Observation and Surveillance

It is about establishing a regular timing for controling the evolution of the condition. According to the SOSORT and the SRS, observation and surveillance is a treatment option, different to doing nothing. It is mandatory that this option is complemented by Education.

Natural History of idiopathic scoliosis is in many case benign, remaining as a mild spine deviation, remaining clinically stable and casuing non sysmptoms or signs other than a more or less noticable back asymmetry. Idiopathic scoliosis is a biphasic process, first it appears and later it can regress, remain stable or progress. Idiopathic scoliosis can be progressive or non progressive.

There is no a validated test to learn about a mild scoliosis to be progressive or not progressive although some researchers are working in cresting some biomechanic and or biological predictors for progression. This is an essential aspect on scoliosis management because treatment to prevent, minimize or partially correct a progressive scoliosis are treatments not easy to follow, especially for adolescents, and are associated to undesirable effects.

Thus, specific treatment should be only recommended when necessary to prevent a mild progressive scoliosis to become a major progressive scoliosis or to correct an already major scoliosis. A non progressive non symptomatic mild scoliosis rarely needs specific treatment other than surveillance and education. The message offered by the doctor, but not just fromt the doctor but also by other members from the multidisciplinary treatment team is essential in order ro prevent about the so called NOCEBO effect. Adolescent Idiopathic scoliosis, the most frequent type, is mainly a cosmetical problem.

Sometimes, stress, false messages a dramatism produces the worse health effect on children, later when adults, rather than the condition it self. Thus, early detection is a nife curting both sides, from one side it is good to have the chance to make an early diagnose, from the other side, knowing about it producess unnecessary stress and force many families to make unnecessary actions, which produces just more stress. What to say about therapy actions offered to prevent progression to ALL the patients no matter curve magnitude, age or symptomatology?

Treating a non progressive scoliosis, the most frequent type, will be always succesful, no matter how you treat. We should not underestimate the side effects of unnecessary and inneffective treatment. Specific treatment has to be recommended individually according to many factors in order to avoid both Overtreatment or Undertreatment, following National or International guidelines like those established by the SOSORT or the SRS.

Specific non operative treatment is based on physiotherapy scoliosis specific exercises (PSSE) and bracing.

Evidence about PSSE is low level. Evidence about bracing is of higher level. However, the quality of PSSE or bracing is assential for success. Non of them can be considered like a farmacologic treatment, where evidence is relatively easy to check and reproduce. Human factor is very important in these tow treatment modalieties and they do mot work just because getting a particular name. Names, as these are not products, are not effective by themselves.

Read more in the next sections…

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