3P-S6-2

NON-SURGICAL TREATMENT OF ADOLESCENT IDIOPATHIC SCOLIOSIS

Cheng J. C.Y.

Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR

Studies on the natural history of untreated adolescent idiopathic scoliosis (AIS) has helped the clinician in estimating the risk of progression of the various types of AIS and in their selection of patients for non-operative and operative treatment more accurately. Lonstein and Carlson found that the most important risk factors related to curve progression are the patient��s chronological age, the maturity status, the Risser sign and the magnitude of the curve. Weinstein in their long-term follow up study showed clearly that idiopathic curves could continue to progress in adulthood. Thoracic curve greater than 60 degrees at the completion of growth will progress continuously up to an average of 29.4 degrees on a follow up of 40 years. Lumbar curves and thoracolumbar curves of 45 to 50 degrees will progress by an average of 15 to 20 degrees on a 40 years follow up.

The aims of non-operative treatment in AIS are to control the curve, to prevent progression, to prevent the need for surgery and to improve cosmesis. Among all the non-operative treatments including orthosis, electrical stimulation, exercises, biofeedback, bracing is the only proven effective treatment for the early cases. In the past few years many multicenter prospective studies have shown convincingly that proper full time bracing program can be successful in up to 78% of AIS cases in controlling the curve progression in immature girls with 25 to 35 degrees curve. In the same group of patients with similar curve, age and maturity, a 68 % chance of progression has been documented in those who have not received any bracing treatment. The indications are for growing child (Rissers 2 or less) with < 25 degrees and documented progression and for cases of 25-45 degrees curves. The contraindications are when the growth is already completed, when there is significant thoracic lordosis and when the curve is already greater than 45 degrees. The most effective brace are the Milwaukee brace (CTLSO) and the underarm brace (TLSO).