Your doctor will recommend treatment based on the severity and location of the curve, skeletal maturity, and potential for progression. Thoracic curves, for example, are more likely to become worse than those in the lumbar or thoracolumbar areas. Doctors consider a number of factors to predict how much growth is remaining, including if and when a girl has begun to menstruate as well as the appearance of certain bones on an X-ray. The smaller the angle and the more fully grown the patient, the less likely a curve is to progress.
In general, observation is recommended for people with spinal curvatures of lesser magnitude and skeletally mature patients with moderate curvatures. These smaller curves usually don't get worse, but doctors often advise periodic X-rays and exams to monitor any progression. Larger curves may be treated with bracing or surgery. These options are discussed in this section.
Orthopedic braces are used to treat patients with moderate curves if substantial growth is remaining or if the curve is progressing. Bracing won't correct a curve but, in some cases, can prevent it from getting worse. There are many types of braces. Some braces are worn up to 23 hours a day until the patient is fully grown. Their effectiveness largely depends on the patient's compliance.
The forerunner of all modern braces, the Milwaukee Brace, is made up of a pelvic circle, a throat mold, and various bars, straps, and pressure pads. It is seldom prescribed anymore since it is not hidden under clothes, and patient acceptance of wearing such a bulky, visible brace in this era is low. More common in recent years, however, are the less bulky TLSO (thoracic lumbar sacral orthosis) or "low profile" plastic braces, which fit from the armpit to the hips. These include the Boston Brace and the Charleston Brace, worn only while the patient is sleeping. While bracing can negatively affect a child's self-esteem, studies show that many children adjust and can participate in normal athletic activities.
Surgery is generally recommended for patients with significant curves and/or curves with documented progression in spite of bracing.
Spinal fusion, which involves fusing together two or more bones in the spine, is the most common surgery for scoliosis. It can be performed from the anterior (front) of the spine, the posterior (back), or in severe cases, both. The surgeon may also use an implant—metal rods fixed to the spine with screws, hooks, or wires—to help maintain the position of the spine after surgery. Most patients with fused spines and implants have good outcomes and can lead normal lives. Although their activities are limited in the immediate postoperative period, most can resume an active lifestyle.
A few nonfusion surgical techniques are being developed for special cases, such as growth-plate stapling and rib-cage expanders. However, fusion remains the main treatment for patients who require surgery. The primary goals of surgery are to prevent further progression of the curves and to maintain proper spinal balance.
Last reviewed on 01/03/2008
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