Scoliosis treatment: Types of braces, Surgery
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 many 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 a 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 do not need to be removed. There are many different ways for a surgeon to perform 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 vary 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 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 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 three-dimensional 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,
- physical therapy,
- 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 the 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.