What is the treatment for scoliosis? (Continued)
There are several different types of braces available for scoliosis. Some need to be worn nearly 24 hours a day and are removed only for showering. Others can be worn only at night. The ability of a brace to work depends on the person following the instructions from the doctor and wearing the brace as directed. Braces are not designed to correct the curve. They are used to help slow or stop the curve from getting worse with good back brace management treatment. Intermittent or chronic discomfort may be a side effect of any treatments used to slow or correct the spinal curvature.
If the curve stays below 40 degrees until the person is finished growing, it is not likely to get worse later in life. However, if the curve is greater than 40 degrees, it is likely to continue to get worse by 1-2 degrees each year for the rest of the person's life, a long-term effect of the disease. If this is not prevented, the person could eventually be at risk for heart or lung problems. The goals of surgery for scoliosis are as follows: correcting and stabilizing the curve, reducing pain, and restoring a more normal curve and appearance to the spinal column.
Surgery involves correcting the curve back to as close to normal as possible and performing a spinal fusion to hold it in place. This is done with a combination of screws, hooks, and rods that are attached to the bones of the spine to hold them in place. The surgeon places bone graft around the bones to be fused (spinal fusion) to get them to grow together and become solid. This prevents any further curvature in that portion of the spine. In most cases, the screws and rods will remain in the spine and not need to be removed. There are many different ways for a surgeon to perform the fusion surgery. It may be all performed from a single incision on the back of the spine or combined with another incision along your front or side. This decision is based on the location and severity of the curve.
Surgery recovery and scar formation varies some from person to person. A doctor will use medications to control the patient's pain initially after surgery. A patient will likely be up out of bed to a chair the first day after surgery and will work with a physical therapist who will assist him or her in walking after the surgery. As the patient continues to recover, it is important to improve muscle strength. The physical therapist can help the patient with exercises for the muscles that will also help with the pain. Typically, a young person will miss about six weeks of school and may take about six months to return to their normal activities, although recovery time varies between individuals.
As with any surgery, there are risks of surgery for scoliosis. The amount of risk depends partially on the patient's age, the degree of curve, the cause of the curve, and the amount of correction attempted. In most cases, the surgeon will use a technique called neuromonitoring during surgery. This allows the surgeon to monitor the function of the spinal cord and nerves during surgery. If they are being placed at increased risk of damage, the surgeon is alerted and can adjust the procedure to reduce those risks. There is a small risk of infection with any surgery. This risk is decreased with the use of antibiotics, but it can still occur in some cases. Other potential risks include injury to nerves or blood vessels, bleeding, continued curve progression after surgery, broken rods or screws, and the need for further surgery. Each of these is rare.
If a tumor such as osteoid osteoma is the cause of the scoliosis, surgery to remove the tumor is generally able to correct the curve.
People with degenerative scoliosis will often have more complaints of back pain and leg pain. This is related to the arthritis in the back and possible compression of the nerve roots that lead to the legs. Nonoperative treatment including physical therapy, exercises, and gentle chiropractic can help relieve these symptoms in some cases. People who fail to improve with these treatments may benefit from surgery. X-rays and possible MRIs will be obtained to plan for surgery. The surgery could include only a decompression or removal of bone spurs that are compressing the nerves. In some cases, a fusion will be necessary to stabilize the spine and possibly correct the abnormal curve. The cost of scoliosis surgery can be high; according to the Spinal Cord Society of surgeons, an average cost per operation (rod implants to straighten the spine) is $150,000 and may be higher or lower depending on the individual procedure.
Are there home remedies for scoliosis?
There are many home remedies that have been described for scoliosis; some involve herbal treatments, diet therapy, massage, physical therapy, stretches, certain exercises, and nutritional supplements like L-selenomethionine. A mattress that is composed of latex, memory foam, or cool gel (latex mattress infused with gel retains less heat than latex alone, also termed gel memory foam) and is adjustable (height of head and foot of bed can be adjusted) is recommended by some clinicians and patients. Patients are advised to discuss these treatments, especially exercises, with their doctor before starting any home remedies. Medical treatments are mainly over-the-counter pain medications when needed. Home remedies and medical treatments may reduce discomfort but do not provide a cure for scoliosis.
