Abstract: Background: Adolescent idiopathic scoliosis (AIS) patients with a Cobb angle >45° are generally referred for surgery, especially in Asia. Physicians do not typically prescribe braces or physiotherapeutic scoliosis-specific exercises for such cases.
Case Presentation: We described a case of right thoracic scoliosis with a Cobb angle of 51°. The parents refused surgery and opted for conservative treatments. We braced the pre-menarchal patient at the age of 10, with Risser at 0, and coached her on exercises, which include traditional Schroth, the Schroth Best Practice, the dynamic neuromuscular stabilization (DNS), and the Pilates exercises. The patient has been very compliant with the brace-wear and the exercises.
The treatment’s outcome was good. The Cobb angle was reduced to 29.5°, the ATR from 15° to 1°, and the right truncal shift was reduced. The spine became more balanced. The reduction in the Cobb angle to below 30° reduced the possibility of the curve being progressive in adulthood. Also, the improved aesthetics positively affect her confidence.
Conclusion: The case illustrates that bracing and physiotherapeutic scoliosis-specific exercise (PSSE) may be indicated in patients who opt not to have surgery. We cannot generalize the outcome to all AIS patients with a curve >45°. However, we opined that rigorous bracing and PSSE therapy should be tried on adolescents with severe scoliosis prior to surgery.
Abstract: A patient with intermittent claudication, evening leg pain, and unsteady gait secondary to peripheral artery disease and diabetic peripheral neuropathy were treated by enhanced external counterpulsation (EECP).
The case arose three years before the consultation. Conventional medical treatments involve controlling hyperglycemia, cholesterol levels, blood pressure, and physiotherapy. Opioids and NSAIDs were prescribed. These approaches reduced the pain from 10/10 to 7/10 in one year but did not improve the paresthesia and hyperesthesia of the feet and the walking distance. Frustrated by the lack of significant improvement after visiting multiple medical establishments and receiving over 100 various physiotherapy treatments, he reluctantly discontinued further physiotherapy treatments. The laboratory tests since 2022 showed that the patient had diabetes. The glycemic parameters were all elevated. Examination using Tensiomed revealed an increased augmentation index and pulse wave velocity. A low nerve score, a measure of the sudomotor response, was also found, suggesting small fibres neuropathy. The findings indicated that the patient had peripheral artery disease (PAD) and early manifestation of diabetic peripheral neuropathy. With his consent, he tried EECP treatment and nutraceuticals on him. His glycemic parameters improved after 19 sessions. After 35 sessions, which spanned over 7 weeks, he could walk for 500 metres, whereas before the intervention, he could only walk 100 metres. Also, the area of the left calf cramp during ambulation was reduced. More importantly, perhaps, the sensation in the sole improved, and he could walk more steadily. His gait was more balanced. Yet, the evening pain still persisted. As we did not only use EECP for treatment, we cannot determine if the benefits derive entirely from the EECP. Further studies are required to elucidate whether EECP intervention improves peripheral artery disease (PAD) or diabetic peripheral neuropathy. Keywords: External Counterpulsation; Peripheral Artery Disease; Intermittent Claudication; Diabetic Peripheral Neuropathy
Abstract: [Purpose] The study investigates whether performing scoliosis-specific exercises is related to curve stabilization in postmenopausal women with a thoracolumbar curve. [Case Description] We describe the outcome of three postmenopausal women with thoracolumbar scoliosis performing scoliosis-specific exercises for around ten years. Case 1 had a normal bone mineral density and thoracolumbar scoliosis over 64° and consistently performed the exercises at home for half an hour daily. Cases 2 and 3 had osteopenia and thoracolumbar curves of 64° and 45°, respectively. They did the exercises sparingly over eight years, particularly during the three years of COVID-19, when they stopped doing the exercises. [Outcome] The outcomes of the three cases differ. Case 1 had the best result, with the thoracolumbar curve stabilized and no pain. Cases 2 and 3 had curve progression and had mild pain, requiring occasional pain medication. [Discussion] Our findings suggest a potential relationship between regular scoliosis-specific exercises, good bone mineral density, and scoliosis stabilization. More research is needed to further our understanding of the interplay between exercise, bone health, and scoliosis progression.
Abstract: Introduction:Observation is the treatment of choice for idiopathic scoliosis with Cobb angles between 15 degrees – 20 degrees in growing children. This passive approach does not address the anxiety of the patient and the stress of the parents. In this paper, we attempt to identify skeletally immature patients with mild scoliosis curvatures that are more at risk of progression and propose possible intervention for this group of subjects. Methods: The literature was searched in Pubmed, and additional references were searched manually in the literature. Results: Many studies have shown that low serum 25[OH]D level, bone mineral density (BMD), and body mass index (BMI) are related to the curve severity or progression of the curve. We suggest that skeletally immature patients (< Risser 2) with mild curves be divided into two groups, viz. Group O (observation) with a lower risk of progression, and Group I (intervention) with a higher risk of curvature progression. We propose early intervention for the latter group. It is suggested that pre-menarcheal, skeletally immature patients with mild idiopathic scoliosis, and low vitamin D, BMD, and BMI should be treated. Also, asymmetric foot biomechanics should be addressed, although nutrition and foot orthoses are regarded to have no role in the management of idiopathic scoliosis. The outcome of early intervention may be utterly different from late treatment when the curvature becomes more structural, and the patient more skeletally mature. Conclusion: Research is required to prove if the intervention is clinically indicated.
