INDICACIONES DEL TRATAMIENTO CONSERVADOR DE LA ESCOLIOSIS

I. Children (no signs of maturity) [21]

a. < 15° Cobb: Observation (6 – 12 month intervals)

b. Cobb angle 15–20°: Outpatient physical therapy with treatment-free intervals (6–12 weeks without physical therapy for those patients at that time have low risk for curve progression). In this context, ‘Outpatient physical therapy’ is defined here as exercise sessions initiated at the physical therapist’s office, plus a home exercise program (two to seven sessions per week according to the physical therapy method being applied). After three months, one exercise session every two weeks may be sufficient.

c. Cobb angle 20–25°: Out patient physiotherapy, scoliosis intensive rehabilitation program (SIR) where available.). SIR, currently available at clinics in Germany and Spain, includes a 3- to 5- week intensive program (4 – 6 hour training sessions per day) for patients with poor prognosis (brace indication, adult with Cobb angle of > 40°, presence of chronic pain).

d. > 25° Cobb: Outpatient physical therapy, scoliosis intensive rehabilitation program (SIR) where available and brace wear (part-time, 12–16 hours)

II. Children and adolescents, Risser 0–3, first signs of maturation, less than 98% of mature height

The following section is based on progression risk rather than on Cobb angle measurement because of the changing risk profiles for deformityas theskeleton matures. For our purposes, progression risk is calculated by the formula shown in figure 1.

a. Progression risk less than 40%: Observation (3-month intervals)

b. Progression risk 40%: Out patient physiotherapy

c. Progression risk 50%: Out patient physiotherapy, scoliosis intensive rehabilitation program (SIR) where available

d. Progression risk 60%: Out patient physiotherapy, scoliosis intensive rehabilitation program (SIR) where available + part-time brace indication (16 – 23 hours [low risk]).

e. Progression risk 80%: Out patient physiotherapy, scoliosis intensive rehabilitation program (SIR) where available + full-time brace indication (23 hours [high risk])

III. Children and adolescents presenting with Risser 4 (more than 98% of mature height)

a. < 20° according to Cobb: Observation (6 – 12 Months intervals)

b. 20 – 25° according to Cobb: Outpatient physical therapy

c. > 25° according to Cobb: Outpatient physical therapy, scoliosis intensive rehabilitation programme (SIR) where available

d. > 35° according to Cobb: Outpatient physical therapy, scoliosis intensive rehabilitation programme (SIR) where available + brace (part time, about 16 hours are sufficient)

e. For brace weaning: Outpatient physical therapy, scoliosis intensive rehabilitation programme (SIR) where available + brace with reduced wearing time.

IV. First presentation with Risser 4–5 (more than 99.5% of mature height before growth is completed)

a. > 25° Cobb: Outpatient physical therapy

b. > 30° Cobb: Outpatient physical therapy, scoliosis intensive rehabilitation program (SIR) where available.

V. Adults with Cobb angles > 30°

Outpatient physical therapy, scoliosis intensive rehabilitation program (SIR), where available

VI. Adolescents and adults with scoliosis (of any degree) and chronic pain

Outpatient physical therapy, scoliosis intensive rehabilitation program (SIR) where available, with a special pain program (multimodal pain concept/behavioral + physical concept), brace treatment when a positive effect has been proven [45].

The prognostic estimation and corresponding indications for treatment apply to the most prevalent condition, idiopathic scoliosis. In other types of scoliosis a similar procedure can be applied. Exceptions include those cases where the prognosis is clearly worse, for example in neuromuscular scolioses where a wheelchair is necessary (early surgery for maintaining sitting capability may be required). Other reasons for the consideration of alternative treatments include:

– Severe decompensation

– Severe sagittal deviations with structural lumbar kyphosis (‘flatback’)

– Lumbar, thoracolumbar and caudal component of double curvatures with a disproportionate rotation compared to the Cobb angle and with high risk for future instability at the caudal junctional zone

– Severe contractures and muscles shortening

– Reduced mobility of the spine especially in the sagittal plane

– others to be individually considered [46]

vía Scoliosis | Full text | Indications for conservative management of scoliosis (guidelines).