When someone decides to undergo scoliosis treatment, it is important they understand all of their options, and the typical results of each treatment. There is no “one-size-fits-all” approach to treating scoliosis. Just like each person is unique, each case of scoliosis is unique, and deserves to be treated as such.
Treating scoliosis becomes more difficult as it progresses. Even if the Cobb angle does not increase over time, the body adapts to maintain the scoliosis, and grows more resistant to change. The muscles, tendons, and spinal discs gradually conform to the altered position of the spine, and the brain grows accustomed to patterns that reinforce the curvature.
Your examinations and re-examinations should include assessments that are important to you. If your lung function is important, always insist upon pre- and post- spirometry testing. If the symmetry of your body is important, make sure your doctor takes postural assessments at each visit, and expresses the results in a manner that allows you to measure the difference between exams. If your chosen treatment method cannot obtain the results you are looking for, try a different approach.
Some scoliosis experts believe if a person with scoliosis is not currently experiencing any pain or problems, then treatment is unnecessary. This short-sighted approach does not take into account the long-term effects of living with alterations in spinal biomechanics. If the alignment in a vehicle is off, driving that vehicle for many miles will eventually result in excessive wear and tear on the tires, shock absorbers, and other components.
If the patient’s expectations for the outcome of care are different from the doctor’s, the patient could be dissatisfied even though the doctor regards the treatment as successful. Focus on what you want to receive from your treatment and be sure to communicate your priorities to your doctor.
People decide to receive scoliosis treatment for many reasons. The most common reason is they don’t like the changes it causes in their posture and appearance. Some people seek help because it causes pain or limitations in physical function. Others, with no health or posture problems, may want to receive treatment simply to reduce or prevent problems from developing down the road.
All information is updated and accurate and from Utah Scoliosis Center
The idea behind watching and waiting (or observation) is to monitor a mild case of scoliosis to see if it gets worse. Watching and waiting is 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. But is this really true? Some scientists have found that, actually, mild cases of scoliosis can limit the body’s ability to exercise effectively. Sometimes, too, even a small scoliosis can cause pain or other problems. Even if the scoliosis isn’t getting worse, wouldn’t it be nice to have an option that could help your loved one achieve their full athletic potential, or take away some of the pain or sleeplessness they may be experiencing as a result of their scoliosis?
Some parents who have been told to watch and wait might prefer to take a more proactive approach, to reduce the chances of the curve getting worse while it is still small. If you’re like one of these parents, or if your loved one is experiencing pain or limitations, this is where the Utah Scoliosis Center can help. We believe that every person living with scoliosis – even if it is just a small curve – should have the right to choose whether or not they would like to receive care.
In most cases for young people with small curves, our treatment does not require as large of a commitment as it does with more severe cases. Some people with small curves have achieved the results they wanted after only a few weeks of care. Also, our doctors can teach your loved one some important exercises for their spine that may be helpful in the future.
...and is typically prescribed if the Cobb angle is 20 degrees or greater. 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. An excellent research article was published in 2014 detailing the most popular scoliosis braces from around the world.
Wearing a Traditional 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.
Traditional Bracing Concerns-
There are a few concerns with scoliosis bracing shared by many doctors and scientists.
#1 - Braces aren’t worn as often as prescribed
Some teenagers do not enjoy wearing a brace. It can be awkward and uncomfortable, and sometimes getting a teenager to wear a brace for the necessary amount of time can be difficult. Some feel the emotional consequences outweigh the physical benefits.
#2 - Braces only prevent scoliosis from worsening
The purpose of bracing is not to correct the scoliosis, but to stop it from getting worse. Wearing a brace does not always improve the appearance of the body after it’s removed. There is also no guarantee problems related to the scoliosis – such as headaches, pain, or sleeplessness – will improve by wearing a brace.
#3 - Traditional Braces can negatively affect daily life
Wearing a brace can make it difficult to breathe, and this in turn can make it harder to exercise. In some cases, bracing can cause pain or discomfort as well.
...when the Cobb angle reaches 40 degrees in adolescents or 45 degrees in adults. The primary goal of surgery is to halt progression of the curve. 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.
There are many different types of scoliosis surgeries, but they generally fall into one of two categories: posterior approach or anterior approach. It is also possible to do a combination of the two approaches.
Posterior surgeries are the most common type of scoliosis surgery and are performed with the patient lying face-down. If the patient’s scoliosis involves the upper (thoracic) spine, this is the procedure that most surgeons will recommend.
Anterior surgeries typically involve an incision that follows the bottom ribs and ends in a north-south direction above the navel, allowing surgeons to access the lower spine very easily.
In 1984, French surgeons Dr. Ives Cotrel and Dr. Jean Dubousset developed the C-D instrumentation. It typically involves double rods, with hooks or screws that are attached to the top and bottom, and then tightened to straighten the spine.
The newest scoliosis surgeries typically involve the fusion of the spinal bones, along with a combination of rods, hooks, and/or screws to hold the fusion in place. These are generally referred to as third-generation constructs. They include systems such as Isola, Universal Spine System (USS), and Texas Scottish Rite Hospital (TSRH) instrumentation. Scoliosis surgeries today use either hook-rod hybrids or total pedicle screws. There is some controversy as to which method is superior.
There are also new surgeries being developed that involve the use of “growing” rods to help small children with scoliosis whose spines are still growing. Without the use of these growing rods, children with scoliosis who had the surgery when they were young would require additional operations as their spine continued to grow. Additional innovations include endoscopic and video-assisted operations, as well as fusionless procedures such as vertebral body spinal stapling and vertical expandable prosthetic titanium ribs (VEPTR).
There are many reasons why people with scoliosis decide to have surgery. Some patients want to improve the appearance of their body (particularly the protrusion of the ribs in the back). Others are concerned about preventing long-term disability and eliminating pain.
It is important to have a detailed consultation with an orthopedic surgeon to ensure you can achieve the results you want. The definition of a successful surgery can sometimes be different for the doctor and the patient. Surgery is generally considered successful by the doctor when it reduces and stabilizes the Cobb angle. However, it has been increasingly recognized among scoliosis experts that surgically reducing the Cobb angle does not always mean an improvement in physical appearance, a reduction in pain levels, or an improvement in quality of life.
Surgery for scoliosis is not a medical emergency, in the same way, for example, surgery for a ruptured appendix might be. You shouldn’t feel pressured into choosing surgery for you or your loved one. While surgery may help some people with scoliosis, not every person experiences the same results. If surgery doesn’t achieve the desired results, options for further treatment are limited.
The Utah Scoliosis Center recognizes that not every parent feels comfortable choosing spinal surgery as a treatment for their child, and that not every person with scoliosis wants to have surgery. We are happy to provide an alternative. If, for any reason, we are not successful in achieving the results you expected, surgery is always available as a choice down the road.
Every case of scoliosis is unique, making treatment outcomes impossible to predict. You should always consult with a qualified scoliosis specialist before beginning any type of treatment for your scoliosis.
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