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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.
Conservative (non-surgical) treatments
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 isn’t even
considered to be scoliosis, but instead is spinal asymmetry. Most of the
time these cases won’t require any treatment, but at regular physician
check-ups 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.
Surgical treatments
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.
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