Although surgical techniques continually improve over the years, conservative approaches are gaining steam.
"In looking at how the field has evolved over the last decade or two, it's obvious that the opportunity for conservative management of scoliosis has evolved dramatically, more dramatically than opportunities for surgical management," says Michael Vitale, MD, chief of the pediatric spine and scoliosis service at NewYork-Presbyterian Morgan Stanley Children's Hospital.
Treating adolescent idiopathic scoliosis requires a unified approach, demanding a multidisciplinary, cross-functional team.
Despite significant opportunity for conservative scoliosis management, dissemination of the technique's benefits has fallen behind that of surgical techniques. Dr. Vitale and other leaders in the field are, therefore, focusing their efforts on establishing best practices in scoliosis conservative management and funneling the information into the mainstream discussion.
Actively involved on the board of the Pediatric Orthopaedic Society of North America, Dr. Vitale says the organization and others are dedicated to improving non-operative management of children with scoliosis.
The first step is early recognition of spinal deformity through screening. If spinal deformity is identified early, adolescents should first try scoliosis-specific physical therapy, says Dr. Vitale.
A specialized method for scoliosis, the Schroth method focuses on postural correction and breathing. The therapy puts patients in touch with their curve, so they understand how to alter their posture and stand in a braced position.
"In a growing child, the straighter you are when you're growing, the straighter [your spine] will be," explains Dr. Vitale. He and his colleagues investigated patient compliance's impact on Schroth therapy. The subset of patients with high compliance had much lower rates of curve progression, explains Dr. Vitale, a finding recently presented at a large international scoliosis meeting.
"Just like taking blood pressure medicine, compliance is key to success for bracing and scoliosis-specific physical therapy. Bracing doesn't work if you don't do it," says Dr. Vitale.
Since compliance is so critical to scoliosis conservative treatment, Dr. Vitale is helping develop an app "to get into the kids' heads." The app allows children to share their physical therapy progress via a fun platform — online.
"We are also developing a seven-minute Schroth app, using the natural proclivity for electronics to get [the children] to do stuff," he explains.
Dr. Vitale also serves as CMO for Wellinks, a wearable health technology company, unveiling Cinch — smart straps for scoliosis — this year. Cinch is connected to a compliance app that tracks information on how tightly and long a child wears the brace.
"Now it's not just we're prescribing a brace, but we have tools to track brace wear with a parental version, a patient version and a physical therapy version," Dr. Vitale says. "The smart brace is a really interesting opportunity to use technology for patients in a way that is productive for their health and in their best interest."
Dr. Vitale urges the population to get on board to prevent progression toward surgery for adolescent idiopathic scoliosis. He actively tweets about non-operative resources available for AIS using the hashtag #cureAIS.
"Our aspiration is that, by working together and employing the full array of treatment options, together we can #cureAIS," says Dr. Vitale.