What is the prognosis for scoliosis?
School screening programs have helped to identify many cases of scoliosis early. This allows people to be treated with either observation or bracing and avoid the need for surgery in many cases. Most people with scoliosis can live full, productive, and normal lives with a relatively normal life expectancy. People with scoliosis are able to become pregnant and have children with no increased risk for complications. They may be at increased risk for additional low back pain during pregnancy. In general, as the degree of spine curvature increases, the prognosis worsens.
Newer advances in surgery have allowed for less invasive surgical methods that have less pain and shorter recovery periods. Surgery recovery time depends on the specific procedure that is performed; some may require an extended hospital stay with an in-patient stay at a rehabilitation facility (several weeks) while others may recover quickly and not require a rehabilitation facility. These techniques are still being developed, but the initial results are very promising.
Occasionally, untreated scoliosis can lead to deformity of the spine that is severe, painful, and result in the individual being unable to work or walk normally. Scoliosis may very rarely compromise breathing and cause death. Complications of pain and infections may rarely occur with treatments but may occur with surgery. Occasionally, patients are too optimistic about their treatments so patients are advised to discuss their expectations and follow up with their doctor to better understand the long-term prognosis and effects of their treatment.
The life expectancy has been reported to be reduced possibly by about 14 years in some individuals, especially those with more severe Cobb angle that is untreated but not all specialists agree with this controversial conclusion. Other clinicians either choose to avoid the controversy and say nothing while others suggest most people will have a near normal life span. Each individual with scoliosis should ask their treating physician about their life expectancy and potential for quality of life in the future with or without various treatment options.
Is there a cure for scoliosis? Is it possible to prevent scoliosis?
At this time, there is no cure for scoliosis. There are good treatment options as discussed above. Researchers are trying to find the causes of the different types of idiopathic scoliosis. This will hopefully lead to better treatments or a cure. Because the cause of idiopathic scoliosis is not known, there is no known way to prevent the problem. However, doctors speculate that doing certain exercises (Pilates, yoga, for example, with moves that torque or twist the spine) may make scoliosis worse. Gymnastics activities (like doing back bends), carrying weight on one side of the body (like a backpack on one shoulder), and using a trampoline are examples of ways to potentially make scoliosis worse.
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Where can people get more information on scoliosis?
National Scoliosis Foundation
5 Cabot Place
Stoughton, MA 02072
This nonprofit voluntary organization provides pamphlets, a newsletter, and other informational material on childhood and adult scoliosis. The foundation also provides support-group information and lists of doctors in each state who specialize in scoliosis.
The Scoliosis Association, Inc.
PO Box 811705
Boca Raton, FL 33481-1705
This association publishes a quarterly newsletter and pamphlets. The association also provides information about local chapters and support groups.
The Scoliosis Research Society
6300 North River Road, Suite 727
Rosemont, IL 60018-4226
The society is a professional organization for orthopedic surgeons interested in scoliosis. It provides pamphlets about the diagnosis and treatment of scoliosis. Price information for ordering pamphlets is available from the society. The society also can provide referrals to physicians.
American Physical Therapy Association
1111 North Fairfax St.
Alexandria, VA 22314
To obtain a copy of the American Physical Therapy Association's brochure about scoliosis, you may send a self-addressed, stamped envelope to their address above.
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Reviewed on 11/30/2016
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2."Amanda-Scoliosis" by University of Utah Hospital - Radiology Department - X-Ray Image.
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6."Surgical result after ventral fusion of scoliosis" by Weiss HR, Goodall D - Weiss HR, Goodall D. Scoliosis. 2008 Aug 5;3:9. PMID: 1868195 doi:10.1186/1748-7161-3-9