Scoliosis
What Is Scoliosis?
Scoliosis is an abnormal side-to-side curvature of the spine that forms either in a “C” shape or an “S” shape. While a healthy spine has natural front-to-back curves, scoliosis involves lateral curvature that can range from mild to severe. The degree of curvature is measured in degrees using an X-ray, and curves greater than 10 degrees are considered scoliosis.
The condition most commonly develops during childhood or adolescence, though it can also occur in adults. The most common type is idiopathic scoliosis, meaning it has no known cause. This accounts for about 80% of all cases. Idiopathic scoliosis is classified by the age at which it develops: infantile scoliosis occurs in children younger than 3 years of age, juvenile scoliosis affects children ages 4 to 10, and adolescent scoliosis develops in ages 11 to 18.
In other cases, the cause of scoliosis may be known. Congenital scoliosis is present at birth and results from a baby's ribs or spine bones not forming properly during fetal development. Neuromuscular scoliosis is caused by nervous system problems that affect muscle function, such as cerebral palsy, muscular dystrophy, spina bifida, and polio. These conditions can weaken the muscles that support the spine, leading to curvature.
Most cases of scoliosis cause no symptoms and may go unnoticed until a routine examination. When symptoms do occur, they can include backaches or lower back pain, spine fatigue after long periods of sitting or standing, uneven hips or shoulders, and a visible spine curvature more to one side than the other. In severe cases, scoliosis can affect posture, cause breathing difficulties due to spine distortion, or impact overall quality of life. It's important to note that curvature of the spine may also occur with spondylolisthesis, in which one vertebra shifts out of position relative to the vertebrae below it.
Nonsurgical Treatments
Most people with idiopathic scoliosis do not require active treatment, particularly when the curve is mild and not progressing. The approach to managing scoliosis depends on several factors, including the severity of the curve, the age of the patient, whether the spine is still growing, and whether the curve is progressing. Our doctors work closely with patients and families to monitor the condition and determine the most appropriate treatment strategy.
Lifestyle Modifications & Monitoring
For mild cases of scoliosis, especially those that are not progressing, regular monitoring is the primary approach. Doctors generally recommend a spinal examination twice a year to track any changes in the curvature. These checkups typically include physical examination and X-rays to measure the degree of curvature and assess whether it is worsening.
While lifestyle modifications cannot correct scoliosis, maintaining an active lifestyle with regular exercise can help strengthen the muscles that support the spine and improve overall posture. Activities such as swimming, yoga, and core strengthening exercises can be beneficial. However, there is no evidence that specific exercises can prevent curve progression or reduce existing curves in most cases.
Maintaining a healthy weight is also important, as excess weight can put additional stress on the spine. For patients experiencing back pain related to scoliosis, proper posture, ergonomic adjustments to work and study environments, and awareness of body positioning during daily activities can help manage discomfort.
Medications & Managing Discomfort
While medications cannot correct spinal curvature, they can help manage pain and discomfort associated with scoliosis. Over-the-counter pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help reduce back pain and inflammation. For patients experiencing more significant pain, doctors may prescribe stronger pain medications or muscle relaxants. It's important to consult with your healthcare provider about appropriate strategies and to discuss any medications before use, as they may interact with other conditions or medications.
Physical & Occupational Therapy
Physical therapy plays an important supportive role in managing scoliosis, particularly for patients experiencing pain or functional limitations. Specially trained therapists can develop exercise programs that focus on core strengthening, flexibility, posture improvement, and managing pain. While physical therapy cannot reverse or significantly reduce established curves, it can help improve quality of life, manage symptoms, and support overall spinal health. For patients using back braces, physical therapists can help with proper fitting and adjustment, teach exercises that can be performed while wearing the brace, and provide strategies to minimize physical and psychological discomfort. Therapists also educate patients on proper body mechanics and ergonomics to reduce strain on the spine during daily activities.
Supportive & Assistive Devices (Back Braces)
For children and adolescents with progressive curves, back braces may be prescribed to prevent further curving of the spine while they grow. Bracing is most effective for children older than age 10 whose bones are still growing and who have curves between 25 and 40 degrees. The goal of bracing is not to correct the existing curve but to prevent it from worsening until the skeleton matures.
Back braces vary in design, and the best kind to use depends on the size and location of the curve. Common types include thoracolumbosacral orthosis (TLSO) braces, which are the most frequently prescribed, and Milwaukee braces for curves higher in the spine. For children and teens, many back braces are adjustable to accommodate changes in body growth. The duration and frequency of brace wear varies depending on the severity of the curve and the doctor's recommendations, but patients are often required to wear the brace 16 to 23 hours per day.
It's important to note that braces do not work for treating congenital or neuromuscular scoliosis, as these types involve structural or neurological issues that cannot be addressed through external support alone. Additionally, wearing a back brace can be challenging emotionally, particularly for children and teens who may feel self-conscious about their appearance. Emotional support from family, friends, and healthcare providers is crucial. Physical therapy and psychological counseling may be beneficial to help patients adjust to wearing a brace and maintain compliance with the treatment plan.
Surgical Treatments
Surgery for scoliosis is generally considered when the spinal curve is severe (typically greater than 45 to 50 degrees), rapidly worsening, or causing significant symptoms such as pain, breathing difficulties, or neurological problems. The decision to proceed with surgery depends on many factors, including the degree of curvature, the rate of progression, the patient's age, the presence of symptoms, and the impact on quality of life. The primary goal of scoliosis surgery is to reduce the spinal curve, prevent further progression, and stabilize the spine.
Spinal Fusion
Spinal fusion is the most common surgical procedure for treating scoliosis. During this operation, an orthopedic surgeon permanently joins two or more vertebrae together to straighten and stabilize the curved portion of the spine. The surgeon inserts metal rods, hooks, screws, and wires to hold the spine in the corrected position while the bone heals together. Bone graft material, which can come from the patient's own body, a donor, or synthetic sources, is placed between the vertebrae to promote fusion. Over time, typically three to twelve months, the vertebrae grow together into a single solid bone structure. To access the spine, the surgeon may make an incision through the back (posterior approach), the front of the body through the belly area or chest (anterior approach), or occasionally from the side beneath the ribs. Following surgery, patients may need to wear a temporary brace to support the spine during the healing process.
Minimally Invasive & Advanced Techniques
Advances in surgical techniques have led to the development of minimally invasive approaches for some scoliosis cases. These techniques use smaller incisions and specialized instruments to achieve similar results to traditional open surgery while reducing tissue damage, blood loss, and recovery time. However, minimally invasive techniques are not suitable for all patients and are typically reserved for less complex cases. Your surgeon will discuss whether you are a candidate for these advanced approaches based on the specific characteristics of your scoliosis.
Growing Rod Surgery (For Young Children)
For very young children with severe progressive scoliosis who still have significant growth remaining, growing rod surgery may be an option. This procedure involves attaching adjustable rods to the spine that can be lengthened periodically as the child grows, typically every six months. This allows the spine to be supported and gradually straightened while still permitting normal growth. Once the child reaches skeletal maturity, the growing rods are typically removed and a final spinal fusion may be performed. This approach helps manage severe curves in young children while minimizing the risk of stunted growth or respiratory complications that can occur with early definitive fusion.