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Treatment Options for Scoliosis

Scoliosis treatment can range from conservative therapies to surgery.

Treatment Options for Scoliosis

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Conservative Treatment

Whenever possible, nonsurgical treatments are chosen first for scoliosis. Spinal surgery will generally be a last resort due to the risks involved. Conservative treatments commonly include medication, bracing, and physical therapy and exercise.

In cases of adult and degenerative scoliosis, if osteoporosis is present, treatment of the osteoporosis may also slow the progression of your scoliosis. This can be accomplished in several ways. Your doctor may recommend medication to treat osteoporosis, and the addition of weight-bearing exercises when appropriate.

In cases of adolescent idiopathic scoliosis, the treatment chosen will vary depending upon the severity of the curve, the age of the patient, and how far along the child is in skeletal maturity. If the child's curve is minor (less than 15–20 degrees), the doctor will likely choose to monitor the curve for progression. The patient will normally have X-rays taken every four to six months during rapid growth years, and then once a year.

A well-rounded rehabilitation program assists in calming pain and inflammation, improving mobility and strength, and helping with daily activities. Adolescents with idiopathic scoliosis should be encouraged to continue their normal activities, including sports.

Exercise has not proven helpful for changing the curves of scoliosis. However, it can be helpful in maintaining flexibility, especially in the hamstrings and low back. Therapy sessions may be scheduled each week for four to six weeks, depending on the recommendations of your healthcare provider.

The goals of physical therapy are to help:

  • Improve back posture
  • Foster aerobic fitness
  • Maximize range of motion and strength
  • Clarify ways to manage the symptoms of scoliosis

Bracing is usually considered with curves between 25 and 40 degrees, particularly if the patient is still growing and the curve is likely to get bigger. It is important that the patient wear the brace daily for the number of hours prescribed by the doctor. Scoliosis often affects more than one area of the spine. A brace can be used to support all the curved areas that need to be protected from progression.

Surgical Treatment

Surgery is generally only considered in patients who have continual pain, difficulty breathing, significant disfigurement, or a steadily worsening curve angle. After skeletal maturity occurs, curves that are less than 30 degrees tend not to progress and, therefore, do not require surgery. Curves above 100 degrees are rare, but they can be life threatening if the spine twists the body to the point it puts pressure on the heart and lungs.

If a curve is 45 degrees or more, surgery is more likely to be considered. Each case of scoliosis is somewhat different and may require a very specialized approach for optimal results. Surgery is suggested to solve the problems brought on by the scoliosis--not just to straighten your spine. The goals of most surgical procedures for scoliosis include:

  • Reducing the deformity (straighten your spine as much as possible)
  • Stopping the progression of the deformity
  • Removing any pressure from your nerves and spinal cord
  • Protecting your nerves and spinal cord from further damage

When scoliosis requires surgery, your doctor can choose from a number of different procedures including laminectomy and spinal fusion.

Surgical Approaches

Anterior Instrumentation
An incision is made in your chest or side, and your intervertebral discs are removed in the area of the curve to make it flexible. Screws can be placed in your vertebrae, and then connected by a metal rod. A bone graft is put in place of the discs that were removed so that the vertebra sitting next to each other will fuse together. The screws attaching the metal rod are tightened down, straightening the curve.

Posterior Instrumentation
This approach is done through your back. Anchors are attached to your spine in the form of hooks, screws, or wires. These anchors are attached to spinal rods that straighten your spine. Bone grafting is done to fuse all instrumented vertebrae in patients whom have finished growing.

Combined Anterior/Posterior Approach
This surgery is actually two operations: one through the front, and the other through the back. The two operations may be staged on separate days or as part of one longer surgery. Staged procedures require one to two additional days in the hospital compared to a single surgical procedure.

Other Considerations
Sometimes, a patient may choose not to have surgery because of the risks, even though it is recommended to them. However, there are also risks of leaving large curves untreated. Those risks include:

  • Increased Back Pain— Patients with large, untreated curves can suffer from daily back pain.
  • Reduced Respiratory Function— Large curves lead to deformities that can decrease the space in the body for vital organs such as the lungs and heart. The reduction in space can compromise a person's ability to breathe and for the heart to function properly. In curves of 100 degrees or more, the effects can be life threatening.

Flat-back Deformity
One possible complication specific to the surgical treatment of scoliosis is flat-back deformity. Your lumbar (lower) spine naturally has a slight inward curve called lordosis. When the vertebrae in your lumbar spine are fused together, this lordosis curve may be lost, leaving you with a "flat-back" deformity. The loss of curve may not appear right after surgery.

References

IMPORTANT SAFETY INFORMATION
As with any medical treatment, individual results may vary. There are potential risks and recovery takes time. People with conditions limiting rehabilitation should not have this surgery. Only a spine surgeon can tell if spine treatment is right for you.

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