Nonoperative treatment of adolescent idiopathic scoliosis.

Nonoperative treatment of spinal deformity will continue to change. In recent years, many long-held tenets regarding the natural history and response to various treatment methods have been challenged, and we do not yet have answers to many of the questions that have been raised. New orthotic devices and electrical stimulation have multiplied treatment approaches. From this array of options, the clinician must decide whom to treat and what method to use. On the basis of the current consensus, patients who have significant, progressive deformity and an immature spine should be treated by one of the nonoperative techniques. The various TLSOs are most favored, although the Milwaukee brace still has a definite role in certain curve patterns and remains the standard of braces. The role of electrical spinal stimulation is uncertain at present, and further research is necessary. We have learned that only appropriate orthotic treatment of scoliosis produces long-term stabilization of deformity. Impressive initial curve correction does not signify the end result, and patients who have curves that are unacceptable when the patient is first seen should be considered for surgical treatment. Thus, while questions remain, the guidelines for treatment outlined in this chapter are appropriate for the present.