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General management of structural scoliosis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Structural scoliosis may progress rapidly, so repeated radiographic assessments of curves must be undertaken at frequent follow-up.

If curves are progressing in severity and cause secondary problems such as respiratory compromise, intervention is required.

Control of curve accentuation in children is achieved with a Milwaukee distraction brace. This device incorporates moulded supports for the chin, occiput and pelvis which are interconnected by vertical metal struts. The brace may be used in the child until the age of ten when spinal fusion then becomes appropriate. Before this, there is a concerted effort to correct primary deformity with a hinged plaster spica - a Risser jacket - or the surgical insertion of metal rods on the concave side of vertebrae.

The treatment of established adult deformity is difficult. Occasionally, anterior and posterior fusion with excision of discs or bone wedges, is performed.

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