Nonoperative procedure
1. Introduction
The initial option for most patients is non-operative treatment, which includes physical therapy and the use of orthesis.
2. Physical therapy
Physical therapy includes back exercises and muscle contractures stretching for adolescents with curves below 60 degrees and adults with mild symptoms.
3. Bracing
The goal is to obtain partial correction of the deformity.
Bracing is less effective:
- in skeletally mature patients
- if kyphosis is greater than 65°
- with vertebral wedging above 10°
Some loss of correction is expected over time after treatment.
If the apex of the deformity is superior to T8 a Milwaukee brace is indicated.
If the apex of the deformity is inferior to T8 a TLSO can be used. However, the Milwaukee brace will generally give better results than a TLSO brace.
Different protocols recommend usage between 16 and 23 hours until skeletal maturity is achieved.
Gradual removal of the brace with usage during sleep is usually indicated.
