Treatment
Most children who have an abnormal spine curve have it to a relatively
small degree, and treatment involves observation to make sure the curve
doesn't progress. Doctors usually recommend observation for people with
curves of less than 20 degrees. People whose skeletons are still growing
need checkups at 3- to 6-month intervals to see if there have been
changes in the curvature of their spine.
If the curve progresses to a more serious degree, treatment may involve
using an orthopedic brace and, in some cases, surgery.
Braces
Doctors recommend the use of braces for growing children with adolescent
idiopathic scoliosis who have curves of 25 to 40 degrees. Bracing
doesn't cure the scoliosis, or even improve the curve. Bracing is used
to prevent further progression of a curve.
Bracing is an option only during years of active growth. Treatment with
bracing ends if the curve progresses into the surgical range (40 to 50
degrees) or if it's successful and the child has reached skeletal
maturity. The person wearing a brace usually may participate in all
normal activities without restrictions. Long-term problems are unusual.
Braces are of two main types:
-
Milwaukee
brace.
This is a full-torso brace with a neck ring that has rests for the
chin and for the back of the head. The brace has a flat bar in the
front and two flat bars in the back. A Milwaukee brace may be used
to stabilize a curve anywhere in the spine.
-
Thoracolumbosacral orthosis (TLSO).
This closer-fitting brace is less visible under the clothes. A TLSO
fits under the arms and around the rib cage, lower back and hips.
This type of brace is used primarily to stop the progression of
curves that occur below the midpoint of the spine.
Surgery
Doctors typically recommend surgical treatment for people whose curves
are greater than 40 to 50 degrees. Scoliosis surgery is generally
successful in improving posture and the function of the back. Surgical
procedures include the following:
-
Posterior
spinal fusion and instrumentation.
The most common surgical procedure for scoliosis is posterior spinal
fusion and instrumentation. The fusion involves placing pieces of
bone taken from the pelvis between two or more vertebrae.
Eventually, the vertebrae and the pieces of bone grow together. The
instrumentation is the insertion of metal rods, hooks, screws and
wires to hold the curve from moving for the 3 to 12 months that it
takes for the fusion to become solid. Instrumentation also applies
forces to the spine to correct the deformity and may make the curve
smaller by as much as 50 percent.
-
Anterior spinal
fusion.
Occasionally, surgery involves the front of the spine. A surgeon
performs this procedure, called anterior spinal fusion, through the
chest cavity.
Some techniques involve performing surgery through several half-inch
incisions. Scoliosis surgery is one of the longest and most complicated
orthopedic surgical procedures performed on children. The operation
takes several hours. Hospitalization can last several days, and
activities are restricted for several months.
Other approaches
Some
people have tried electrical stimulation of muscles, chiropractic
manipulation and exercise as ways to treat scoliosis. There's no
evidence that any of these methods prevent spinal curvature from
progressing. Although exercise alone can't stop scoliosis, exercise
directed or prescribed by physical medicine professionals may have the
benefit of improving overall health and well-being.
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