 Practical approach for adolescent idiopathic scoliosis according to the Society on Scoliosis Orthopaedic and Rehabilitation Treatment 2011 consensus document

	Cobb angle
	0–10° + hump	11°–15°	16°–20°	21°–25°	26°–30°	31°–35°	36°–40°	41°–45°	46°–50°	>e50°
Risser 0
Min	Ob 6	Ob 6	Ob 3	PSE	PSE	SSB	PTRB	PTRB	PTRB	FTRB
Max	Ob 3	PSE	PTRB	FTRB	FTRB	FTRB	FTRB	FTRB	Su	Su
Risser 1
Min	Ob 6	Ob 6	Ob 3	PSE	PSE	SSB	PTRB	PTRB	PTRB	FTRB
Max	Ob 3	PSE	PTRB	FTRB	FTRB	FTRB	FTRB	FTRB	Su	Su
Risser 2
Min	Ob 8	Ob 6	Ob 3	PSE	PSE	SSB	SSB	SSB	SSB	FTRB
Max	Ob 6	PSE	PTRB	FTRB	FTRB	FTRB	FTRB	FTRB	Su	Su
Risser 3
Min	Ob 12	Ob 6	Ob 6	Ob 6	PSE	SSB	SSB	SSB	SSB	FTRB
Max	Ob 6	PSE	PTRB	FTRB	FTRB	FTRB	FTRB	FTRB	Su	Su
Risser 4
Min	No	Ob 6	Ob 6	Ob 6	Ob 6	Ob 6	Ob 6	Ob 6	SSB	FTRB
Max	Ob 12	PSE	PTRB	FTRB	FTRB	FTRB	FTRB	FTRB	Su	Su
Risser 4–5
Min	No	Ob 6	Ob 6	Ob 6	Ob 6	Ob 6	Ob 6	Ob 6	SSB	FTRB
Max	Ob 12	PSE	PTRB	FTRB	FTRB	FTRB	FTRB	FTRB	Su	Su

Note: Adapted from Negrini S, Aulisa AG, Aulisa L, et al. 2011 SOSORT guidelines: Orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis. 2012;7:3.¹²

Abbreviations: Ob, observation every 12/8/6/4 months; PSE, specific physiotherapeutic exercises; SSB, soft bracing; PTRB, part-time rigid bracing (12–20 hours); FTRB, full-time rigid bracing (20–24 hours) or cast; Su, surgery; Min, minimum; Max, maximum.

Table 2 Treatment options implied by curve type according to the Lenke classification

Curve type	Structural regions recommended for fusion	Approach
Main thoracic	MT	PSF or ASF
Double thoracic	PT, MT	PSF
Double major	MT–TL/L	PSF
Triple major	PT, MT, TL/L	PSF
Thoracolumbar/lumbar	TL/L	ASF or PSF
Thoracolumbar/lumbar, main thoracic	TL/L, MT	PSF

Abbreviations: ASF, anterior spinal fusion; PSF, posterior spinal fusion; PT, proximal thoracic; MT, main thoracic; TL/L, thoracolumbar/lumbar.

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.

NegriniSAulisaAGAulisaL2011 SOSORT guidelines: Orthopaedic and rehabilitation treatment of idiopathic scoliosis during growthScoliosis20127322264320

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