Scoliosis Approach


 

IDIOPATHIC SCOLIOSIS

Idiopathic scoliosis treatment requires a multidisciplinary approach of physical therapy and excellent orthotists for braces.  Surgical management is always the last resort.


NON-SURGICAL TREATMENTS

External Bracing

Bracing has been used for generations to prevent mild to moderate cases of scoliosis from progressing. A brace is only effective in young patients with significant growth remaining. The amount of growth remaining can be determined by x-rays of the hands or the top of the pelvis. Once bracing begins, the brace often needs to be worn until growth is completed which is usually around age 14 in females and 16 in males.


  • The most common brace utilized in my practice is a Wood Chenau brace associated with the SCHROTH Method.
  • At times I utilize other effective braces such as the Providence Brace which incorporates straps, are less bulky, and/or can be worn at night.
  • The Milwaukee Brace which comes over the neck or under the chin was widely used in the past but is now almost never used.




Exercise/ Physical Therapy

It is vitally important for individuals who have scoliosis and / or wear a brace to keep their core strong. While no one method of exercise or manipulation has been proven to help prevent all progression of scoliosis, I do recommend the SCHROTH method which is taught by specialty trained physical therapists.  There is growing proof of its effectiveness in treating mild to moderate scoliosis. We have four trained Schroth therapists at Paley Institute. Physical therapy regimens such as the Schroth method have been found to be effective in maintaining core strength and increasing comfort. It may take up to 20 visits for the child or adolescent to be proficient in performing the exercises at home.


SURGICAL TREATMENTS

Spinal Fusion

This is the most common type of surgery for scoliosis. Rods and screws are attached to the vertebrae to fuse the bones together helping to straighten the spine. This procedure is only utilized for severe curves where all other treatment methods have failed. There is often no need for bracing after this surgery and patients may return to their activities in as little as one to two months.  Movement and physical therapy are important after scoliosis surgery.


Fusionless Surgery

Devices such as Vertical Expandable Prosthetic Titanium Rib (VEPTR) and growing rods such as the implantable magnetic rods (MAGEC) are used to straighten the spine without fusing vertebrae. This surgery is less commonly performed and is usually utilized for very young patients with progressive scoliosis who have a great deal of growth remaining. There is currently a great deal of interest and research into these techniques as they would allow for the avoidance of fusion.



Vertebral Body Tethering

A treatment of surgery performed anteriorly (through the chest or side) without fusion is utilized in patients with moderate curves who have growth remaining.  It is performed by placing screws in the vertebral body and a flexible band connecting them to avoid the need for fusion.l


Thoracoplasty

A cosmetic procedure that involves the removal of a protruding rib and is at times combined with other procedures.


HEMIVERTEBRA

Mild non-progressive curves caused by hemivertebra are typically treated non-surgically and just observed. However, bracing has proven ineffective in managing hemivertebra.


Surgical treatment of a hemivertebra involves removal of the deformed vertebra and can be performed on children ranging in age from infants to adolescents. Under general anesthesia, an incision is made on the back, the hemivertebra is removed, and the vertebrae above and below are fused together. The child may have to wear a brace after surgery until the spine heals.


SPONDYLOLISTHESIS

Conservative treatment options for spondylolisthesis include:

  • Rest
  • Activity restrictions such as avoiding lifting or bending
  • Physiotherapy for range of motion and core strengthening
  • Anti-inflammatory medications
  • Epidural injections
  • Bracing

Severe spondylolisthesis can be treated with a decompressive laminectomy. This is a surgical procedure where the section of the vertebra (typically the lamina) and tissue that are placing pressure on the nerves are removed. However, this makes the spine unstable so a spinal fusion would also be performed to hold the adjacent vertebrae in place and proper alignment.


KYPHOSIS

Kyphosis has several treatment options ranging from conservative non-surgical methods to surgical correction of the spine.

Conservative treatment is most often the first choice and includes medications, exercises, casting, and bracing for the spine. Physical therapy exercises and rehabilitation programs can help to increase strength and mobility leading to some relief of pain. In cases where the kyphosis is a result of osteoporosis, the primary goal is to slow the progression of osteoporosis through the intake of vitamin D, calcium supplements, hormone replacement therapy, and/or regular exercises.


Surgery is only considered in cases that are severe or unresponsive to other treatment methods where potential benefits outweigh the risks. The goal of surgery is to straighten the spine by fusing the vertebrae to form a solid bone reducing the deformity.

Location
David S. Feldman, MD
901 45th Street, Kimmel Building
West Palm Beach, FL 33407
Phone: 561-762-3005
Office Hours

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561-762-3005