Update in Nonoperative Management of Adolescent Idiopathic Scoliosis to Prevent Progression

Abstract

The primary goal of nonoperative treatment of adolescent idiopathic scoliosis (AIS) is to prevent curve progression. The risk of progression and estimation of growth remaining should be performed through a combination of serial X-rays, menarche history, serial height measurement, triradiate cartilage status, Risser grade, and Sanders Skeletal Maturation Stage with a left-hand bone age X-ray. For AIS patients with growth remaining and a curve magnitude between 25 and 45 degrees, conservative treatment with a rigid thoracolumbosacral orthosis (TLSO) is indicated. Rigid TLSOs (e.g., Wilmington, Boston, Rigo-Cheneau) are superior to other brace types, but there is insufficient evidence to recommend a specific type of rigid TLSO. Brace wear for at least 13 hours per day is indicated until skeletal maturity to limit curve progression. Physiotherapeutic scoliosis-specific exercises (PSSE) should be considered in addition to bracing for patients with moderate curves because there is growing evidence that PSSE improve overall patient-perceived back status when used as an adjunct to brace treatment. However, PSSE have not been shown to decrease the likelihood of curve progression for patients with mild curves; therefore, insufficient evidence exists to recommend PSSE for asymptomatic patients with mild curves. The nonoperative treatment of AIS remains an active area of investigation, and further research is needed to better compare brace types, optimize brace weaning, and understand the effectiveness of PSSE. Key Concepts: • For adolescent idiopathic scoliosis patients with growth remaining and a curve magnitude between 25 and 45 degrees, conservative treatment with a rigid thoracolumbosacral orthosis (TLSO) is indicated until skeletal maturity to limit curve progression. • The success of brace treatment is time dependent, and rigid TLSOs should be worn for at least 13 hours per day. Electric brace-wear sensors are helpful in routine clinical practice to assist with counseling patients and families. • Rigid TLSOs (e.g., Wilmington, Boston, Rigo-Cheneau) are superior to other brace types, but there is insufficient evidence to recommend a specific type of rigid TLSO. • Physiotherapeutic scoliosis-specific exercises (PSSE) should be considered in addition to bracing for patients with moderate curves. • Insufficient evidence exists to recommend for or against PSSE for patients with mild curves.