Scoliosis Treatment

How is scoliosis treated?

Scoliosis treatment is planned according to the type of curvature, the patient’s age, and some additional factors.

Scoliosis is a spinal condition in which the spine curves sideways in an “S” shape to the right or left. This is different from the condition known as kyphosis, in which the spine curves forward. The main symptom in all forms of scoliosis is that the spine curves sideways.

Children and adolescents should consult a pediatric orthopedic surgeon who specializes in spinal disorders. Adults should consult an orthopedic spine surgeon or physical therapist.

Whether or not treatments are surgical depends on the person’s type of scoliosis and the age at which it develops. In mild cases, especially affecting children and adolescents, the pediatric orthopedic surgeon may simply monitor the spinal curve over time to determine if treatment is needed. In other cases, early bracing and/or rehabilitation may eliminate the need for surgery.

What are the types of scoliosis treatment?

Treatment for adolescent scoliosis is determined by the degree of spinal curvature at diagnosis and the progression of this curvature. Mild cases may not require any treatment. More severe cases can be treated nonsurgically, using braces or with spinal fusion surgery.

Use of Corset in Scoliosis Treatment

For curves measuring less than 25 degrees, the orthopedist may recommend monitoring to determine if additional intervention is necessary.

Teens with curves between 25 and 45 degrees may be candidates for bracing. Bracing has been shown to stop progression in up to 75% of patients, although it does not correct the curve. In most cases, patients wear the brace for 18 hours a day and only remove it for hygiene and athletic activities. However, some patients may only need to wear the brace at night.

The type of brace you choose depends on how many curves are present and where the curve or curves are located in the spine. Some models provide bracing in the pelvis, front, back and neck, while others provide bracing across the torso and underarms.

While many braces are rigid, flexible braces have been developed in recent years. Suitable for patients with only one curve, these types of braces are worn as vests and allow the patient to participate in some athletic activities. Patients continue to wear the brace until they stop growing and reach skeletal maturity. This allows the supporting muscles in the patient’s back and torso to become stronger after a period of inactivity. In some cases, physical therapy is recommended in addition to the use of a brace.

Schroth Method

This scoliosis treatment was created by Katharina Schroth, who developed her own breathing technique and exercises to manage a scoliosis that could not be successfully treated with a brace.

The Schroth method is a non-surgical physical therapy and exercise treatment for scoliosis that can be used on scoliosis patients of all ages. The aim is to lengthen the trunk and correct imbalances in the spine by developing the inner muscles of the rib cage. In this treatment, a specially trained physical therapist teaches the patient specific exercises and corrective breathing techniques to straighten the spine and not rotate it. It is based on exercises adapted to the curvature of the spine of each patient.

Schroth exercises focus on the following:

  • Restoring muscle symmetry and alignment of posture
  • Breathing into the concave side of the body
  • Developing posture awareness in the patient

What are Schroth exercises?

When you look at our bodies in scoliosis, it looks like a sideways curve in the shape of a C or S. But what you can’t see with the naked eye is how the vertebrae in the spine rotate to create a curve. The spaces between the vertebrae can also compress and stretch in some areas. That’s why physical therapy for scoliosis requires a 3-dimensional approach to address the curve from every angle.

Spinal rotation in scoliosis is different for each person. Schroth exercises are tailored to the unique curvature of your spine. The exercises can be done standing, sitting, or lying down. Braces such as therapy balls, poles, and Schroth rods can also be used to help correct scoliosis.

Schroth exercises, while varying from person to person, include three important components:

Muscle Symmetry: Changes in the curvature of your spine also affect the muscles in your back. The muscles on one side of your back may become weak and wasted. On the other side, the muscles may be overworked and prominent. Schroth exercises address both issues by aiming to achieve muscle symmetry.

Rotational Angular Breathing Breathing is an important part of the Schroth method. The goal is to rotate the spine with the breath to help reshape the rib cage and surrounding soft tissue.

Being Aware of Your Posture: Being aware of the position of your spine is the first step to correcting it. Mirrors are one of the best aids in this regard. Postural awareness is especially important when it comes to activities of daily living. If you have scoliosis, you need to be aware of positions that may make it worse.

Most patients see a noticeable improvement in the degree of their spinal curvature after completing the Schroth program. The length of the program can vary, but it usually takes between 5 and 20 sessions. The length and frequency depend largely on the patient’s tolerance and the degree of scoliosis.

In addition to correcting the curve, a Schroth program provides:

  • Improved posture and overall mobility
  • Easier breathing
  • Less pain

What is the surgical treatment of scoliosis?

Patients whose curves continue to progress beyond 50 degrees, with or without a brace, usually require surgical intervention.

Surgical methods are used to treat scoliosis. However, the most common type of surgery is posterior spinal instrumentation. During this procedure, bone grafts (from the patient’s own body, a donor, or synthetic materials) are placed between the vertebrae. Over time, the bone graft helps the bones fuse into a solid piece. Instrumentation such as rods, screws, plates, or cages are then placed to hold the vertebrae in place while fusion occurs. This instrumentation provides immediate stability and alignment to the spine after surgery.

The type of instrumentation varies depending on the individual case, but usually includes metal implants made of titanium or stainless steel. These implants help maintain proper spinal alignment during healing and may reduce the need to wear a brace after surgery. In lumbar surgeries, additional options such as interbody devices or cages may be used to enhance fusion.

What is the recovery time for scoliosis surgery?

Most spinal fusion patients stay in the hospital for 3 to 5 days and, working with a physical therapist, are up and about the day after surgery. Children and teens can usually return to school in 4 to 6 weeks and to full activity in 3 months. A full recovery can take 6 to 12 months.

Patients who have combined anterior and posterior spine procedures may have slightly longer hospital stays. However, recovery times from modern scoliosis spine surgeries are significantly shorter than they were decades ago, when people would sometimes spend weeks or months in a cast in the hospital.

What are the risks of scoliosis surgery?

Rare complications of spinal fusion for scoliosis include infection and spinal cord abnormalities or injury. Antibiotics are used to treat infection and continuous monitoring of spinal cord sensory and motor function is necessary.

Fusion surgery generally produces very good results with a correction rate of 60% to 100%, depending on the flexibility and location of the curve. However, spinal fusion does cause some loss of range of motion. The degree of this loss varies depending on the section of the spine being corrected and the number of vertebrae fused.

Can scoliosis heal without treatment?

Scoliosis cannot correct itself, but not all patients will need treatment. Only about 5% of children or adolescents with scoliosis will need to wear a brace or have surgery.

In some cases, the progression of the curve can be monitored over time. However, if your pediatrician or family doctor suspects your child has scoliosis, it is important to have them evaluated by an appropriate specialist as soon as possible. Early intervention, such as bracing, can prevent the need for surgery later in life.

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