Idiopathic Scoliosis Guidelines

Updated: Dec 02, 2020
  • Author: Charles T Mehlman, DO, MPH; Chief Editor: Jeffrey A Goldstein, MD  more...
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Guidelines

SOSORT Guidelines for Conservative Treatment of Idiopathic Scoliosis During Growth

In 2018, the International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) published guidelines on the use of conservative treatment approaches to idiopathic scoliosis. [104] Recommendations included the following.

Bracing

Bracing is recommended to treat adolescent idiopathic scoliosis. 

Bracing is recommended to treat juvenile and infantile idiopathic scoliosis as the first step in an attempt to avoid surgery or at least postpone it to a more appropriate age.

Bracing is recommended in patients with evolutive idiopathic scoliosis above 25° during growth; in these cases, physiotherapeutic scoliosis-specific exercises (PSSEs) alone (without bracing) should not be performed unless prescribed by a physicans expert in scoliosis.

Casting (or rigid bracing) is recommended to treat infantile idiopathic scoliosis to try stabilizing the curve. 

It is recommended not to apply bracing to treat patients with curves below 15° ± 5° Cobb, unless this is otherwise justified in the opinion of a clinician specializing in conservative treatment of spinal deformities.   

Bracing is recommended to treat patients with curves above 20° ± 5° Cobb, still growing (Risser 0 to 3), and with demonstrated progression of deformity or elevated risk of worsening, unless otherwise justified in the opinion of a clinician specializing in conservative treatment of spinal deformities. 

Very hard rigid bracing (casting) is recommended to treat patients with curves between 45° and 60° in an effort to avoid surgery.

It is recommended that each treating team provide the brace that they know best and have more experience with. No particular brace that can be recommended over the others.

It is recommended that braces be worn full-time or no less than 18 hours daily at the beginning of treatment, unless otherwise justified in the opinion of a clinician specializing in conservative treatment of spinal deformities.

Give that there is a dose response to treatment, it is recommended that the hours of bracing per day be proportionate to the severity of the deformity, the age of the patient, the stage, the aim and overall results of treatment, and the achievable compliance. 

It is recommended that daily brace wear be proportionate to the deformity severity, the age of the patient, the scoliosis stage, the aim and overall results of treatment, and the expected compliance. 

It is recommended that braces be worn until the end of vertebral bone growth and that the wearing time then be gradually reduced, unless otherwise justified in the opinion of a clinician specializing in conservative treatment of spinal deformities. 

It is recommended that the wearing time of the brace be gradually reduced, while stabilizing exercises are performed, to allow adaptation of the postural system and maintain results. 

It is recommended that any means be used to encourage compliance, including a careful adherence to the recommendations defined in the SOSORT Guidelines for Bracing Management.

It is recommended that compliance to bracing be regularly checked through compliance-monitoring devices.

It is recommended that brace quality be checked by means of an in-brace x-ray. 

It is recommended that the prescribing physician and the constructing orthotist be experts according to the criteria defined in the SOSORT Guidelines. 

It is recommended that bracing be applied by a well-trained therapeutic team that includes a physician, an orthotist, and a therapist, according to the criteria defined in the SOSORT Guidelines. 

It is recommended that all phases of brace construction (prescription, construction, check, correction, follow-up) be carefully followed for each single brace according to the criteria defined in the SOSORT Guidelines.

It is recommended that the brace be specifically designed for the type of the curve to be treated. 

It is recommended that the brace proposed for treating a scoliotic deformity on the frontal and horizontal planes take into account the sagittal plane as much as possible. 

It is recommended to use the least invasive brace suitable for the clinical situation, provided that equivalent effectiveness is retained, so as to reduce the psychological impact and ensure better patient compliance.

It is recommended that braces not restrict thorax excursion in a way that reduces respiratory function.

It is recommended that braces be prescribed, constructed, and fitted in an outpatient setting.

It is recommended that braces be regularly changed according to growth and/or specific pathologic needs as judged by a physician expert on scoliosis.

It is recommended that out-of-brace x-rays be regularly performed to check the effectiveness of bracing treatment: the number of hours out of brace before x-ray should correspond to the daily weaning time.

Physiotherapeutic scoliosis-specific exercises

Prevention of scoliosis progression during growth

PSSEs are recommended as the first step in treating idiopathic scoliosis to prevent or limit progression of the deformity and bracing. 

It is recommended that PSSEs follow the SOSORT Consensus and be based on autocorrection in three dimensions, training in activities of daily living (ADLs), stabilization of the corrected posture, and patient education.

It is recommended that PSSEs follow one of the schools whose approach has been shown to be effective in scientific studies.

It is recommended that PSSE programs be designed by therapists specifically trained in the approach they use.

It is recommended that PSSEs be proposed by therapists included in scoliosis treatment teams, with close cooperation among all members.

It is recommended that PSSEs be individualized according to patient needs, curve pattern, and treatment phase. 

It is recommended that PSSEs always be individualized, even if performed in small groups.

It is recommended that PSSEs be performed regularly throughout treatment to achieve best results. 

It is recommended that therapists implement a compliance system for exercise tracking. 

It is recommended that therapists regularly assess the quality of PSSEs performed by patients.  

It is recommended that PSSE difficulty be progressively increased according to patient ability. 

It is recommended that PSSEs be taught individually in a one-to-one relationship to ensure individualized care; regular performance could also be at home or in small groups.

Use during brace treatment and surgical therapy

1. It is recommended that PSSEs are performed during brace treatment.

2. It is recommended that, while treating with PSSEs, therapists work to increase compliance of the patient to brace treatment.

3. It is recommended that spinal mobilization PSSEs are used in preparation to bracing.

4. It is recommended that stabilization PSSEs in autocorrection are used during brace weaning period.

5. It is recommended that PSSEs in painful operated patients are used to reduce pain and increase function.

6. It is recommended that aerobic physiotherapy training be used prior to surgery.

Other conservative treatment

It is recommended that manual therapy (gentle short-term mobilization or soft-tissue-releasing techniques) be proposed only if it is associated with stabilization PSSEs, unless otherwise justified in the opinion of a clinician specializing in conservative treatment of spinal deformities.

It is recommended that correction of real leg-length discrepancy, if needed, be decided on by a clinician specializing in conservative treatment of spinal deformities.