Abstract: Introduction: Leg length discrepancy is common among patients with scoliosis. Some studies reported reduced functional scoliosis curves with correction of leg length discrepancy. Others, however, have shown that induced leg length discrepancy has little effects on spinal deformities. Also, small number of studies assessed the use of foot orthoses in patients with faulty foot biomechanics and their impact on idiopathic scoliosis. In this context, a review of the literature is needed to determine the current evidence for the appropriate use of sole lift and foot orthoses in a context of scoliosis. Methods: A literature review was performed. Results: It appeared that sole lifts are indicated for functional lumbar scoliosis when the level of the sacrum is parallel to that of the hips. Sole lifts may not be indicated for patients with structural scoliosis, seemingly inducing a compensatory curve. Custom foot orthoses were found to reduce spinal curves in juvenile patients with mild idiopathic scoliosis and concomitant abnormal foot biomechanics. Conclusion: Sole lift appeared to be indicated in the presence of certain types of functional scoliosis. Custom foot orthoses can be considered in the management of mild idiopathic scoliosis in juvenile patients. Evidence, however, is low and quality studies are needed to validate these findings.
Abstract:
Scoliosis is prevalent in elderlies over the age of 60. Of the different curve types, the thoracolumbar curve is the most common curve type operated upon, as it is associated with marked trunk shift and disability. Current physiotherapy treatments consist of electrotherapy, aquatic exercises, core-strengthening exercises, and dry needling. Outcome of these treatments has not been satisfactory. Longterm successful rate of conservative treatment of symptomatic adult scoliosis is low, as the treatment addresses symptoms but not the biomechanics involved in adult scoliosis. Recent studies have shown that physiotherapeutic scoliosis-specific exercises (PSSE) and bracing stabilized the curves in 80% of the subjects. Thus PSSE and bracing should be added to the standard physiotherapy care in the management of symptomatic adult scoliosis. For asymptomatic patients with thoracolumbar curve that has an increased risk of progression, PSSE should be considered as preventative exercises. Patients who do not respond to conservative treatments and have significant spinal stenosis should be referred for surgery.
Abstract: Study design: This is a pilot prospective cohort study. Objectives: To investigate if outpatient Schroth exercises (SBP) affect thoracolumbar or lumbar curves in adult scoliosis patients. Background: Adult scoliosis tends to progress and is associated with an increased prevalence of low back pain. The outcome of conservative treatment is not satisfactory, as treatment is not directed towards spinal deformity. This study investigates if SBP influences the thoracolumbar and lumbar curves in patients with adult scoliosis. Materials and methods: Adult patients with thoracolumbar and lumbar curves ≥ 20° were taught SBP exercises once weekly for 4 weeks. They then performed the exercises at home three times a week, for 9 months. Baseline measurements included Cobb angles, coronal offset, sagittal vertical axis (SVA), T4-12 kyphosis, L1-S1 lordosis, sacral slope, pelvic incidence and pelvic tilt. They were compared to post-intervention measurements, using paired t tests. Results: SBP exercises statistically significantly decreased the Cobb angle (p = 0.0032) improved the ATR (p = 0.012), increased the sacral slope (p = 0.03), decreased the pelvic tilt (p = 0.0032) and the SVA (p = 0.032). Conclusion: The SBP exercises improved the Cobb angles and SVA in adult scoliosis patients with thoracolumbar and lumbar curves.
Abstract:
The effectiveness of spinal bracing in the treatment of adolescent idiopathic scoliosis has been controversial. Some studies have shown that bracing is only as effective as observation, whilst others have shown that bracing is superior to observation, halting progression and effectively reducing progression to surgical threshold. Recently, some studies have even shown improvement of curves with bracing. Yet, many of these studies have been judged to be of low methodological quality. In 2005, the Scoliosis Research Society (SRS) attempted to standardize the inclusion criteria and outcome measurements for bracing studies, to enable comparison among studies. In the guidelines, progression of ≤ 5° is regarded as success. It is apparent that SRS did not regard improvement of curves probable. Improvement which is defined as a decrease of ≥ 6° was not proposed until 2009. This may reflect an improvement in outcome with bracing in the last one to two decades. The present review attempts to determine if there is a trend of improvement in outcome with bracing in the last 3 decades. Manual literature search was made in the PubMed using the keywords of brace, conservative treatment and adolescent idiopathic scoliosis. Relevant English articles on the outcome of wearing rigid braces from 1990-2016 were retrieved and reviewed to determine if there is a trend towards improvement in outcome with bracing and if bracing halts progression and improves curves. Results show that there has been an apparent improvement in the effectiveness of bracing in reducing surgical rate since 2005. Close inspection shows that the reduction in surgical rate is not due to an improvement over time, but is related to the types of brace. The effectiveness of Boston brace is not consistent over the years. The surgical rates vary and no consistent trend of improvement can be discerned in the last 2-3 decades. The surgical rate reported in 2007 for TLSO was as high at 79% and that in 2014 for Boston brace was 28%. The surgical rates with European braces (Progressive Action Short Brace (PASB), Cheneau derivatives and Lyon/Sforzesco braces), however, are consistently lower, at less than 8%. Similarly, the European braces have been found to be able to improve curves in over 50% of the at risk patients. Bracing does not therefore only halt progression of curves. Given a well-constructed brace, with good patient compliance, improvement of curves in over 50% of the patients is possible, particularly when used in conjunction with scoliosis specific exercises.
English