A spinal deformity in which a sideways curvature of the spine is present usually starting after age 9.
Idiopathic scoliosis treatment requires a multidisciplinary approach of physical therapy and excellent orthotists for braces. Surgical management is always the last resort.
While the cause of scoliosis is unknown, it usually runs in families and typically affects girls and young women more often and severely than boys and young men. Mild cases that do not cause pain or discomfort require no treatment. However, cases that are moderate to severe and with or without pain or discomfort require treatment which is determined on a case by case basis.
Children with mild cases of scoliosis may not exhibit any symptoms. Moderate to severe scoliosis may cause parts of the torso and/or pelvic area to become uneven. For example, one shoulder may be higher than the other or the waist may be uneven.
The first step in checking for scoliosis is taking a family history to see if other family members have had scoliosis. Next, questions are asked to determine if the scoliosis causes pain, numbness, or tingling. Finally, the child is observed and physically examined. As a part of the exam, children may be made to perform the Adam’s forward bend test where they are asked to stand and bend forward while the doctor observes the evenness / unevenness of the shoulders, shoulder blades, and rib cage. An MRI and/or x-ray may be requested if a noticeable amount of unevenness is noted.
The severity of the scoliosis curve is measured in degrees and based on the angle of the curve in the spine shown on X-rays.
- 20 degrees or less is a mild curve
- 20-40 degrees is a moderate curve
- 40 degrees or more is a severe curve
There is also a genetic test that utilizes the saliva of a young patient to determine if a mild to moderate case of scoliosis will progress further. While the test has limited use and application it is sometimes performed to aid in determining a treatment plan.
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.
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.
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
A cosmetic procedure that involves the removal of a protruding rib and is at times combined with other procedures.