Scoliosis

  • Medical Author:
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

What is the treatment for scoliosis?

Treatment of scoliosis is based on the severity of the curve and the chances of the curve getting worse. Certain types of scoliosis have a greater chance of getting worse, so the type of scoliosis also helps to determine the proper treatment. There are three main categories of treatment: observation, bracing, and surgery. Consequently, there are treatments available that do not involve surgery, but in some individuals, surgery may be their best option.

Functional scoliosis is caused by an abnormality elsewhere in the body. This type of scoliosis is treated by treating that abnormality, such as a difference in leg length. A small wedge can be placed in the shoe to help even out the leg length and prevent the spine from curving. There is no direct treatment of the spine because the spine is normal in these people.

Neuromuscular scoliosis is caused by an abnormal development of the bones of the spine. These types of scoliosis have the greatest chance for getting worse. Observation and bracing do not normally work well for these people. The majority of these people will eventually need surgery to stop the curve from getting worse.

Treatment of idiopathic scoliosis usually is based on the age when it develops.

In many cases, infantile idiopathic scoliosis will improve without any treatment. X-rays can be obtained and measurements compared on future visits to determine if the curve is getting worse. Bracing is not normally effective in these people.

Juvenile idiopathic scoliosis has the highest risk for getting worse of all of the idiopathic types of scoliosis. Bracing can be tried early if the curve is not very severe. The goal is to prevent the curve from getting worse until the person stops growing. Since the curve starts early in these people, and they have a lot of time left to grow, there is a higher chance for needing more aggressive treatment or surgery.

Adolescent idiopathic scoliosis is the most common form of scoliosis. If the curve is small when first diagnosed, it can be observed and followed with routine X-rays and measurements. If the curve or Cobb angle stays below about 20-25 degrees (Cobb method or angle, is a measurement of the degree of curvature), no other treatment is needed. The patient may return to see the doctor every three to four months to check for any worsening of the curve. Additional X-rays may be repeated each year to obtain new measurements and check for progression of the curve. If the curve is between 25-40 degrees and the patient is still growing, a brace may be recommended. Bracing is not recommended for people who have finished growing. If the curve is greater than 40 degrees, then surgery may be recommended.

As explained above, scoliosis is not typically associated with back pain. However, in some patients with back pain, the symptoms can be lessened with physical therapy, massage, and exercises, including yoga (but refraining from twisting pressures on the spine). These activities can help to strengthen the muscles of the back. Medical treatment is mainly limited to pain relievers such as nonsteroidal anti-inflammatory medications (NSAIDs) and anti-inflammatory injections. These treatments are not, however, a cure for scoliosis and will not be able to correct the abnormal curve. Continue Reading

Reviewed on 4/27/2016
References
REFERENCES:

Fu, K.M., J.S. Smith, D.W. Polly, C.P. Ames, et al; Scoliosis Research Society Morbidity and Mortality Committee. "Morbidity and Mortality Associated With Spinal Surgery in Children: A Review of the Scoliosis Research Society Morbidity and Mortality Database." J Neurosurg Pediatr 7.1 Jan. 2011: 37-41.

Mehlman, Charles T. "Idiopathic Scoliosis." Medscape.com. Dec. 18, 2014. <http://emedicine.medscape.com/article/1265794-overview>.

Negrini, S., S. Minozzi, J. Bettany-Saltikov, F. Zaina F, et al. "Braces for Idiopathic Scoliosis in Adolescents." Spine (Phila Pa 1976) 35.13 June 1, 2010: 1285-1293.

Phan, P., N. Mezghani, C.E. Aubin, J.A. De Guise, and H. Labelle. "Computer Algorithms and Applications Used to Assist the Evaluation and Treatment of Adolescent Idiopathic Scoliosis: A Review of Published Articles 2000-2009." Eur Spine J. Jan 30, 2011.

IMAGES:

1. Getty Images

2. "Amanda-Scoliosis" by University of Utah Hospital - Radiology Department - X-Ray Image.

3. "Scoliosis patient in cheneau brace correcting from 56 to 27 deg" by Weiss HR - Weiss HR. Scoliosis 2007, 2:19. PMID: 18163917. doi:10.1186/1748-7161-2-19

4. Getty Images

5. Getty Images

6. "Surgical result after ventral fusion of scoliosis" by Weiss HR, Goodall D - Weiss HR, Goodall D. Scoliosis. 2008 Aug 5;3:9. PMID: 18681956. doi:10.1186/1748-7161-3-9

7. iStock

8. N/A
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