Scoliosis Treatment

Scoliosis Treatment

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 well understood. In essence:

  • A small degree of curvature in a patient nearing skeletal maturity is not likely to need treatment;
  • Conversely, a younger patient with a bigger curve is likely to have a curve will continue to advance and will need treatment.

There are three main scoliosis treatment options for adolescents:

  • Observation
  • Back braces
  • Scoliosis surgery

No exercises for scoliosis have proved to reduce or prevent curvature. However, exercise is highly recommended for both scoliosis and non-scoliosis patients alike to keep back muscles strong and flexible.

This page will discuss non-surgical options for scoliosis treatment.

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Observation

Once scoliosis is detected, observation by a physician is the next step. The physician will measure the curve on a regular schedule and base treatment decisions on the rate of curvature progression.

Measuring and Tracking Scoliosis Curves

The orthopedic surgeon may order an X-ray of the spine and use the "Cobb method" - an extremely accurate measuring technique - to calculate the curvature of the spine and its progression.

  • Curves that are less than 10 degrees are not considered to represent scoliosis but are considered to be spinal asymmetry. These types of curves are extremely unlikely to progress and generally do not need any treatment, but the child's physician should continue to monitor the curve during regular checkups.
  • Curves beyond 20 to 30 degrees in a growing child should be observed at 4 to 6 month intervals by an orthopedic surgeon with expertise in scoliosis.

In a patient that is still growing, treatment will be needed if the following factors are present:

  • The spinal curve progresses more than 5 degrees during a typical period of observation, or;
  • The spinal curve has already reached 30 degrees or more.

If the curve progresses less than 5 degrees during a specified period of observation, the physician may determine that the curve is not worsening rapidly enough to cause deformity, and treatment may not be necessary.

Back Braces for Scoliosis

Scoliosis treatment for patients with progressing curves, or curves over 25 degrees in a skeletally immature patient (e.g. girls who are about 11 to 13 years old, and boys who are about 12 to 14 years) is usually centered on use of a back brace.

Bracing typically is not used for adolescents who are already skeletally mature or almost mature. 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 unlikely do much good.

Bracing does not straighten the curve that is already present. Instead, the goal of a back brace is to stop the progression of the spinal curve as the child continues to grow. The child will continue to wear the brace until he or she reaches skeletal maturity. Once the individual stops growing, there is little likelihood of progression of a curve.

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

Fitting and Wearing a Back Brace

Working under the direction of an orthopedic surgeon, an orthotist will fit a custom brace to the individual. The braces usually are made of molded plastic and fit tightly around the body and are worn under the clothes every day. Some are worn overnight; some are worn 23 hours a day.

Although braces for scoliosis are more comfortable than ever before, they still have a low compliance rate for various reasons: children and adolescents feel different from their peers when they have to wear them, and some genuinely cause discomfort and perhaps difficulty breathing.

Support for children wearing back braces is key to their effectiveness. Studies clearly show that the more closely patients follow their prescribed bracing regimen, the less the scoliosis curve progresses.

Two Main Types of Back Braces

There are two types of commonly used scoliosis braces:

  • The TLSO (thoracolumbar sacral orthosis), which includes a popular model called the Boston Brace, 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.

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.

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Article written by: Peter F. Ullrich, Jr., MD