How doctors decide to treat their patients’ scoliosis depends on many factors. There are both conservative and non-conservative treatments for scoliosis. Conservative treatment is treatment that does not involve surgery; this may involve bracing, physical therapy, etc. Non-conservative treatment is treatment involving surgery; surgical options include spinal fusion and anterior scoliosis corrective surgery.
Traditional Treatments
Below is an overview of the basic treatment options prescribed by most doctors according to the patient's Cobb angle. It is important to consult your doctor when choosing the best treatment path for you and your lifestyle.
10 - 25°: Observation
Observation is suggested for mild spinal curves and/or curves that are at low risk of worsening. The idea behind watching and waiting is to monitor a mild case of scoliosis to see if it gets worse. This method of treatment is often prescribed for young teenagers with a small curve who have not finished growing. Typically, x-rays are taken every six months or so. If the curve gets worse, then treatment (typically with a brace) is recommended. The advantage of watching and waiting is that many cases of scoliosis may not need treatment with a brace or surgery. Many experts believe that mild cases of scoliosis do not have a large impact upon a person’s health; however, even small curves may cause pain or limit one's ability to exercise effectively, and many patients with mild scoliosis turn to alternative treatments to reduce the curve's chances of worsening while it is still small.
25 - 45°: Bracing
If you are still growing, your doctor may recommend that you wear a brace to keep the curve in your spine from getting worse while you grow. Braces are typically prescribed for patients with Cobb angles of 25 to 45 degrees, but bracing may be appropriate for curves under 20 degrees in younger patients.There are many different types of scoliosis braces. The most common scoliosis brace used in the United States is the Boston brace. In Europe, the Chêneau brace is widely considered the standard scoliosis brace, and many new scoliosis braces are based around its design. Other types of braces include night-time braces (such as the Charleston brace or the Providence brace), and soft braces (also called dynamic braces) such as the SpineCorTM brace. Many experts believe if a brace is worn for at least 13 hours every day (and preferably as much as 16 or even 23 hours), bracing can prevent the Cobb angle from progressing to surgical levels. The purpose of bracing is not to correct the scoliosis, but to stop it from getting worse. Because wearing a brace can be restrictive and uncomfortable, some feel the emotional consequences outweigh the physical benefits. Children and their parents should consider the magnitude of the curve and risk of progression when choosing bracing as an option. At first, bracing may be stressful for the family because of the additional appointments and necessary lifestyle adaptations. Children and their parents should also consider the specific brace design and skill level of the orthotist before deciding to proceed with a brace.
over 45°: Surgery
Most scoliosis surgeons agree that children who have very severe curves (45-50° and higher) will need surgery to lessen the curve and prevent it from getting worse. The operation for scoliosis is a spinal fusion; the basic idea is to realign and fuse together the curved vertebrae so that they heal into a single, solid bone. The primary goal of surgery is to halt progression of the curve, for cases of scoliosis above 40 degrees have a high risk of continuing to progress in the absence of treatment, even after the spine is finished growing. Today, surgeons are able to not only prevent progression of the curve but also correct it significantly. Most patients recover from surgery with curves that have been straightened to less than 25°. Children and their parents should weigh the pros and cons of choosing surgery.
Risks of surgery to fix a spinal curve include:
Risks of surgery to fix a spinal curve include:
- Lost time at school for recovery
- Problems that can happen in any surgery, such as problems from anesthesia
- No more growth in the fused area of a child’s spine. This could mean that a child may be slightly less tall than he or she would be without fusion
- Problems that can happen with back surgery, such as nerve damage, lung problems, or spinal cord damage
- Spinal fusion surgery results in stiffness and reduced range of motion in the areas of their spine that are fused. Generally, this stiffness doesn’t interfere with everyday activities, but athletes who participate in a sport that requires significant flexibility in the spine (gymnasts, dancers, divers, etc.) should discuss this with their surgeon.
Alternative/Conservative Treatments
Corrective Bracing
The Wood Cheneau Rigo (WCR) brace is a thermoplastic brace designed to treat scoliosis conservatively while taking into consideration that scoliosis is a three-dimensional deformity. While traditional braces focus primarily on Cobb angle correction or prevention of angle progression, the WCR Brace focuses on Cobb angle correction and on rotational correction. The WCR Brace derotates the spine by alternating areas of pressure and areas of expansion. The pressure areas push the body into the areas of expansion, allowing for dynamic correction. With every breath, the spine derotates into these expansion areas, resulting in postural improvements and aesthetics. The WCR Brace also focuses on optimally aligning the trunk over the pelvis, further improving patients’ posture. Derotating the spine, aligning the trunk and pelvis, and achieving good Cobb-angle correction require careful analysis of each patient’s individual scoliosis and attention to detail.
Schroth Therapy
Schroth therapy is a form of conservative management of scoliosis named after Katharina Schroth (who suffered from scoliosis) involving curve specific exercises focusing on improving strength, flexibility and posture. This method of treatment focuses on strengthening and stretching exercises to de-rotate and elongate the back into a more normal posture. This technique also utilizes special breathing exercises to produce forces that assist with the reshaping of the trunk. It is recommended to perform 30 minutes of exercises 5-6 times a week. The Schroth method targets the muscles in the thoracic and lumbar region as well as the shoulder and pelvic muscles. Strengthening and stretching muscles in the trunk can assist with improving your posture and hopefully reshaping your back. This method is initiated once a scoliosis curve has been determined via X-ray and rotation is present and scoliosis curve angle is greater than 15 degrees. There have been cases in which Schroth therapy has resulted in improvements over over 10 degrees.
The information on this website is not intended as a substitute for medical professional help or advice but is to be used only as an aid in understanding scoliosis.