Future of Scoliosis Treatment
George H. Thompson, MD Past President, Scoliosis Research Society
The treatment of idiopathic scoliosis, particularly conservative treatment, has been controversial. It has been difficult to determine which patients were going to progress, and who would benefit from conservative treatment (physical therapy, bracing, etc.) or require surgery.
Genetic testing will soon be available, that will help answer some of the questions. An analysis of 51 DNA markers associated with scoliosis has allowed determination of three specific groups of patients: no risk for progression, moderate risk, and those that will progress to 45 degrees or more and probably require surgery. When this testing is available, it may change the entire paradigm of management of scoliosis. Those that will not require treatment will need to be followed only periodically for confirmation. Those that are in-between will still require periodic evaluation and may benefit by conservative methods of treatment, such as physical therapy and bracing. Those in the high risk category for curve progression, may have earlier surgical intervention involving fusionless techniques.
This will make the application of growth modulation techniques, such as, vertebral body stapling, more applicable. This may be effective in controlling curve progression until skeletal maturity, at which time the staples could be removed or perhaps even left in place. As a consequence, spinal mobility will not have been affected but curve progression will have been prevented. Further refinement of genetic testing may ultimately identify those patients who will benefit by physical therapy or bracing, so that these treatments can be begun at the earliest possible stage to maximize their effectiveness.
This is an exciting time as the future of idiopathic scoliosis is changing. Genetic testing will be one of the major advancements in the past 50 years. This type of testing should be commercially available within the next several years. It will result in further opportunities for cooperative relationships between the Scoliosis Research Society (SRS) and SOSORT. New criteria for management will be developed and will also be given an opportunity for more scientific assessment of the results of the various forms of treatment.
The technology already exists to create a brace-free, fusion-free scoliosis world a reality. We just need to connect the dots and link the existing technologies into a treatment program that is directed by the genetic testing (scoliscore), rather than Cobb angle. It is just a matter of having the right conversations, with the right people, at the right time. Stay tuned.