Scoliosis Treatment Options
What are the treatments for scoliosis?
Treatment options are based on the location and severity of the symptoms and the underlying cause of the curvature. All treatment decisions are made on a case-by-case basis. The goal is pain relief, restoration of stability, and reduced disability.
The mainstay of scoliosis treatment is nonsurgical management including weight loss if appropriate, activity modification, pain management, spinal injections, physical therapy, heat and cold therapy, acupuncture, and chiropractic manipulation. If that is insufficient corticosteroid injections or never blocks can help reduce inflammation and pain and allow participation in physical therapy. When pain is severe, nerve ablation with a special probe can temporarily destroy part of the painful nerves to stop pain signals to the brain. If that is unsuccessful to relieve pain and improve function, surgery may be necessary to restore quality of life.
Scoliosis treatment options
Treatment options for scoliosis depend on the patient’s age, whether the spine is still growing, the severity of the curve, the location of the curve, the potential for curve progression, and any associated medical conditions. When Dr. Girardi confirms a diagnosis of scoliosis, he will perform a risk assessment for curve progression which will help guide his treatment recommendations.
The following are some common scoliosis treatment options:
- Observation may be the initial course of action if a patient is still growing physically and has a milder curve, they will be observed every 4-6 months during adolescence with a physical exam and x-rays. Observation may also occur if a patient has stopped growing and has a curve of no more than 45 degrees. If the patient is an adult, observation with x-rays may be recommended every five years or sooner if symptoms progress. During the observation period, Dr. Girardi may recommend physical therapy to reduce the physical symptoms of the spinal curvature.
- Non-surgical treatment typically involves bracing the back. This care may be appropriate for patients who are still growing and have a spinal curve between 25 and 45 degrees which is a moderate to severe curvature. A brace is not intended to correct the curve, but to keep it from progressing. Bracing is a customized treatment that is developed based on factors including the location of the curve, the number of curves, the flexibility of the curve, and the condition of the vertebrae. Bracing works by applying pressure to the curves in the spine and helps to encourage the spine to grow in a straighter direction. It can be an effective part of a comprehensive treatment plan, especially when combined with physical therapy and regular monitoring.
- When conservative options do not improve symptoms, spinal instability is commonly treated with surgery. The goal of surgery is to halt curve progression and reduce the severity of the deformity. It is typically recommended for patients with severe scoliosis who have not responded to other forms of treatment, such as bracing or physical therapy. Most patients experience a significant improvement in their symptoms after surgery, although it may take several months to see the full benefits. It is an effective way to correct severe curvatures adn improve the patient’s quality of life.
What if scoliosis is left untreated?
90% of scoliosis cases do not require anything more than periodic monitoring of the spinal curvature. If an increase in spinal deformity is observed on x-rays, Dr. Girardi will discuss the potential for active treatment.
Untreated scoliosis may get worse in some cases. Factors that predict this include the age of the patient and the extent of the curve at the time of diagnosis. Studies suggest that a child under the age of 10 who has a curve greater than 35 degrees is vulnerable to worsening if treatment is not received. When the diagnosis is made after a person has stopped growing, the likelihood of rapid progression in the spinal curve is very low. The exception is a curve greater than 50 degrees. This extent of curvature could progressively worsen by a few degrees each year if treatment is not obtained.
Treatment is based on the severity of the condition
Mild cases of scoliosis may require no treatment beyond periodic medical examinations and imaging. Cases of scoliosis affecting the following groups bear especially careful monitoring:
- Girls, who have a higher rate of progressive scoliosis
- Individuals with larger or double (S-shaped) curves
- Individuals whose abnormal curve is in the thoracic spine
Once patients have reached maturity, and their bones have stopped growing, as assessed by the onset of puberty and tests to assess bone growth, there is very little risk of worsening scoliosis.
Moderate to Severe Scoliosis
When treatment for moderate scoliosis is necessary, it most often takes the form of a back brace. While the brace will not cure the condition, it will prevent it from worsening. Braces for scoliosis are only used in children whose bones are still growing. More serious cases of scoliosis may require surgical intervention.
Surgical Scoliosis Treatment
Dr. Girardi may recommend surgery if the spinal curve is greater than 50 degrees. Sometimes, surgery is appropriate for the correction of smaller curves that are causing persistent symptoms that do not improve with physical therapy and other modalities. Scoliosis surgery may involve fusing certain vertebrae in the spine and stabilizing the straightened spine with appropriate fixtures until the bones heal together.
Spinal reconstruction surgery is an option for cases of severe spinal deformity and misalignment that affects a major portion of the spine.
Most patients with scoliosis, even if it becomes severe, are able to be successfully treated and to lead normal, productive lives.
At a Glance
Dr. Federico Girardi MD
- Triple fellowship-trained spinal surgeon
- Performs over 400 spinal surgeries per year
- Professor of orthopedic surgery at Cornell University
- Learn more