Factors that influence outcome in patients with scoliosis and kyphosis include the degree of deformity at initial presentation, skeletal maturity at diagnosis determined by Risser stages of ossification) and persistent progression of curvature (defined as an increase in angulation of more than 5 degrees). McLain and Karol reviewed the nonoperative treatment modalities available for patients with kyphosis and idiopathic scoliosis.
The initial approach for most patients with scoliosis is observation. Serial roentgenography is the standard approach for follow-up, with the frequency of testing determined by the magnitude of the curve. Children with a 10 to 20 degree curve are usually observed. Children with a 20 to 30 degree curve are also observed, but roentgenograms are obtained at intervals of three to six months.
Bracing is indicated in patients with skeletal immaturity who have a curvature progression of more than 5 degrees. Skeletally immature patients who present with curvature of 30 to 40 degrees may need immediate bracing, since a delay may result in progression of the curve, warranting surgical intervention. Bracing is not beneficial in patients with curvatures of more than 50 degrees.
The authors conclude that, despite skepticism about its efficacy, bracing is the only nonoperative method to alter the natural progression of curvature. Although the Milwaukee brace remains the gold standard for orthotic treatment in patients with adolescent idiopathic scoliosis and kyphosis, many new braces provide the same benefits with more comfort and better appearance. In the past, patients have been instructed to wear the braces 23 hours each day. However, studies have shown that wearing braces 16 hours each day may produce the same benefits. Bracing can also be beneficial in patients with kyphosis.
COPYRIGHT 1994 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group
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Kallmann syndrome