Indications for early surgery in cases of lumbar and dorsolumbar scoliosis: the role of vertebral rotation.

There are very few objective criteria for the choice between conservative and surgical treatment of lumbar and dorsolumbar scoliosis ranging from 40 to 50 degrees. We reviewed the long-term results obtained in 76 patients treated with plaster braces because they had refused surgical treatment; in 56% of the cases a nearly 10 degree gain was maintained after the onset of treatment; all of the cases which showed improvement presented a reduction in the curve by at least half and rotation by at least one-third in tests in suspension or in bending, and this was maintained in plaster. In cases where the long-term results were poor, however, rotation did not change. In conclusion, of the many parameters examined, only a combined assessment of the reducibility of both the Cobb angle and of rotation provides a valid indication for the treatment of lumbar and dorsolumbar curves ranging from 40 to 50 degrees.