Scoliosis: Treatment Options and Surgical Considerations for Adolescents

Scoliosis

A female sixth grader has a 35-degree scoliosis.
The physician recommends waiting until the growth period is over before considering surgery.
I would like to inquire about the following:
1.
There are several physical therapy clinics that assist with rehabilitation for scoliosis.
Is it advisable to pursue physical therapy?
2.
What is the effectiveness and degree of improvement with bracing?
3.
Are there any other adjunctive treatment methods you would recommend?
4.
If the curvature remains around 35-45 degrees after the growth period, would surgery still be recommended? What is the reasoning behind this?
5.
What is the recommended age for surgery, and is there a possibility of needing further adjustments or additional surgeries post-operatively?
6.
What home care considerations should be taken into account? Are there specific exercises or movements to avoid? How often should follow-up evaluations be conducted? Thank you.

Albee, 10~19 year old female. Ask Date: 2021/07/11

Dr. Wang Shouji reply Orthopedics

Hello, the majority of the causes of scoliosis are unknown.
Non-surgical treatment typically involves the use of braces for correction.
Severe curvature may affect cardiopulmonary function, in which case surgical correction is considered.
Most activities and exercises are generally permissible, as long as heavy lifting is avoided.
If there is back pain or discomfort, rehabilitation may be beneficial; however, the effectiveness of treatments aimed at correcting scoliosis is uncertain, and I cannot make any recommendations in that regard.
Changhua Hospital cares about your health.
Wang Shou-ji.

Reply Date: 2021/07/11

More Info

Scoliosis, or spinal curvature, is a condition that can significantly impact adolescents, particularly during their growth spurts. In your case, with a 35-degree curvature, it's essential to consider various treatment options and the implications of surgical intervention. Here’s a comprehensive overview addressing your questions:
1. Physical Therapy: Engaging in physical therapy can be beneficial for adolescents with scoliosis. While it may not correct the curvature, it can help strengthen the muscles surrounding the spine, improve posture, and enhance overall flexibility. Physical therapists can design individualized exercise programs that focus on core strengthening and spinal stabilization, which may alleviate discomfort and improve function.

2. Bracing: The use of a brace is often recommended for adolescents with moderate scoliosis (typically between 25 and 45 degrees) who are still growing. Bracing aims to prevent further curvature progression during growth. The effectiveness of bracing largely depends on adherence to wearing the brace as prescribed. Studies suggest that bracing can be effective in halting progression in many cases, especially if initiated early and worn consistently.

3. Other Treatment Options: In addition to physical therapy and bracing, some alternative treatments may be considered, such as chiropractic care or specific scoliosis-specific exercise programs like the Schroth method. However, it's crucial to consult with a healthcare provider before starting any alternative therapies to ensure they are appropriate and safe.

4. Surgical Considerations: If the curvature remains between 35-45 degrees after growth has ceased, surgery may still be recommended, particularly if the curvature is progressive or causing significant pain or functional impairment. Surgical intervention, typically spinal fusion, aims to correct the curvature and stabilize the spine. The decision for surgery is often based on the degree of curvature, the presence of symptoms, and the potential for progression.

5. Age for Surgery and Post-Operative Adjustments: The optimal age for surgical intervention varies, but it is generally recommended after skeletal maturity, which can be assessed through X-rays. Post-surgery, while many patients experience significant improvement, some may require further adjustments or additional surgeries later in life due to changes in spinal alignment or growth of adjacent segments.

6. Home Care and Activity Restrictions: After surgery, patients should follow specific guidelines to ensure proper healing. This includes avoiding high-impact sports, heavy lifting, and activities that may strain the back. Regular follow-up appointments are essential to monitor the spine's condition and ensure that healing is progressing as expected. Typically, follow-ups are recommended every 6-12 months after surgery, but this can vary based on individual circumstances.

In summary, scoliosis management in adolescents involves a multidisciplinary approach that includes physical therapy, bracing, and, in some cases, surgical intervention. The decision-making process should involve careful consideration of the curvature degree, growth status, and individual patient factors. Regular monitoring and adherence to treatment plans are crucial for optimal outcomes. Always consult with a spine specialist or orthopedic surgeon to tailor the treatment plan to your specific needs.

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