Depending on the severity and location of pain, degenerative scoliosis is treated with one or more non-surgical options, or with surgery.
Most patients with degenerative scoliosis do not need surgery. The goals of non-surgical treatment are to:
- Reduce pain, rather than to correct the spinal curvature. The curvature itself typically is not the cause of pain, nor is it likely to progress enough to cause a deformity.
- Increase strength, flexibility and range of motion, all of which help support the spine and reduce future pain.
Medications to treat degenerative scoliosis are almost identical to medications used to treat patients experiencing pain from osteoarthritis of the spine, since they are caused by the same condition: the deterioration of the facet joints and resulting inflammation.
- Pain relievers. NSAIDs, such as ibuprofen or medications that treat inflammation from arthritis (e.g. Celebrex) can help reduce pain. Acetaminophen (e.g. Tylenol) is also an excellent pain reliever.
- Epidural injections or facet injections. Injections, in which an anti-inflammatory medication and/or numbing agent are injected directly into the affected area, can decrease acute inflammation in the back.
Therapy and Chiropractic Manipulation
As with most back pain, increasing strength and mobility both relieve pain and prevent future pain. Treatments that strengthen the back and keep it flexible include:
- Physical therapy. An appropriate physical therapy program can provide a strengthening and stretching routine that will keep the soft tissues and joints limber as well as begin to strengthen muscles.
- Pool therapy (water therapy). Gravity being counteracted by the body’s buoyancy helps patients exercise with less discomfort, so individuals can condition muscles without experiencing stress on the facet joints.
- Chiropractic or osteopathic manipulation. Adjustments and manipulation by a qualified chiropractic professional or osteopathic physician can keep the facet joints mobile and help reduce pain.
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Other Nonsurgical Treatments
In addition to medication and the above therapies, other treatments can help reduce stress on the facet joints to relieve pain. These approaches include:
- Weight loss. Losing weight helps decrease the pressure across the facet joints.
- Bracing. Rarely, a corset brace may be recommended to help eliminate motion in the back, which helps decrease stress across the facet joints. This purpose of bracing is not the same as bracing for patients with idiopathic (adolescent) scoliosis, who may be required to wear a brace 18+ hours a day to stop the progression of curvature. Since the possibility of a curve worsening is remote in patients with degenerative scoliosis, the goal of a brace is to restrict motion to relieve pain enough to participate in daily activity and, ideally, to partake in physical conditioning.
All of these treatments can be used alone or in combination to decrease back pain. Since there is no cure for joint degeneration and arthritis in the spine, the emphasis of treatment should not be on becoming pain free, but on managing the pain and allowing the patient to stay functional and maintain daily activities.
If the patient’s pain continues to prevent him or her from getting through daily activities, a variety of surgical options may be considered. The recovery time from surgery is significant, ranging from 3 to 12 months, so the patient’s symptoms should be severe enough to necessitate such a decision.