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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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