Treatment for scoliosis is based on the skeletal maturity (expectations of growth and degree of curvature) of the patient. The younger the patient and bigger the curve, the more likely the curve is to progress. For patients with idiopathic scoliosis, the main treatment options are observation, bracing and surgery. Other forms of treatment include electrical stimulation, physical therapy and various manual manipulation techniques, but none are as effective.
The degree of curvature is measured on X-rays by what is known as the Cobb method, which is accurate within 3 to 5 degrees.
In cases of curves less than 10 degrees, there is very little chance of the condition getting any worse. In fact this condition is known as spinal asymmetry rather than scoliosis. Most of the time these cases will not require any treatment. However, the physician should check the spine regularly throughout the patient’s childhood to determine whether or not the curvature has progressed.
Curves of 20 to 30 degrees in a growing child should be monitored every four to six months to check for 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 brace is no longer effective when the child stops growing.
Curves greater than 50 degrees will sometimes continue to progress after the child has stopped growing. Therefore, the objective of any treatment is to get the child into adulthood with less than 50 degrees of curvature.
There are two types of common braces. One is for most of the 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, which should be worn while sleeping, applies more pressure and bends the child against the curve.
Unfortunately, some curves continue to progress even with appropriate bracing. This may lead to needing more aggressive, surgical treatment. In some cases the physician will continue bracing the spine for a period of time, allowing the child to grow more before performing surgery to fuse the spine.
For patients with a curve of 40 to 45 degrees that is still progressing, or a curve of 50 degrees or more, surgery is recommended. The objective is to fuse the spine into a more corrected position so 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. 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. A correction of about 50% can usually be obtained with this method.
Patients should be monitored regularly for the first year or two after surgery. Once the bone is solidly together, there is no need for further treatment. In general, patients can return to their normal lifestyle and activity level.