Scoliosis treatments

Scoliosis is an abnormal curvature of the spine that affects 2-3 percent of Americans, mostly adolescents between the ages of 11 and 16, with only 0.1 percent of them requiring surgery.  The treatment for scoliosis depends on a number of issues, including your age, the extent of the curvature in your back, your health history and your history with various medications and treatments. 

If you are concerned about scoliosis in yourself or your child, it is important to seek medical advice. To diagnose the extent of your condition, your doctor will ask you questions about your medical history and perform a variety of physical exams. The following exams will help determine the extent of the condition:

• Physical exam—The first test the doctor will likely do is to have you or your child bend over so that the spine protrudes from the back. This test will show the shape of the spine. A healthy spine will be straight, but a person with scoliosis may have an abnormal bump, bend, or prominence. The doctor will also look for asymmetry in the waist and shoulder blades.
• X-ray (radiograph)—If the doctor does determine that there is a possibility of scoliosis or another spinal deformity, he or she may choose to do an X-ray to get a better visual of the spine. During the exam, radiation is sent through the back to capture an image. This image shows white areas for bone mass and black for everything else, which gives a clear visual of the bone structure. 
• Magnetic resonance imaging (MRI)—Sometimes the doctor will also choose to order an MRI.  MRIs are not often performed on the same day as your visit.  Unlike X-rays, MRIs do not use radiation. They use a magnetic field to visualize your spine.  A computer then creates an image based on information collected.  Unlike an X-ray, the MRI will show your disc, spinal cord, nerves and muscles.
• Bone density scan (DEXA)—This is a scan that is often used by physicians as part of general health screening for women that are postmenopausal.  This form of imaging of your spine allows your doctor to determine the strength of your bones. If the test reveals that your bones are weak, you may benefit from medications to strengthen them.

Research

Research on scoliosis treatment options includes advancements in brace technology to slow the progression of spinal curvature in children affected by this disease, as well as creating an easier method of surgical treatment. Brace technology has not always been an effective approach to stopping the progression of this disease; however, as brace technologies become more advanced, researchers have seen an improvement. One of the biggest issues regarding the effectiveness of brace treatment is patient adherence or compliance with treatment. If your doctor prescribes a brace for your child, it is imperative that it be used in the prescribed manner and for the length of time each day recommended. Otherwise, the brace treatment will not be effective.

Another research focus is determining what causes scoliosis. While studies show that there appears to be a genetic cause, it is still uncertain which gene or genes cause this abnormal curvature to appear. Studies have shown that the disease is passed down through family members, and further proof that genetics plays a role includes studies done on twins that showed the same extent of the disease. However, researchers are still struggling to determine which gene or genes cause this condition. Many hypothesize suggest that there could be multiple genetic factors that trigger it; once these are found, treatment options can be targeted at these specific genes.

Surgical advancements have also been made in how some minor cases of scoliosis are treated. For example, with minimally invasive spinal surgery, researchers have found a way to treat curvature without risking complications (such as muscle damage from creating an incision along the entire length of the spine). These less invasive options also provided for a quicker recovery, less postoperative pain, and a shorter stay in the hospital.

As research on causes and treatments is ongoing, it is a good idea to keep an open dialogue with your doctor as well.

Scoliosis can significantly affect the quality of life for children, even in its milder forms. Because the curvature of the spine can continue to worsen as a child grows, it's important to monitor and treat scoliosis as early as possible to prevent future complications, which can range from back pain to impaired heart and lung function.

For adults with adult degenerative scoliosis, a lateral (or forward) curvature of the spine that's caused by degeneration of the facet joints between the vertebrae of the spine, orthopedic specialists need to monitor how the curvature progresses and changes over time. Unlike for children, bracing is not generally utilized for adult treatment as it has not been shown to effectively treat adult scoliosis. In pediatric forms of scoliosis, the goal of bracing is to “guide” the spine as it grows. However, in a fully grown adult spine, bracing can lead to deconditioning and weakening of the surrounding spinal muscles, which may lead to more pain or an increase in scoliosis.

Management for adult degenerative scoliosis usually includes physical therapy, medications for pain, and injections. In cases with that lead to significant pain and dysfunction, surgery is necessary to correct the issue. Surgical advances continue to be made in this area as well, with increased availability of minimally invasive procedures for treatment.

Nonsurgical treatment

If the curvature of the spine is less than 40 degrees, many doctors will choose to treat scoliosis without surgery. For very mild cases, treatment can be simple observation to ensure that the bones are finished growing and will not continue to curve or lead to any complications. For children with slightly more curvature, or those whose bones are still growing and make them at risk for curving even more, a brace will be used to support the back and prevent the curvature from continuing.  

Surgery

In cases where the curvature of the spine exceeds 40 to 50 degrees, scoliosis requires surgery. The aim of scoliosis surgery is to repair the spine and prevent it from continuing to curve. Most people with severe scoliosis are treated using one of the following surgical techniques:

• Minimally invasive spine surgery—This type of surgery was first performed in the 1980s and has since undergone much advancement. Doctors use smaller incisions to insert metallic implants that support the correct curvature of the spine and prevent it from curving further. This is a preferred method for smaller curvatures because it does not require opening up the back along the spine, risking damage to muscles.
• Spinal fusion—This is the most common surgery for patients with moderate to severe cases of scoliosis. It works by joining two or more vertebrae together so they cannot move independently and continue growing abnormally. This typically is done using metal screws, rods, and bone grafts taken from the patient or a cadaver. Spinal fusion surgeries are typically done once a child’s bones have finished developing. 
• Adult degenerative scoliosis fixation—Adult degenerative scoliosis surgery, also known as fixation of adult degenerative scoliosis, is a procedure that can correct the curvature of scoliosis in adults by approximately 50 percent and, at the same time, stop the progression of the spinal curve(s) of scoliosis. It is a combination of two commonly used and time-tested procedures: a spinal instrumentation system and spinal fusion. Spinal instrumentation is the use of metal hooks and screws applied to two or three vertebrae of the spine to anchor long rods, which are used as a temporary splint to reduce and secure the spine while bone grafts are added to fuse with the existing bone.

The length of recovery following surgical treatment varies depending on the preoperative nature of the deformity, the extent of surgery performed, and the age of the patient. Patients may get back to full activities as soon as three months after surgery or as late as 12 months for more complicated adult surgeries. Often, patients benefit from a brief stay in an inpatient rehabilitation facility following the initial hospital stay.