Treatments for Scoliosis
Treatments for Scoliosis
The list of treatments mentioned in various sources
for Scoliosis
includes the following list.
Always seek professional medical advice about any treatment
or change in treatment plans.
- Watchful waiting - mild conditions may require no treatment other than monitoring for worsening.
- Treatment of any underlying cause of scoliosis
- Bracing
- Spinal cast
- Spinal brace
- Milwaukee brace
- Thoracolumbosacral orthosis (TLSO)
- Surgery
- Other treatments that have not been successful
- Chiropractic manipulation
- Electrical stimulation
- Nutritional supplementation
- Exercise - not successful in correcting scoliosis but desirable to maintain mobility.
- Supportive treatments to cope with the spinal curvature:
- Built-up shoe - if one leg is longer than the other
Scoliosis: Is the Diagnosis Correct?
The first step in getting correct treatment is
to get a correct diagnosis.
Differential diagnosis list for Scoliosis may include:
Hidden causes of Scoliosis may be incorrectly diagnosed:
Scoliosis: Marketplace Products, Discounts & Offers
Products, offers and promotion categories available for Scoliosis:
Scoliosis: Research Doctors & Specialists
- Spinal Specialists:
- Neck Health Specialists:
- Child Health Specialists (Pediatrics):
- more specialists...»
Research all specialists including ratings, affiliations, and sanctions.
Hospital statistics for Scoliosis:
These medical statistics relate to hospitals, hospitalization and Scoliosis:
- 0.02% (2,559) of hospital consultant episodes were for scoliosis in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 89% of hospital consultant episodes for scoliosis required hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 32% of hospital consultant episodes for scoliosis were for men in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 68% of hospital consultant episodes for scoliosis were for women in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- more hospital information...»
Hospitals & Medical Clinics: Scoliosis
Research quality ratings and patient incidents/safety measures
for hospitals and medical facilities in specialties related to Scoliosis:
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Choosing the Best Treatment Hospital:
More general information, not necessarily in relation to Scoliosis,
on hospital and medical facility performance and surgical care quality:
Discussion of treatments for Scoliosis:
Many children who are sent to the doctor by a school
scoliosis screening program have very mild spinal curves that do not
need treatment. When a child does need treatment, the doctor may send
him or her to an orthopaedic spine specialist.
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.
- Observation--Doctors follow patients without treatment and
re-examine them every 4 to 6 months when the patient is still growing
(is skeletally immature) and has an idiopathic curve of less than 25
degrees.
- Bracing--Doctors advise patients to wear a brace to stop a
curve from getting any worse when the patient:
- is still growing and has an idiopathic curve that is more than
25 to 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; or
- is still growing and has an idiopathic curve between 20 and 29
degrees that is getting worse.
As a child nears the
end of growth, the indications for bracing will depend on how the
curve affects the child's appearance, whether the curve is getting
worse, and the size of the curve.
- Surgery--Doctors advise patients to have surgery to correct
a curve or stop it from worsening when the patient is still growing,
has a curve that is more than 45 degrees, and has a curve that is
getting worse.
Are There Other Ways To Treat
Scoliosis?
Some people have tried other ways to treat scoliosis,
including manipulation by a chiropractor, electrical stimulation,
dietary supplements, and corrective exercises. So far, studies of the
following treatments have not been shown to prevent curve progression,
or worsening:
- Chiropractic manipulation
- Electrical stimulation
- Nutritional supplementation
- Exercise--Studies have shown that exercise alone will not
stop progressive curves. However, patients may wish to exercise for
the effects on their general health and well-being.
Which Brace Is Best?
The decision about which brace to wear depends on the type
of curve and whether the patient will follow the doctor's directions
about how many hours a day to wear the brace.
There are two main types of braces. Braces can be
custom-made or can be made from a prefabricated mold. All must be
selected for the specific curve problem and fitted to each patient. To
have their intended effect (to keep a curve from getting worse), braces
must be worn every day for the full number of hours prescribed by the
doctor until the child stops growing.
- Milwaukee brace--Patients can wear this brace to correct
any curve in the spine. This brace has a neck ring.
- Thoracolumbosacral orthosis (TLSO)--Patients can wear this
brace to correct curves whose apex is at or below the eighth thoracic
vertebra (see "Normal Spine" diagram). The TLSO is an underarm brace,
which means that it fits under the arm and around the rib cage, lower
back, and hips.
If the Doctor Recommends Surgery,
Which Procedure Is Best?
Many surgical techniques can be used to correct the curves
of scoliosis. The main surgical procedure is correction, stabilization,
and fusion of the curve. Fusion is the joining of two or more vertebrae.
Surgeons can choose different ways to straighten the spine and also
different implants to keep the spine stable after surgery. (Implants are
devices that remain in the patient after surgery to keep the spine
aligned.) The decision about the type of implant will depend on the
cost; the size of the implant, which depends on the size of the patient;
the shape of the implant; its safety; and the experience of the surgeon.
Each patient should discuss his or her options with at least two
experienced surgeons.
Patients and parents who are thinking about surgery may
want to ask the following questions:
- What are the benefits from surgery for scoliosis?
- What are the risks from surgery for scoliosis?
- What techniques will be used for the surgery?
- What devices will be used to keep the spine stable after
surgery?
- Where will the incisions be made?
- How straight will the patient's spine be after surgery?
- How long will the hospital stay be?
- How long will it take to recover from surgery?
- Is there chronic back pain after surgery for scoliosis?
- Will the patient's growth be limited?
- How flexible will the spine remain?
- Can the curve worsen or progress after surgery?
