Scoliosis

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Scoliosis Treatment

The treatment is determined by the cause of the scoliosis, the size and location of the curve, and the stage of bone growth (how near the growth centers are to closure). Most cases of adolescent idiopathic scoliosis require no treatment (less than 20 degrees) but should be followed at regular intervals (often every 6 months).

As curves progress above 25 to 30 degrees in a child who is still growing, bracing is usually recommended to help slow the progression of the curve. Their are many different kinds of braces used which have names such as the Boston Brace, Wilmington Brace, Milwaukee Brace and Charleston Brace, named for the centers where they were developed. Each has a different appearance and there are different ways of using each type properly. The selection of a brace and the manner in which it is used is determined by many factors, including the specific characteristics of your curve, and will be decided on by you and your doctor.

A back brace does not reverse the curve; rather the spine is straightened by the brace from asymmetric pressure, and can be adjusted with growth. Bracing is not effective in congenital or neuromuscular scoliosis and is less effective in infantile an juvenile idiopathic scoliosis.

Curves of 40 degrees or greater usually require surgery because curves this large have a high risk of progressing even after bone growth stops.

Surgical correction involves correcting the curve (although not all the way) and fusing the bones in the curve together. The bones are held in place with one or two metal rods held down with hooks and screws until the bone heals together. Sometimes surgery is performed through an incision in the back and sometime through an incision on the abdomen or beneath the ribs. A brace may be required after surgery to stabilize the spine.

The limitations imposed by the treatments are often emotionally difficult and may threaten self-image, especially of teenagers. Emotional support is important for adjustment to the limitations of treatment.

Physical therapists and orthotists (orthopedic appliance specialists) can be helpful in explaining the treatments and ensuring a comfortable fit of the brace to increase the compliance with the treatment plan.