Scoliosis Treatment: Diagnostics and Therapy Methods

Q: What specific models of rigid corrective braces are used in orthopedic practice?

In orthopedic practice, a Chêneau-type corrective brace is used to treat progressive deformity. This model provides three-dimensional correction, acting on the spine simultaneously in the frontal, sagittal, and horizontal planes. The brace has a derotating effect due to asymmetric loading and locally applies forces strictly to the apex and base of the deformity. A distinctive feature of its design is the absence of an upper support, which completely eliminates pressure on the shoulder girdle, cervical spine, and skull of the patient.

Diagnostics and Deformity Assessment

To properly choose treatment tactics, it is necessary to assess the degree of curvature and its stability. Radiography is the primary tool.

Determining the Cobb angle: on an anteroposterior radiograph, neutral vertebrae (upper and lower vertebrae at the curve boundaries with no signs of rotation) are identified. Lines parallel to the intervertebral cleft are drawn at their base, to which perpendiculars are dropped. The angle of their intersection indicates the degree of deformity.
Stability index (Kazmin method): calculated from supine and standing radiographs. Formula: (180° - α) / (180° - α₁), where α and α₁ are the arc magnitudes in degrees in the lying and standing positions, respectively. A value of 1 indicates a completely fixed deformity, and 0 indicates a completely mobile one.
Risser sign: necessary to determine whether the child's growth is complete. The stage of iliac crest ossification is evaluated — from the appearance of the first ossification centers (stage I) to their complete fusion with the main bone (stage IV).

Degrees of Scoliosis Development

The clinical and radiologic picture changes as the pathology progresses:

Grade I: determined radiologically. Vertebrae exhibit moderate rotational displacement, causing their spinous processes to align in a spiral.
Grade II: characterized by pronounced torsion (displacement in three planes). Compensatory curves form in the opposite direction to maintain the body's vertical axis. A muscular "ridge" and a slight rib hump are clinically noticeable.
Grade III: lateral deviation is 25–40°. At the apex of the curve (in the zone of maximum rotation), the vertebrae become wedge-shaped. A prominent rib hump develops due to chest deformation and impaired rib development.
Grade IV: the curvature angle is 41–90°. Severe deformation of the torso and pelvis, thoracic kyphoscoliosis, and significant deviation of the trunk axis are observed.

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Conservative Therapy for Non-Progressive Forms

In children under three years of age, the main method is proper positioning in a plaster bed for fixation in the correction position. During the first months, the infant stays in it constantly, and afterwards — only during sleep. The prognosis is generally favorable.

Treatment of grade I–II scoliosis is carried out on an outpatient basis and aims to eliminate risk factors:

Organization of sleep and daily routine: a firm bed with a small pillow is required. If the child sleeps on their side, a bolster is placed under the curve. Strict control over matching the desk and chair height to the child's growth is mandatory.
Sports and activity: physical therapy, massage, cross-country skiing, and active games are indicated. Breaststroke swimming is the optimal sport, as it completely excludes rotational movements of the spine.

Management of Progressive Scoliosis

If dynamic monitoring reveals progression, the patient is referred to specialized boarding schools where treatment is combined with education.

Educational routine: classes are conducted in the supine position on special couches.
Therapeutic measures: throughout the day, children receive massage, undergo muscle electrical stimulation sessions, and practice in the pool.
Orthopedic correction: removable corrective braces are used, which must be worn all day and removed at night. Sleep takes place in plaster beds equipped with special detorsion pillows.

Strict Contraindications in Therapy

In the conservative treatment of scoliosis, any physical exercises that stretch the ligamentous apparatus of the spine are strictly contraindicated.

Previously used functional treatment methods involving spinal traction have proven ineffective: they lead to a rapid worsening of the condition, accelerating scoliosis progression twofold.

Briefly: answers to topical questions

What surgical methods are used for the operative treatment of grade IV scoliosis?

For the surgical treatment of grade IV scoliosis, interventions on the ligaments, discs, and vertebral bodies are used in combination with posterior bone-plastic fixation.

On the tendon-ligamentous apparatus — transection of the supraspinous and interspinous ligaments, incision of the facet joint capsules.
On the intervertebral discs — discectomy, enucleation of discs at the apex of the deformity.
On the vertebral bodies — wedge resection, epiphysiodesis.

Correction is performed using metal implants: Kazmin, Harrington, Rodnyansky distractors, as well as pedicle screw systems. If a rib hump is present, resection of the most prominent ribs or thoracoplasty is additionally performed.

What specific models of rigid corrective braces are used in orthopedic practice?

In orthopedic practice, the Cheneau corrective brace is used to treat progressive deformity. This model provides three-dimensional correction, acting on the spine simultaneously in the frontal, sagittal, and horizontal planes. The brace has a derotating effect due to asymmetric loading and localized force application strictly to the apex and base of the deformity. A design feature is the absence of an upper support, which completely eliminates pressure on the shoulder girdle, cervical spine, and patient's skull.

How to memorize

To remember safe sports for scoliosis, use the acronym SVSB (in Russian): Swimming (breaststroke only!), Skiing, Volleyball, Basketball.

Class and exam questions

What is the apex of the curvature curve?

This is the zone of maximum vertebral rotation. At the same time, the neutral vertebrae located at the curve boundaries show no signs of twisting at all.

What is the Kazmin stability index used for?

It helps the orthopedist determine the degree of deformity fixation. The index is calculated from the difference in curvature magnitude between standing and supine radiographs.

Can spinal traction be used in scoliosis?

Strictly no. Exercises stretching the ligamentous apparatus of the spine are prohibited because they accelerate disease progression twofold.

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What else to study on this topic

Pathogenesis of compensatory curves and rib hump formation
Biochemical disorders (mucopolysaccharide and amino acid metabolism) in scoliosis
The role of electromyography in neurogenic forms of deformity
Detailed analysis of Risser apophyseal development stages
Biomechanics of torsional vertebral displacement

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Treatment of scoliosis