Treatment of Moderate Scoliosis

Introduction to Treatment Guidelines

The American College of Radiology recommends radiographic evaluation every 6 months during active treatment to assess curve magnitude and progression, using PA technique to reduce breast radiation exposure 4, 5
Bracing is indicated for curves 25-45° in growing patients, as this represents the window where orthotic intervention can prevent progression to surgical thresholds, with combine bracing and physical therapy focusing on core strengthening and postural awareness to optimize outcomes 1, 2

Clinical examination every 6 months using Adam's forward bend test and scoliometer measurement is recommended 1, 3
Radiographic evaluation every 6 months during active treatment to assess curve magnitude and progression, using PA technique to reduce breast radiation exposure 4, 5
Assess Risser index on radiographs to determine skeletal maturity and progression risk 4, 5
Rapid curve progression (>1° per month) indicates aggressive disease requiring escalation of treatment 4, 3

For patients with Neurofibromatosis Type 1, annual clinical evaluation with Adam's forward bend test is mandatory, with immediate orthopedic referral if scoliosis is detected 6
Dystrophic scoliosis in NF1 progresses more rapidly and presents earlier than non-dystrophic forms 6
Approximately 50% of NF1 patients with childhood scoliosis experience curve progression into adulthood with significant back pain 6

Surgery is indicated for curves >50° in skeletally immature patients or curves >50° with documented progression in mature patients, as these curves will continue progressing throughout life 1, 2
Surgery is NOT indicated for moderate scoliosis (25-45°) unless there is documented progression despite optimal bracing or exceptional circumstances 1