Treatment for scoliosis is based on the skeletal maturity of the patient, that is, how much more the patient is expected to grow, as well as on the degree of curvature. The younger the patient and the bigger the curve, the more likely the curve is to progress. For patients with idiopathic scoliosis, there are three options for treatment. These options are observation, bracing, and surgery. Many other forms of treatment have been tested, including electrical stimulation, physical therapy, and various manual manipulation techniques, but none have been proven to be effective.
There are several types of structural scoliosis. Adolescent Idiopathic Scoliosis accounts for about 8 in 10 cases of scoliosis. This type of scoliosis typically presents during adolescence, but it can also start earlier in childhood or infancy.
The degree of curvature is measured on x-rays by what is known as the Cobb method, and this is accurate to within 3 to 5 degrees.
In cases of curves that are less than 10 degrees, there is very little chance of the condition getting any worse. In fact, this is not even considered to be scoliosis, but instead spinal asymmetry. Most of the time these cases will not require any treatment, but at regular physician checkups throughout childhood, the physician should determine whether or not the curvature has progressed at all.
Curves that are 20 to 30 degrees in a growing child should be checked every 4 to 6 months to see if they are worsening. Any curves over 30 degrees in a growing child will require treatment, usually in the form of a back brace. Using a brace is intended to stop the growth of a curve, but will not correct the degree of curvature that already exists. The use of the brace is discontinued when the child stops growing.
Patients with curves of greater than 50 degrees sometimes continue to progress after the child’s growth has stopped. Therefore the objective of any treatment is to get the child into adulthood with less than a 50-degree curvature.
There are two types of commonly used braces. One is worn almost all day and night but can be taken off for swimming or playing sports. This brace applies three-point pressure and prevents the progression of the curvature. The other applies more pressure and bends the child against the curve. It is worn only at night while the child is sleeping.
Unfortunately, some curves continue to progress even with appropriate bracing. This may lead to the child needing more aggressive, surgical treatment. In some cases the physician will continue bracing the spine for a period of time, to allow the child to grow more before moving to the surgery option, which fuses the spine.
For patients with a 40 to 45-degree curve that is still progressing, or a curve of 50 degrees or more, surgery will likely be recommended. The objective is to fuse the spine in a more corrected position so that the curve will not continue to progress into adulthood. In addition to preventing further curvature, scoliosis surgery can also reduce the amount of deformity. Rods, cables, screws and hooks are used to move the spine back into the proper position, and when the spine fuses with the bone grafts it no longer moves out of place. Although the rods can be removed once the spine has fused, there is usually no reason to do so. Typically a correction of about 50% can be obtained with this method.
Patients should be regularly monitored for the first year or two. Once the bone is solidly fused there is no need for further treatment. In general, patients undergoing this surgery can return to a normal lifestyle and activity level.