Review: Idiopathic Adolescent Scoliosis

posted 16 Mar 2013, 07:42 by Damian Wood   [ updated 16 Mar 2013, 07:42 ]
Writing in the New England Journal of Medicine (DOI: 10.1056/NEJMcp1209063) Dr Timothy Hresko from Boston Children's Hospital provides a review of the current management of Adolescent Idiopathic Scoliosis for the generalist. The key clinical points from the review:
  • The diagnosis of scoliosis is suspected on the basis of physical examination and is confirmed by radiography, performed while the patient is in a standing position, that reveals spinal curvature of 10 degrees or greater.
  • Idiopathic scoliosis is present in 2% of adolescents. Adolescents with scoliosis should have a thorough physical examination to rule out hereditary connective-tissue disorders (e.g., Marfan's syndrome), neurofibromatosis, or neurologic conditions.
  • Most adolescents with nonprogressive idiopathic scoliosis can be seen by a primary care physician and do not require active treatment.
  • Bracing is commonly recommended in patients with an immature skeleton with curve progression of 25 to 45 degrees, but data to support this approach are observational and inconsistent; a randomized trial comparing bracing with observation for idiopathic scoliosis is currently in progress.
  • Surgical treatment is recommended in patients with an immature skeleton who have progressive scoliosis greater than 45 degrees