Treatment & Coping
Is treatment recommended in most scoliosis cases?
In 90 percent of cases, scoliotic curves are mild and do not require active treatment. In the growing adolescent, it is very important that curves be monitored for change by periodic examination and standing x-rays as needed. Increases in spinal deformity require evaluation by an orthopaedic surgeon to determine if active treatment is required.
What factors determine treatment for scoliosis?
- Patient age
- Bone age (the maturation of bone is not always the same as the chronological age)
- Degree of curvature
- Location of curve in the spine
- Status of menses/puberty
- Patient gender
- Curve worsening
- Associated symptoms such as back pain or shortness of breath
What are treatment options for spinal deformities?
The treatment options for scoliosis fall into three main categories:
Observation of scoliosis
Observation is for curves that have a small degree measurement when patients are growing (adolescent scoliosis), or for moderate size curves (< 40-45 degrees) when patients are done growing. For adults, observation and physical therapy are for those patients who have mild symptoms and have curves that are not large.
Nonoperative treatment, such as bracing, is for curves between 25 and 45 degrees in growing children to prevent further progression of the curve while growth of the spine remains. The goal of bracing is to prevent further progression since the brace cannot correct curves.
Surgical treatment is reserved for curves which are generally greater than 50 degrees for adolescent patients and adults. Surgery can be performed for smaller curves if the appearance of the curvature is bothersome to the patient or if symptoms are associated with the scoliosis in the adult patient. The goals of surgical treatment are to obtain curve correction and to prevent curve progression by fusing the spine at the optimum degree of safe correction of the deformity. This is generally achieved by placing metal implants onto the spine that are then attached to rods, which correct the spine curvature and hold it in the corrected position until fusion, or knitting of the spine elements together.
How is treatment determined for adolescents?
In planning a child's treatment, a doctor will take into account how severe the child's curve is and where it occurs in the spine. The child's age is also an important factor — if the child's spine is still growing, it will affect treatment choices. The doctor will determine how likely it is that the curve will get worse, and then suggest treatment options to meet the child's specific needs. Most scoliosis surgeons agree that children who have very severe curves (50 degrees and higher) will need surgery to lessen the curve and prevent it from getting worse.
What does successful brace treatment require?
- Early detection while the patient is still growing
- Mild to moderate curvature
- Regular examination by the orthopaedic surgeon
- A well-fitted brace that is replaced if the child outgrows it
- A cooperative patient and supportive family
- Maintenance of normal activities, including exercise, dance training, and athletics, with elective time out of the brace for these activities as supervised by the physician.
If my doctor recommends bracing:
What kind of a brace will I need and why?
There are many types of braces, all designed to prevent curves from increasing as the adolescent grows. Your doctor will work with an orthotist (a professional who makes assistive devices like braces) to recommend the best type of brace for you. The kind of brace you need depends upon several factors, such as:
- Where your curve is located on your spine
- The flexibility of your curve
- The number of curves you have
- The position and rotation of some of the vertebrae in your spine
- Any other medical conditions you may have
What does a brace look like?
There are two major kinds of braces: plastic (rigid) braces and soft (dynamic) elastic braces.
- A rigid brace is like a shell that covers the front and back of your upper bodygenerally from under the armpits down to the pelvis. The brace usually fastens with three Velcro straps, and can easily be removed to take showers or do other activities.
- Some plastic braces appear straight (symmetrical), while others curve in and out (asymmetrical).
- The soft braces use elastic straps, Velcro, and various smaller plastic or metal pieces to put the brace into the shape that is best for your type of curve, and help keep it in place as you move around.
- Whether you need a plastic or soft brace, your orthotist will custom-make your brace to comfortably fit your body.
Does bracing work?
Several research studies show that bracing for scoliosis can keep your spinal curve from growing large enough to require surgery. Your curve will most likely get smaller as it is being held in the brace. When your spine is fully grown and you stop wearing the brace, your scoliosis curve will eventually go back to its original size. In some cases, the curve stays smaller after bracing treatment. There are some cases, however, where the curve continues to grow even though a brace is worn. So bracing can work, but doctors need more research to show when and how bracing can be even more effective.
How long will I need to wear the brace? Can I wear it at night only?
You need to wear a brace until your spine stops growing. This timing varies quite a bit from person to person. Your doctor will check your brace and the status of your growth every 4 to 6 months. The amount of time each day that you have to wear the brace depends upon several things, including your growth and the type of brace you wear. The most common daytime braces are worn 16 to 23 hours each day. Some braces are worn only while you sleep, but they do not work for all curve types. Your doctor will advise you about which brace and wearing time is best for you. What will it be like to wear a brace? It may take some practice to get used to putting on your brace, but soon you will become an expert at it. Clothes in loose-fitting styles will easily cover your brace. As long as your doctor approves, you will be able to remove your brace to play sports or do other recreational activities.