- Will additional surgery be likely?
- Will the patient be able to do all the things he or she wants to
do following surgery?
(Source: excerpt from
Questions and Answers about Scoliosis in Children and Adolescents: NIAMS)
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Book Excerpts: Treatment of Scoliosis
Treatments of Scoliosis: Online Medical Books
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for more information about the treatments of Scoliosis.
Scoliosis & Kyphosis:
Treatment
(In a Page: Signs and Symptoms)
- Scoliosis
–Treat underlying cause if applicable (e.g., tumor)
–<20–25° of deformity: Observation
–20–40° of deformity: Bracing (preferably to be worn 23 hours/day); bracing stops progression only; Milwaukee brace (includes neck ring) gives best results but poor compliance; lumbosacral orthosis (Boston brace) has poorer results but better compliance
–>40° of deformity: Surgery (posterior spinal fusion with rods) is usually indicated; progression is very likely
–More aggressive treatment is usually indicated if progression >5°, female, younger, or if secondary, treatment generally more aggressive - Kyphosis: Bracing or surgery, similar to scoliosis
>
>
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Scoliosis:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Treatment options include observation while child is growing, bracing, and surgery
–Many curves do not progress enough to require treatment
–Spinal curve progression may occur despite bracing; however, for idiopathic scoliosis, response to brace wearing is dose-related and many patients do not like to wear the brace
-
Exercise and electrical stimulation have not been shown to alter natural progression of curve
-
Bracing for curves in 20–40° degree range may slow curve progression but does not reduce the magnitude of curve despite a well-made brace and compliance
-
Surgery is reserved for progressive curves >40° in skeletally immature (Risser scale 0–1) and >50° in skeletally mature patients
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Scoliosis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Only two treatments effectively treat scoliosis: spinal bracing and surgery. If monitored closely, a properly constructed and fitted brace can successfully halt progression of a curve in approximately 70% of cooperative patients. Most braces should be worn over a long T-shirt or similar article of clothing for 23 hours a day. However, mild curvatures may require less. Exercises must be done daily both in and out of the brace to maintain muscle strength. Patients should be seen for follow-up and brace adjustment every 3 months. Radiographs should be repeated at 6-month intervals. As the skeleton matures, as seen radiographically, brace wear should be gradually decreased until it’s worn only at night.
The primary indications for surgery are relentless curve progression (usually curves over 40°) or significant curve progression despite bracing. Surgery corrects lateral curvature by posterior spinal fusion and internal stabilization with metal rods. A distraction rod on the concave side of the curve “jacks” the spine into a straight position and provides an internal splint. An alternative procedure, anterior spinal fusion, corrects curvature with vertebral staples and an anterior stabilizing cable. Some spinal fusions may require postoperative immobilization in a brace. Postoperatively, periodic checkups are required for several months to monitor stability of the correction.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Scoliosis:
Treatment
(Handbook of Diseases)
The severity of the deformity and potential spine growth determine appropriate treatment, which may include such noninvasive measures as close observation, exercise, or a brace. For more serious deformity, surgery or a combination of methods may be needed. To be most effective, treatment should begin early, when spinal deformity is still subtle.
Noninvasive measures
A curve of less than 25 degrees is mild and can be monitored by X-rays and an examination every 3 months. An exercise program that includes sit-ups, pelvic tilts, spine hyperextension, push-ups, and breathing exercises may strengthen torso muscles and prevent curve progression. A heel lift also may help.
A curve of 25 to 39 degrees requires management with spinal exercises and a brace. (Transcutaneous electrical nerve stimulation may be used as an alternative.)
A brace halts progression in most patients but doesn’t reverse the established curvature. Such devices passively strengthen the patient’s spine by applying asymmetric pressure to skin, muscles, and ribs. Braces can be adjusted as the patient grows and can be worn until bone growth is complete.
Surgery
A curve of 40 degrees or more requires surgery (spinal fusion with instrumentation) because a lateral curve continues to progress at the rate of 1 degree a year even after skeletal maturity.
CLINICAL TIP: Some surgeons may prescribe Cotrel dynamic traction for 7 to 10 days for preoperative preparation. This traction consists of a belt-pulley-weight system. While in traction, the patient should exercise for 10 minutes every hour, increasing muscle strength while keeping the vertebral column immobile.
Surgery corrects lateral curvature by posterior spinal fusion and internal stabilization with a Harrington rod or other fixation devices. A distraction rod on the concave side of the curve “jacks” the spine into a straight position and provides an internal splint.
An alternative procedure, anterior spinal fusion with instrumentation, corrects curvature with vertebral staples and an anterior stabilizing cable. Some spinal fusions may require postoperative immobilization in a brace.
Postoperatively, periodic checkups are required for several months to monitor stability of the correction.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Know how to recognize and manage scoliosis because an early diagnosis and treatment are especiallyimportant to prevent serious consequences:
Treatment
(Avoiding Common Pediatric Errors)
The American Academy of Pediatrics recommends that infants, children,
and adolescents with severe scoliosis be referred to a pediatric orthopedic surgeon. The orthopedist will conduct a standing anteroposterior
roentgenogram of the spine to confirm the diagnosis. Treatment recommendations will depend on the degree, flexibility, and location of the curve.
Current guidelines are to follow closely every 3 to 6 months with spinal
radiographs and photographs for <15-to 20-degree curvature; to use a
Milwaukee brace for between 20 and 40 degrees; bracing or surgery between
40 and 50 degrees; and spinal fusion for >50 degrees.
>
» READ BOOK EXCERPT ONLINE »
Source: Avoiding Common Pediatric Errors, 2008
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