Various generations of hook, screw and rod systems have evolved which allows improved correction and less postoperative immobilization. More recently the advent of thoracoscopic approaches to the thoracic spine have allowed small incisions in the chest to either loosen the anterior spine for improved correction or stopping spinal growth. Placement of rods and screws through these small incisions may be an option for isolated thoracic curves, which may eliminate the long posterior incisions. Treatment of congenital and neuromuscular curves is less frequent and more complex and therefore will not be discussed extensively. Bracing appears to be far less useful in these children and surgical options may be discussed in the appropriate candidates.
Extension exercises, reassurance and observation treat postural kyphosis.
Unfortunately compliance in the adolescent who has no complaints of pain is limited. Scheuermann's kyphosis natural history appears to be modified somewhat by treatment. 4 Bracing kyphotic curves greater than 50 may allow some improvement of cosmesis and pain. The goal of treatment for patients with spondylolysis is reduction of symptoms and prevention of spondylolesthesis. Conservative measures include modification of activity, antiinflammatory medication, and bracing.