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| Home > Spinal Disorders > Spine Deformities > Scoliosis - Disorder Treatment |
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SCOLIOSIS
Disorder Treatment
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Non-surgical Treatment
Whenever possible, nonsurgical treatments are chosen first. If the patient's curve is minor (less than 15-20 degrees), the doctor will likely choose to monitor the curve for progression. The patient will normally have X-rays taken every four to six months during rapid growth years, and then once a year.
- Physical Therapy
Adolescents and adults with scoliosis may work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving mobility and strength, and helping with daily activities. Adolescents with idiopathic scoliosis should be encouraged to continue their normal activities, including sports.
Exercise has not proven helpful for changing the curves of scoliosis. However, it can be helpful by addressing pain, posture, and spinal stabilization. Therapy sessions may be scheduled each week for four to six weeks.
The goals of physical therapy are to learn ways to manage the symptoms of scoliosis, improve spine posture and
maximize spinal stabilization.
- Bracing
Bracing is usually considered with curves between 25 and 40 degrees-particularly if the patient is still growing and the curve is likely to get bigger. It is important that the patient wear the brace daily for the number of hours prescribed by the doctor. Scoliosis often affects more than one area of the spine. A brace can be used to support all the curved areas that need to be protected from progression.
Sometimes an adolescent might feel self-conscious about wearing a brace. Though the brace can help the curve from getting worse, it may take some time for the patient (and caregiver) to get used to it. Adults tend to be less concerned about what their peers think, but adolescence is a time when appearance is often of great importance. Listen to the child's concerns and look for ways to help overcome feelings about appearance.
A spinal brace may provide some pain relief. In adults, it will not cause the spine to straighten. Once you have reached skeletal maturity, bracing is used for pain relief rather than prevention. If there is a difference in the length of your legs (or if the scoliosis causes you to walk somewhat crooked), special shoe inserts, called orthotics, or a simple shoe lift may reduce your back pain.
Surgical Treatment
Surgery is generally only considered in patients who have continual pain, difficulty breathing, significant disfigurement, or a steadily worsening curve angle. After skeletal maturity occurs, curves that are less than 30 degrees tend not to progress and, therefore, do not require surgery. Curves above 100 degrees are rare, but they can be life threatening if the spine twists the body to the point it puts pressure on the heart and lungs.
If a curve is 45 degrees or more, surgery is more likely to be considered. The main surgery for scoliosis is spinal fusion with instrumentation. Nearly all surgeries will use some type of rods in order to help straighten the spine.
The surgeon may use a posterior approach, which involves going into the spine through the back, or an anterior approach, which is performed from the front or side. The operation can be performed from both the front and the back (a combined approach). The choice depends upon the flexibility of the spine, the location and degree of the curve, and whether there is pressure on any of the nerve roots. The age of the patient is a factor in deciding which type of surgery is used. Patients whose spines are immature are more likely to require combined anterior and posterior fusion.
An explanation of the surgical options for scoliosis are listed below. For a detailed explanation of the individual treatments (fusion, instrumentation), please visit the Surgical Treatments section of the web site.
- Anterior Fusion with Instrumentation
An incision is made in the chest or flank, and the intervertebral discs are removed in the area of the curve to make it flexible. Screws can be placed in the vertebrae, and then connected by a metal rod. A bone graft is put in place of the discs that were removed so that the vertebra sitting next to each other will fuse together. The screws attaching the metal rod are tightened down, straightening the curve.
- Posterior Fusion with Instrumentation
This approach is done through the back. Anchors are attached to the spine in the form of hooks, screws, or wires. These anchors are attached to spinal rods that straighten the spine. Bone grafting is done to fuse all instrumented vertebrae.
- Combined Anterior/Posterior Fusion with Instrumentation
This surgery is actually two operations-one through the front, and the other through the back. The two operations may be staged on separate days or as part of one longer surgery. Staged procedures require one to two additional days in the hospital compared to a single surgical procedure.
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Excerpts of this article (text/graphics) were provided by
"AllAboutBackandNeckPain.com" DePuy Spine ©2003.
All rights reserved.
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