Management of scoliosis

The etiology and nature of truncal deformity in idiopathic scoliosis remains unclear. Only 2 methods are effective to halt or correct the spinal deformity. The first is bracing in young patients and the second is surgical correction for severe curve. Bracing is feasible for children with a Cobb angle between 20 degrees to 35 degrees, while surgical correction is the only choice if the Cobb angle is greater than 40 degrees. Recent surgical developments have led to good correction results with reduced operative scale through continuous spinal cord monitoring, evolution of spinal implants, and better perioperative and postoperative care. The newer spinal systems can produce 3-dimensional reconstruction of the deformity and maintain truncal balance afterwards. The newer implants are user-friendly and low-profile. The combined hook/screw application (hybrid) and the all-screw placement methods have become quite popular. With these methods, the correction rate is increased with reduced loss of correction at follow-up. Navigation systems facilitate accurate insertion of pedicle screws into the vertebral bodies, while video-assisted endoscopic instruments allow early ambulation. These methods are useful in cases of thoracic scoliosis. In the future, in order to minimize the operative scale and prevent deformity, important goals are elucidation of the real nature and the causes of scoliosis and restriction of the number of fusion levels by use of emerging technologies.