Continued
scoliosis was performed in
New York by Russell Hibbs in 1914
Whether the pathologic changes are anatomic or biochemical is unknown. And the etiology of scoliosis, while still apocryphal, is probably multifactorial.
NATURAL HISTORY
School screening studies indicate a prevalence rate of larger curves that may require treatment of around two percent. Because only larger curves require treatment, knowledge of the risk factors for progression is essential for treatment to alter the natural history in a beneficial way. Factors related to curve progression are sex, age, maturity, curve pattern and curve magnitude. The patient -at greatest-risk for progressionwould be an -
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immature, pre-menarchal female with a large right thoracic curvature. Such a patientshould be treated if her curve presents at 25° or more or has been documented to have progressed.
NONOPERATIVE TREATMENT
For most patients, periodic observation until skeletal maturity is indicated as few will progress and there are no clinical sequelae of astable, non-progressive curvature for even as much as 40 ° . It is the patient with progressive spinal deformity who can expect a variety of problems early in life -pain, fatigue, cardiopulmonary decompensation and poor self-image.
Bracing is prescribed when progression is documented in a skeletally immature patient. The type of brace, the number of hours per day it is worn, the duration of treatment and the concomitant performance of exercise are all controversial.
In the 1980s, the nocturnal use of electrical stimulation of the musculature on the convex side of the curve was prescribed with an initial wave of enthusiasm, which since has ebbed as no effect on the natural history of scoliosis has been demonstrated.
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