Treatment of Scoliosis

Scoliosis is an abnormal curvature of the spine. This is an abnormal curvature of the spine, as opposed to an exaggerated excessive curvature of the normal spinal curves. The abnormal curvature of the spine may be observed in front to back X-rays in which the bilateral elements of the body, such as lungs and hips, can be seen separately rather than in overlap. Contrary to popular belief, scoliosis in most cases is not a serious condition and usually does not cause problems such as back pain. Scoliosis may become a problem if the lateral curvature becomes severe and gets worse over time. Let's talk about some of the available treatments for scoliosis.

There are three main treatment options for those with adolescent scoliosis why require medical intervention:
  • Observation
  • Back Braces
  • Surgery
Observation: Scoliosis may first be noticed by the patient, parent, school nurse/gym teacher, or a qualified specialist. Once the condition has been recognized, a physician will typically take the next step in determining how bad the problem is. The severity of the patient's abnormal curvature will then be tracked and monitored through examinations, measurements, and X-Rays.

Measuring and Tracking: To calculate the curvature of the spine and its progression, two specific types of tests may be performed: X-Rays and the "Cobb method." An ideal lateral curvature of the spine would be zero degrees. Curves less than 10 degrees are monitored but are not considered to be a concern among physicians. Curvatures in excess of 20-30 degrees are of a concern to physicians, especially in juveniles who are still growing. When these curves are present in growing individuals, then orthopedic surgeons will closely monitor the progression every four to six months.

Upon follow-up examination and measurements, orthopedists will pursue treatment options for patients if one or more of the following factors are present:
  • The spinal curve has progressed more than 5 degrees from one measuring period to the next, or;
  • The overall spinal curvature has progressed beyond and angle of 30 degrees.
If neither of these two factors is present, then the patient may continue with their lives without requiring any treatment interventions, especially if they don't experience any pain or limitations related to their conditions.

Back Braces: for patients that require early intervention, back bracing is usually the safest and most promising option. Back bracing is usually considered to be an appropriate therapy to those patients with a greater than 25 degree curvature, who are still determined to be skeletally immature (still growing). Back bracing is not considered to be an effective treatment option for those that are fully grown.

Back bracing is not expected to reverse the curve that has developed, or to straighten the spine. Rather, the goal of this treatment is to slow or stop the progression of the condition. Once the child/adolescent has begun to use the back brace, he or she will continue to use it until they reach skeletal maturity.

Fitting and Wearing a Back Brace: There are no off the rack products that are available in stores or online, when it comes to these systems. Back braces are usually fitted to a person's custom profile and shape, by an orthopedic surgeon. The braces are composed of a molded plastic, and they are designed to fit tightly around the body. These braces can be worn under the clothes so that they aren't very noticeable. Some bracing units are designed to be worn during waking hours, and others must be worn during sleep and 23 hours a day. Today, back bracing technology has progressed to make them more comfortable and less obtrusive. Still, compliance to these braces remains an issue due to the continuing discomfort and the age of its users (2-18). Obstacles to treatment compliance include the comfort of the devices as well as the embarrassment of the children being perceived as different from their peers. In some cases, the devices cause breathing difficulty among their users. For the children that are in compliance with bracing treatment, these devices are effective in slowing or stopping the progression of the scoliotic curve. There are two main types of back braces:
  • A Charleston bending back brace applied more pressure and bends the child or adolescent against the curve. This brace is only worn at night when the child/adolescent is sleeping.
  • The TLSO (thoracolumbar sacral orthosis): is can be custom molded to apply three-point pressure to stop the curve progression. One popular model listed under this type is called the Boston Brace.
Though one of these two types can be successful at stopping the curve progression, they may not be successful in all cases, due to a number of factors. In these cases, the braces may still be worn to try to minimize the curve progression until the child has grown to the stage where a spinal fusion is recommended.