A three-dimensional deformity of the spine is referred to as adolescent idiopathic scoliosis. Different research teams have made great efforts to actively get to the etiology of scoliosis, but it still remains unclear. Treatment of this condition requires a sound clinical judgment and also a thorough understanding of the natural history of this disorder.
Bracing can present a challenge to the orthopedic surgeon in the evaluation of adolescent idiopathic scoliosis, an institution of conservative treatment, and the monitoring stages. Most patients, however, only require clinical monitoring. The review of the patient’s history, as well as a thorough physical examination, can help make for an easier diagnosis and help establish the risk for the progression of this condition as well.
The factors that can help the orthopedic surgeon assess the likelihood of the progression adolescent idiopathic scoliosis are gender, curve location, skeletal maturity, growth velocity, and the magnitude. Bracing has been identified as being the only nonsurgical measure currently proven to be effective in helping to halt the progression of scoliosis. Other types of conservative treatments do not have any effect in modifying the natural history of this condition. The results of bracing have a direct relation to being compliant with the brace treatment itself, optimal results can only be achieved with cooperation from the patient and from full support from their families.
Between 2% to 4% of adolescents are affected by adolescent idiopathic scoliosis, which is the most common form of scoliosis. In both male and females, the incidence of scoliosis is the same. In females, however, the risk of curve progression is ten-fold greater. Most young people with the condition will not develop clinical symptoms. However, scoliosis can progress onto rib deformity and respiratory problems, causing cosmetic problems which can be significant in the long term and may also be a cause of emotional distress to some of the patients.
Scoliosis screenings had been a routine part of the physical examinations for adolescents for decades. However, this was not recommended by the U.S Preventive Services Task Force and American Academy of Family Physicians, as the harm from the screening can outweigh the benefits by exposing many of the low-risk adolescents to radiographs and referrals which are unnecessary.
The Scoliosis Research Society, however, declares that the potential benefits resulting from the detection of scoliosis early will justify the screening programs. They further add that greater care should be exercised when making the decision as to which of the patients detected with positive screening results, will be in need of further evaluation.
Primary care physicians have the main duty, which can be defined by identifying patients who seem to be at a risk of developing further problems as a result of scoliosis. Further care has to be taken by the primary care physicians, so as not to overtest or over-refer the patients who are not likely to develop any further problems. The Adam’s forward bend test and a scoliometer measurement are two types of physical examinations which can provide a guide to the judicious use of radiologic testing for orthopedic referrals and Conn angle measurement. The options that can be employed for treatment of the same are surgery, braces, and observation.
