Treatment Options for Scoliosis
Scoliosis is often noticed by a parent, family member, pediatrician, or through a school screening process. From there, referral to an orthopedic spine specialist should take place. Following are the steps taken in evaluating patients for scoliosis:
- Medical history: The doctor talks to the patient and parent(s) and reviews the patient's records to look for medical problems that might be causing the spine to curve, such as birth defects, trauma, or other disorders that can be associated with scoliosis.
- Physical examination: The doctor looks at the patient's back, chest, pelvis, legs, feet, and skin. The doctor checks if the patient's shoulders are level, whether the head is centered, and whether opposite sides of the body look level. The doctor also examines the back muscles while the patient is bending forward to see if one side of the rib cage is higher than the other. If there is a significant asymmetry (difference between opposite sides of the body), the doctor will refer the patient to an orthopedic spine specialist (a doctor who has experience treating people with scoliosis).
- X-ray evaluation: Patients with significant spinal curves, unusual back pain, or signs of involvement of the central nervous system (brain and spinal cord) such as bowel and bladder control problems need to have an x-ray.
- Curve measurement: The doctor measures the angle of the curve on the x-ray image. Curves that are greater than 20 degrees require treatment. In many instances, curves of less than 20 degrees require observation only.
The doctor will suggest the best treatment for each patient based on the patient's age, how much more he or she is likely to grow, the degree and pattern of the curve, and the type of scoliosis. The doctor may recommend observation, bracing, or surgery.
Doctors follow patients without treatment and re-examine them every 4 to 6 months when the patient is still growing and has a spinal curve of less than 25 degrees.
Note: Determining timeline of growth remaining is done in two primary ways:
- Time since onset of first menstrual cycle in females
- Using the Risser sign, a way of measuring skeletal maturity
Doctors may prescribe specific exercises to manage symptoms, improve posture, and maximize range of movement. Physical therapy has always been part of the Boston Brace protocol. Today there are many schools of physiotherapy scoliosis specific exercises such as Schroth, Scientific Exercise Approach to Scoliosis (SEAS), and Barcelona Scoliosis Physical Therapy School (BSPTS) to name a few.
Doctors may recommend wearing a scoliosis brace to stop a curve from getting any worse if the patient:
- Is still growing and has an idiopathic curve of more than 25-30 degrees
- Has at least 2 years of growth remaining, has an idiopathic curve that is between 20 and 29 degrees, and, if a girl, has not had her first menstrual period
- Is still growing and has an spinal curve of 20-29 degrees that is getting worse
Boston O&P manufacturers and offers a number of scoliosis braces - symmetrical/asymmetrical, daytime/nighttime, front opening/back opening, etc. We are the scoliosis experts and offer any brace a patient could use or your doctor could prescribe. Our four most popular braces are the Boston Brace Original, the Boston Brace 3D®, the Boston Brace Night Shift and the Boston Brace RC.
Note: As mentioned, braces are designed to prevent the curve from getting worse. While we have seen a large number of curves improving, the long-term goal is to have the same degree curve at start of treatment as at discharge from the brace (after growth stops).
Casting vs Bracing For Infantile Scoliosis
Mehta casting (chin to hips) has proven to be effective in correcting the curve for those patients meeting the rib vertebral angle difference (Mehta angle) criteria. The concern with this method is the repeated exposure to anesthesia (FDA issued a warning). Bracing has been used for some time in between cast changes and during the summer months to provide a break for the patients. Some facilities are now applying casts without the use of anesthesia. With the advances in both scanning and brace design, we are seeing positive results with the use of bracing only.
The results we have seen to date show that bracing has comparable results to Mehta casting. Both options have proven successful but we believe in a brace vs a body cast for a number of reasons including the child's comfort, bathing, and the fact that the patient can avoid having to go under anesthesia altogether.
Doctors may recommend surgery to correct a curve or stop it from worsening when the patient is still growing, has a curve of more than 45 degrees AND has a curve that is getting worse.