Scoliosis is the medical term for curvature of the spine. Scoliosis occurs in approximately 2% of women and less than 1/2% of men. It usually starts in the early teens or pre-teens and may gradually progress as rapid growth occurs. Once rapid growth (puberty) is over then mild curves often do not change while severe curves nearly always progress. Curves are measured in degrees and persons with curves measuring under thirty degrees entering adulthood are considered having a mild curve while those over 60 degrees are considered severe. The treatment options depend on the severity and the age of the person. We can, of course, make up a long list of treatments; only a few have actually been shown to affect the outcome of scoliosis. Numerous studies have failed to show any
benefit from exercise,manipulation, meditation or drugs. While exercise is beneficial to maintaining good muscle tone and a healthier heart and lungs, there is no evidence that it affects, one way or the other, the curve progression. It may help in reducing discomfort.
The treatment options depend on the severity and the age of the person. We can, of course, make up a long list of treatments; only a few have actually been shown to affect the outcome of scoliosis.
Treatment Option 1: Wear a Brace
Bracing has been shown to be an effective method to prevent curves from getting worse. From a practical aspect though this treatment is reserved for children and adolescents in whom the prediction of a rapid increase in the curve needs to be thwarted. A brace worn 16 or more hours per day has been shown to be effective in preventing 90% or more of the curves from getting worse. Unfortunately, a brace worn 23 hours per day and worn properly does not guarantee that the curve will not continue to increase. Still, in curves that are mild i.e. between 20 and 35 degrees a brace may be quite effective.
We tend to use a brace for 23 hours per day. Using it part time seems to create problems of when to put it on, when to take it off, and for how long; whereas if it becomes part of the routine it becomes a standard function. Additionally, logic supported by data shows that the more the brace is on the better the chance of maintaining correction.
Note however, that a brace usually does not correct a curve. At best it will stop it from worsening.
Treatment Option 2: Surgery
For those persons who already have a significant curve with a significant deformity surgery can reduce the curve and significantly reduce the deformity. Usually surgery is reserved for teen and pre-teens who already have a curve around 40 degrees or more. In our practice we tend to be more aggressive than many in doing surgery around 40 degrees while there are many excellent surgeons who defer to 45 or 50 degrees.
There are three major types of curves each with their own method of correction.The usual scoliosis curve is athoracic curve ( i.e. at the level of the chest.) In these curves the procedure is a posterior spinal fusion. A fusion is a procedure
where the individual bones are made solid each to the one above and below. Typically 10 or more segments are included. In order to first get as much correction of the curve, multiple hooks or wires are attached to the back of the individual vertebra and then these are connected to one or two metal rods which have been pre-bent to the desired contour. The correction is done and then little bits of bone are flaked off the back of the vertebra so that when healing occurs the flakes of bone cross and become solid. The metal rod hopefully holds the correction until it is solid approximately in one year.