September 18, 2019
What Happened to Scoliosis School Screening?
Idiopathic scoliosis (IS) occurs in about 5% of the adolescent population. The Cobb angle is often used to help determine the course of treatment. Generally, curves below 25 degrees are treated with Physiotherapeutic Scoliosis Specific Exercises (PSSE). This can include physical therapies such as Schroth. Once a curve gets to about 45 degrees the word ‘surgery’ starts to pop up. In between 25 and 45 degrees it is a combination of bracing and PSSE that is recommended. But what about the curves that are at higher risk of progression? Many people choose not to have surgery. That is their prerogative.
A retrospective review was presented at SOSORT 2019 in San Francisco by Garvin and Dobrich. A cohort of children between 8 to 18 years with skeletal immaturity were chosen for retrospective analysis. On average the children had curves at about 30 degrees with a Risser Score of about 1 out of 5 at the beginning of physiotherapy. A Risser Score provides us with some guideline as to how much growth the child has left. The more growth remaining, the higher the risk of progression. A score of 5 out 5 would indicate that growth is complete. This cohort of children would be considered at high risk of progression. These children had participated in Schroth therapy. As per international recommendations a curve was considered stable if it did not change more than 5 degrees. The majority of these children did not progress even after one year of Schroth.
Another set of researchers from Bulgaria (Chongov and Dimitrova) showed that the Schroth method had a ‘positive effect on scoliosis correction after 12 months of therapy and further improved at 24 months follow-up.’ This cohort only analysed children who did not wear a brace.
Karavidas from Greece also presented a prospective study on children who attended regular supervised Schroth sessions with their physiotherapist and performed their home program at least 5 days per week. These children had Cobb angles greater than 15 degrees, had a Risser score of 0-2 and an angle of trunk rotation (ATR) more than 5 degrees (ATR gives us some indication of what the curve and trunk are doing without an X-ray). This group was compared to a control group who did generic exercise or no exercise at all. The conclusion of this study showed that ‘Schroth exercises (PSSE) reduced the risk of progression in AIS patients during the riskiest period of growth spurt. PSSE proved to be superior to general or no exercise.’ The author confirmed in the conclusion that PSSE ‘should be the first step of scoliosis treatment, in order to avoid progression and bracing.