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Scoliosis

Treatment of adolescent idiopathic scoliosis depends on the size and location of the curve and the growth remaining of the patient. There are three types of treatment in AIS:

  1. Observation
  2. Bracing
  3. Surgery

Curve in Degrees and Treatment
0-20 Observe for progression
20-25 Brace if progression documented, and substantial growth remaining
25-30 Brace if progressive and growth remains
30-40 Brace if growth remains
40-45 Brace if growth remains vs. surgery
>50 Surgery

Examination
Frontal-Posterior: Scoliosis is a lateral curve of the spine and is identified when a child is examined from the front or from the back. Because serious forms are always associated with rotation of the spine, the best evaluation of scoliosis is a view in the forward bend position in which the alignment of the eye is along the axis of the spine.

Indications for Referral to an Orthopedic Specialist
A 1-cm rib hump in the thoracic region or a ½ -cm or greater hump in the lumbar region are indications for orthopedic referrals. Measurement of the angle of trunk rotation is designed with a specially designed scoliometer, a measurement of 5-7 degrees on the scoliometer is criteria for referral. A five-degree curve on the scoliometer roughly correlates with a 20-degree scoliosis as measured by the Cobb ruler while a seven-degree curve correlates closely with upwards of a 30-degree curve.

Helpful Links
http://www.srs.org/professionals/

http://www.aafp.org/afp/2001/0701/p111.html

http://www.scoliosis.org/index.php

Pediatric Orthopedics and Spine
Gregory McDowell, MD, 406-237-5050

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