Reversal of childhood idiopathic scoliosis in an adult, without surgery: a case report and literature review

Abstract

BackgroundSome 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.Case presentationA 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.ConclusionThis 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.

Adults with idiopathic scoliosis improve disability after motor and cognitive rehabilitation: results of a randomised controlled trial

“…Sparse evidence is available concerning AS conservative treatment as it is mostly based on case reports and case series, including injections, bracing, spinal exercises (both active and device assisted), chiropractic and osteopathic care, pilates, myofascial release, and cardio-respiratory training [16][17][18][19][20][21][22][23][24][25][26][27]. A systematic review on non-surgical treatments in AS concluded that evidence for conservative care was lacking and clinical research was suggested to define the target population (type of AS, curve magnitude, pain, etc.)…”

Effects of Sitting Habits and Physical Activity Levels on Spine and Pelvis Deformations in School Children

“…In addition one case report showed good long term results with a multimodal treatment -exercises together with manipulative medicine [12]. Literature is however still lacking studies that compare different kind of Scoliosis Specific Exercises.…”

“…Surgery is generally considered to be the only intervention that can stop curve progression, while scoliosis specific exercises and orthesis are mainly considered for pain control [3,4]. In the literature, the prevailing treatment is surgery [3]; but scoliosis specific exercises together with other type of physical treatment, such as manipulation program, has also been proposed to avoid or stop curve progression [11,12]. In a shortterm case series Weiss et al showed 43.93 % of 107 patients improved 5 or more Cobb degrees immediately after 4-6 weeks of in-patient exercise program [9].…”

Living with a Severe Spinal Deformity: An Innovative and Personal Patient Account of Self-Management Using a Corset, Postural Correction, and Exercises

“…In highly progressive curves, exercises appear to slow down the progression of the curvature [10]. Using traction and massage, Brooks et al [11] were able to improve chest expansion and decrease thoracic curvature in an adult with idiopathic scoliosis. Negrini et al [12] hypothesized that the improvement of adult scoliosis that was achieved by one of their patients is a consequence of recovery from a postural collapse without any changes in bone structure.…”