Our objective was to present a comprehensive overview of diverse therapeutic options. In addition to the main pillars of treatment for scoliosis in adolescents, orthotic treatment and corrective spinal fusion, we also discussed less popular options. These include, for example, Schroth physical therapy, as mentioned by Weiss, or unilateral vertebral stapling. In our article, we acknowledge the lack of studies with high levels of evidence, for conservative as well as for surgical options. We are not aware of any study with evidence level I that has documented the superiority of physical therapy over natural development for the progression of scoliosis. The level II–brace study by Katz et al that was missed by Weiss, was dealt with in an entire paragraph in our article. For this reason we cannot quite follow his criticism. In selected patients, a reduction in the progression of scoliosis from 2/3 to 1/5 has been observed (1).
Furthermore, Weiss claims that in an 8-year old patient with lumbar scoliosis of 45 degrees (this was confirmed in a control measurement on the original roentgenogramm), surgery could be avoided by using a full time brace. Unfortunately, this claim directly contradicts what has been reported in the current literature (1–3).
Furthermore, Weiss complains that we did not devote enough space to the therapeutic options in surgical complications. In our publication we mentioned a revision rate after surgical treatment for adolescent scoliosis of 4% (4). A more differentiated review of this topic would have its place within the remit of orthopedic literature and would have exceeded the remit of our review article. In the sense of radiation protection, we emphasized the necessity to adhere to the relevant rules and guidelines. All the images in our article originate from the US. And our department fully complies with all relevant rules and guidelines. In spite of their benefits, the irradiated area and gonadal protection should not obscure the anatomy of interest. In order to be able to do a detailed orthopaedic assessment of scoliosis, it is necessary to examine the entire thorax, including the ribs, and the entire spine from the occiput all the way to the hip joints. The purpose of such investigations include the identification and assessment of possible rib anomalies or asymmetries, pelvic growth signs, a possible pelvic obliquity or a pelvic anteversion or retroversion. All factors are of vital importance to the subsequent therapeutic procedures.
In the US, each radiograph requires pagination. However, during the image editing process for the published article, these were removed in some cases.
Dr. med. Per Trobisch
Shriners Hospital for Children
3551 N Broad Street,
Philadelphia, PA 19140
Conflict of interest statement
The authors of all contributions declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
|1.||Katz DE, Herring JA, Browne RH, et al.: Brace wear control of curve progression in adolescent idiopathic scoliosis. J Bone Joint Surg Am 2010; 92: 1343–52. MEDLINE|
|2.||Dolan LA, Weinsteil SL: Surgical rates after observation and bracing for adolescent idiopathic scoliosis: an evidence-based review. Spine 2007; 32: 91–100. MEDLINE|
|3.||Nachemson AL, Peterson LE: Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis: a prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J Bone Joint Surg Am 1995; 77: 815–22. MEDLINE|
|4.||Trobisch P, Suess O, Schwab F: Idiopathic scoliosis. Dtsch Arztebl Int 2010; 107(49): 875–84. VOLLTEXT|