What happens if I don’t wear a brace?
If your doctor recommends a brace and you choose not to wear it, then you run the risk of your curve getting larger. Depending on how big your curve gets, you may need surgery to correct it. Or you may choose to do nothing about the curve and run the risk of it continuing to increase. This may cause various medical and quality of life issues later in your life.
What factors influence the recommendation for surgery?
- Area of the spine involved
- Severity of the scoliosis
- Presence of increased or decreased kyphosis
- Pain (rare in adolescents, more common in adults)
- Growth remaining
- Personal factors
What questions should I ask my doctor and/or surgeon regarding costs, risks and complications if surgery is recommended?
- What are the risks of surgery?
- What testing is needed before surgery?
- How much does spinal fusion surgery cost?
- How many spinal surgeries has my surgeon performed and has he or she had good results?
- If surgery is for my child, should my child see a neurosurgeon?
- How long will surgery last?
- Will I be in a lot of pain? What can help me cope with pain?
- Should I or someone else donate blood? Will I need a transfusion?
- How long will I be in the hospital? [If an adolescent] Can my parents stay with me in the hospital?
- What kind of physical limitations will I have?
- Do I need to wear a brace after surgery?
- Will I need physical therapy?
- How soon after surgery can I shower or wash my hair?
- When can I go back to school or work?
- When can I be active again (i.e., play sports)?
- Will surgery limit my flexibility (e.g., bending over, ability to walk, range of motion?)
- Should I have allograft bone used for my fusion or my own bone harvested?
- If I have a spinal fusion, will I need antibiotics before dental work?
- Will the metal detectors go off in airport security after I have rods placed in my spine?
- Will I need more than one surgery?
- Who can I speak with or what can I read to better prepare for surgery?
Does smoking interfere with bone healing?
Yes. Smoking has been found to delay healing of tissues, including bones. If bone healing does not occur, a scoliosis operation may not end up being successful over the long term. Ask your doctor about methods to try to quit smoking well in advance of any scheduled operations.
Can a metal implant (spinal instrumentation) rust or be rejected?
No, the metal implant does not rust, and is not subject to rejection by the body.
What happens if no treatment is done? Will the curve get worse?
Two factors can strongly predict whether a scoliosis curve will get worse: young age and a larger curve at the time of diagnosis. Children younger than 10 years with curves greater than about 35 degrees tend to get worse without treatment. Once someone is done growing, it is very rare for a curve to progress rapidly. We know from studies that once someone is fully grown, scoliosis less than 30 degrees tends not to get worse, while those curves greater than 50 degrees can get worse over time, by about 1 to 1 1/2 degrees per year.
What are other effective ways to cope with scoliosis?
Many patients and their parents ask about the effectiveness of treatment options other than bracing and surgery.
Will physical therapy help my scoliosis?
It has not been proven that physical therapy can help people with scoliosis. Different physical therapy methods have been designed to offset the effects of scoliosis, and improve the shape and look of your body. There is some scientific evidence to show that physical therapy may help you to look straighter and improve your breathing. However, there is little evidence to show that physical therapy is more effective than doing nothing in stopping the curve from getting worse during growth. If you have spinal problems in addition to your scoliosis (such as back pain), your doctor may prescribe physical therapy to address your specific needs.
Will chiropractic treatment help my scoliosis?
Chiropractic is a controversial method of treatment that seems most effective in treating acute, short-term pain. Chronic conditions do not seem effectively managed by long-term chiropractic care. Patients who have scoliosis and choose chiropractic treatment should be referred to a spinal orthopaedist or neurosurgeon if their curves keep increasing. Insurance may or may not cover chiropractic treatment.
Will acupuncture help treat and manage my back problems?
Acupuncture uses fine needles that are intended to stimulate points in the body and supposedly create an energy flow to treat many illnesses. There is no scientific evidence that proves this theory or that its use helps in treating back problems or back pain. Insurance usually does not cover such treatment.
Will yoga help treat and manage my back problems?
Most yoga systems are intended to improve muscles through stretching, holding positions, and breathing exercises. Some yoga systems also include meditation. How much it will help with back problems is not proven, but those with back pain may be helped. Insurance may or may not cover treatment.
How can massage help my back problems?
Massage may help those with back pain. Your spinal orthopaedist or neurosurgeon may refer you to one. There are many techniques of massage. Be sure to find out if your massage therapist is licensed by the state in which you live, and where he or she has been trained. Insurance generally does not pay for massage treatments.
Will Pilates make my scoliosis or back problems better?
Pilates are vigorous exercises that focus on strengthening abdominal and back muscles. There also is emphasis on posture and breathing. Exercises should gradually increase in level of difficulty, and should not increase back pain. Pilates are not intended for those with severe back pain. Patients should ask about the training of any instructor.