Brooks William J, Krupinski Elizabeth A, Hawes Martha C
Restorative Care Foundation, Kansas City, MO 64152, USA.
Scoliosis. 2009 Dec 15;4:27. doi: 10.1186/1748-7161-4-27.
Some patients with mild or moderate thoracic scoliosis (Cobb angle <50-60 degrees) suffer disproportionate impairment of pulmonary function associated with deformities in the sagittal plane and reduced flexibility of the spine and chest cage. Long-term improvement in the clinical signs and symptoms of childhood onset scoliosis in an adult, without surgical intervention, has not been documented previously.
A diagnosis of thoracic scoliosis (Cobb angle 45 degrees) with pectus excavatum and thoracic hypokyphosis in a female patient (DOB 9/17/52) was made in June 1964. Immediate spinal fusion was strongly recommended, but the patient elected a daily home exercise program taught during a 6-week period of training by a physical therapist. This regime was carried out through 1992, with daily aerobic exercise added in 1974. The Cobb angle of the primary thoracic curvature remained unchanged. Ongoing clinical symptoms included dyspnea at rest and recurrent respiratory infections. A period of multimodal treatment with clinical monitoring and treatment by an osteopathic physician was initiated when the patient was 40 years old. This included deep tissue massage (1992-1996); outpatient psychological therapy (1992-1993); a daily home exercise program focused on mobilization of the chest wall (1992-2005); and manipulative medicine (1994-1995, 1999-2000). Progressive improvement in chest wall excursion, increased thoracic kyphosis, and resolution of long-standing respiratory symptoms occurred concomitant with a >10 degree decrease in Cobb angle magnitude of the primary thoracic curvature.
This report documents improved chest wall function and resolution of respiratory symptoms in response to nonsurgical approaches in an adult female, diagnosed at age eleven years with idiopathic scoliosis.
一些轻度或中度胸段脊柱侧弯（Cobb角<50 - 60度）的患者，其肺功能受损程度与矢状面畸形以及脊柱和胸廓灵活性降低不成比例。此前尚无关于成年后儿童期起病的脊柱侧弯临床体征和症状在无手术干预情况下长期改善的记录。
1964年6月，一名女性患者（出生日期：1952年9月17日）被诊断为胸段脊柱侧弯（Cobb角45度），伴有漏斗胸和胸段脊柱后凸减小。强烈建议立即进行脊柱融合手术，但患者选择了由物理治疗师在为期6周的训练期间教授的每日家庭锻炼计划。该方案一直执行到1992年，1974年增加了每日有氧运动。胸段主弯的Cobb角保持不变。持续的临床症状包括静息时呼吸困难和反复呼吸道感染。患者40岁时开始了一段由整骨医生进行临床监测和治疗的多模式治疗期。这包括深层组织按摩（1992 - 1996年）；门诊心理治疗（1992 - 1993年）；以胸壁活动为重点的每日家庭锻炼计划（1992 - 2005年）；以及手法医学治疗（1994 - 1995年，1999 - 2000年）。胸壁活动度逐渐改善、胸段脊柱后凸增加以及长期呼吸道症状的缓解与胸段主弯Cobb角大小降低超过10度同时出现。
本报告记录了一名11岁时被诊断为特发性脊柱侧弯的成年女性，通过非手术方法使胸壁功能得到改善以及呼吸道症状得到缓解。
