Scoliosis Treatment

Decision for scoliosis treatment decisions are primarily based on two factors:

1. The skeletal maturity of the patient (or rather, how much more growth can be expected)

2. The degree of spinal curvature.

Although the cause of idiopathic scoliosis is unknown, the way scoliosis curves behave is fairly well understood. Basically, the younger the patient and the bigger the curve, the more likely the curve is to progress.

There are essentially three scoliosis treatment options for adolescents:

• Observation

• Back braces

• Scoliosis surgery
  

Observation

The scoliosis curvature is measured on x-rays by what is known as the Cobb method, and this form of measurement is accurate to within 3 to 5 degrees.

Curves that are less than 10 degrees are not considered to even represent scoliosis but rather just spinal asymmetry. These types of curves are extremely unlikely to progress and generally do not need any treatment. If the child is very young and physically immature, then the progress of the curve can be followed during the child's regular check up with his or her pediatrician. If the curve is noticed to progress beyond 20 degrees, then the child should be referred to an orthopedic surgeon with expertise in scoliosis for continued treatment.

Curves that are between 20 to 30 degrees in a growing child can be observed at 4 to 6 month intervals. Any progression that is less than 5 degrees is not considered significant. If the curve progresses more than 5 degrees, then the curve will need treatment. Any curve over 30 degrees in a skeletally immature patient (child who is still growing) will need treatment.

Scoliosis treatment for patients with progressing curves, or curves over 30 degrees in a skeletally immature patient, is usually centered on use of a back brace.

Back Braces

Bracing is designed to stop the progression of the spinal curve, but it does not reduce the amount of angulation already present. The majority of curve progression happens during a child's growth phase, and once the growth has ended, there is little likelihood of progression of a curve. Therefore, bracing is continued until the child is skeletally mature and finished growing.

Curves that tend to continue to progress after skeletal maturity are those that are greater than 50 degrees in angulation, so the treatment objective is to try to get the child into adulthood with less than a 50 degree curvature.

There are two types of commonly used scoliosis braces: a thoracolumbar sacral orthosis (TLSO) and a Charleston bending brace.

• The TLSO is a custom molded back brace that applies three-point pressure to the curvature to prevent its progression. It can be worn under loose fitting clothing, and is usually worn 23 hours a day. This type of scoliosis brace can be taken off to swim or to play sports.

• A Charleston bending back brace applies more pressure and bends the child against the curve. This type of scoliosis brace is worn only at night while the child is asleep.

Since bracing only works to stop the progression of the curvature in a growing child, it is not used for those children who are already skeletally mature or almost mature. It is only used for younger children (e.g. girls who are about 11 to 13 years old, and boys who are about 12 to 14 years). If an older child has a curve greater than 30 degrees and is almost mature, his or her curvature will be treated with observation only, as there is little growth left and bracing will be unlikely to do much good.

Unfortunately, even with appropriate bracing, some scoliosis spinal curves will continue to progress. For these cases, especially if the child is very young, bracing may still be continued to allow the child to grow before fusing the spine.

• Article written By:
• Peter F. Ullrich, Jr., MD

October 7, 2007

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