Skip to main content
AAPM&R Events Main banner
JFK Johnson
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
In-Person
In-Person
On Demand
On Demand
Live Stream
Live Stream
Invite Only
Invite Only
Ticketed
Ticketed
Coffee Break
Coffee Break
Meal
Meal
Reception
Reception
Back

Musculoskeletal and Sports Medicine

Can very severe adolescent idiopathic scoliosis(AIS) be altered by serial part time rigid bracing and therapeutic exercise-a case report

(Kiosk 2) Can Very Severe Adolescent Idiopathic Scoliosis(ais) Be Altered by Serial Part Time Rigid Bracing and Therapeutic Exercise-a Case Report

Friday, November 17, 2023
8:00 AM – 9:15 AM CT

    Primary Author(s)

  • POWEI BLAKE CHEN, MD

    Attending
    Chi Mei Medical Center
    Tainan City, Tainan, Taiwan (Republic of China)

    • Co-Author(s)

  • WC

    WILLY CHOU, PhD

    Superintendent
    Chi Mei Medical Center, Chiali
    Tainan, Tainan, Taiwan (Republic of China)

Case Diagnosis: Very severe thoracic Adolescent Idiopathic Scoliosis, apex: T8-T9, right curvature; Rigo classification for BSPTS: 3curve, A3. Initial Cobb’s angle(T5-L1):79', angle of trunk rotation: 22.5'.

Case Description: The 11.5 y/o girl without menarche or known congenital diseases, who first visit our OPD on 2022/04/09. Prominent right upper back hump was noted; besides, intermittent whole back soreness was complained. Her initial x-ray took in local clinic revealed Cobb’s angle around 35' in 2021/10, and she only received TENS and hot pack for symptomatic treatment, and no experience of therapeutic exercises or bracing.

Discussion: Based on 2016 SOSORT guidelines, the highest percentage aim of treatments is avoiding surgery and for sever cases, to keep < 45' is the primary aim, and for adolescent with Risser 0 and severe scoliosis, rigid bracing is still the minimal treatment option. The mechanism of angular correction by elongation is not due to tensile stresses in the spine, but rather to the bending moments (stresses) created at the various disc spaces. These bending moments correct the angular deformity. The axial component provides most of the corrective bending moment when deformity is severe (Cobb’s angle>53').

Setting: She started scoliosis-specific exercises 30 mins/week in our hospital with subsequent home programs(70-140mins/week) since 2022/4/20, and serial part time rigid bracing was applied since 2022/5/7, she wore 12-21 hours/day.

Assessment/Results: Cobb’s angle: On 2022/5/14, in-brace:61'; 6/18, neutral:71', in-brace:58'; lastly, on 2022/10/22, **neutral:55', in-brace:53', ATR:17.5'.

Conclusion: Surgery remains an option for severe AIS, but it has not been proven superior to bracing or therapeutic exercise, even for severe ones. By this case, for people who before puberty, even very severe AIS can be grossly altered by serial part time rigid bracing with especially increased axial loading. However, exact bracing type, adjustment timing and exercises’ FITT during before puberty period needs further study.