Abstract
Background: Adolescent idiopathic scoliosis (AIS) patients with a Cobb angle >45° are generally referred for surgery, especially in Asia. Physicians do not typically prescribe braces or physiotherapeutic scoliosis-specific exercises for such cases.
Case Presentation: We described a case of right thoracic scoliosis with a Cobb angle of 51°. The parents refused surgery and opted for conservative treatments. We braced the pre-menarchal patient at the age of 10, with Risser at 0, and coached her on exercises, which include traditional Schroth, the Schroth Best Practice, the dynamic neuromuscular stabilization (DNS), and the Pilates exercises. The patient has been very compliant with the brace-wear and the exercises.
The treatment's outcome was good. The Cobb angle was reduced to 29.5°, the ATR from 15° to 1°, and the right truncal shift was reduced. The spine became more balanced. The reduction in the Cobb angle to below 30° reduced the possibility of the curve being progressive in adulthood. Also, the improved aesthetics positively affect her confidence.
Conclusion: The case illustrates that bracing and physiotherapeutic scoliosis-specific exercise (PSSE) may be indicated in patients who opt not to have surgery. We cannot generalize the outcome to all AIS patients with a curve >45°. However, we opined that rigorous bracing and PSSE therapy should be tried on adolescents with severe scoliosis prior to surgery.
Keywords
Adolescent idiopathic scoliosis, AIS, Chêneau brace, Brace, Scoliosis-specific exercises, PSSE