The treatment for scoliosis depends on a number of issues, including your age, the extent of curvature in your back, your health history and your history with various medications and treatments. Scoliosis is an abnormal curvature of the spine that affects two to three percent of Americans, mostly adolescents between the ages of 11 and 16, with only one-tenth of one percent of them requiring surgery.
Scoliosis can significantly affect the quality of life for children, even in its milder forms. If you are concerned about scoliosis in yourself or your child, it is important to seek medical advice. To diagnose the extent of your condition, your doctor will ask you questions about your medical history and perform a variety of physical exams. The following exams will help determine the extent of the condition:
- Physical exam – The first test the doctor will likely do is to have you or your child bend over so that the spine protrudes from the back. This test will show the shape of the spine. A healthy spine will be straight, but a person with scoliosis will have an abnormal bend. The doctor will also look for asymmetry in the waist and shoulder blades.
- X-ray (radiograph) – If the doctor does determine that there is a possibility of this abnormality, he or she may choose to do an X-ray to get a better visual idea of the bone structure. During the exam, radiation is sent through the back to capture an image. This image shows white areas for bone mass and black for everything else, which gives a clear visual of the bone structure.
- Magnetic resonance imaging (MRI) – Unlike X-rays, MRIs do not use radiation. It requires being put into a vessel containing a magnetic field and radio waves. These waves are then aimed at your spine, causing the vertebrae to vibrate. A computer then creates an image based on these vibrations.
If the curvature of the spine is less than 40 degrees, many doctors will choose to treat scoliosis without surgery. For very mild cases, treatment can be simple observation to ensure that the bones are finished growing and will not continue to curve or lead to any complications. For children with slightly more curvature, or those whose bones are still growing and make them at risk for curving even more, a brace will be used to support the back and prevent the curvature from continuing.
In cases where the curvature of the spine exceeds 40 to 50 degrees, scoliosis requires surgery. The aim of scoliosis surgery is to repair the spine and prevent it from continuing to curve. Most people with severe scoliosis are treated using one of two surgical techniques:
- Minimally invasive spine surgery – This type of surgery was first performed in the 1980s and has since undergone much advancement. Doctors use smaller incisions to insert metallic implants that support the correct curvature of the spine and prevent it from curving further. This is a preferred method for smaller curvatures because it does not require opening up the back along the spine, risking damage to muscles.
- Spinal fusion – This is the most common surgery for patients with severe cases of scoliosis. It works by joining two or more vertebrae together so they cannot move independently and continue growing abnormally. This typically is done using metal rods and bone casts taken from the patient or from a cadaver. Spinal fusion surgeries typically are done once a child’s bones have finished developing.
The multidisciplinary team of spine experts at Northwell Health Orthopaedic Institute performs scoliosis surgery as well as a broad range of nonsurgical and surgical treatments for conditions that affect the bones.
Research on treatment options includes advancements in brace technology to slow the progression of spinal curvature in children affected by this disease, and creating an easier method of surgical treatment. Brace technology has not always been an effective approach to stopping the progression of this disease. As braces become more advanced, researchers have seen an improvement, but there is still work to be done.
Surgical advancements also have been made in how minor cases of scoliosis are treated. For example, with minimally invasive spinal surgery, researchers have found a way to treat curvature without risking complications such as muscle damage from creating an incision along the entire length of the spine.
Another research focus is determining what causes scoliosis. While studies show that there appears to be a genetic cause, it is still uncertain which gene or genes cause this abnormal curvature to appear. Studies have shown that the disease is passed down through family members. Further proof that genetics is a factor includes studies done on twins showing the same extent of the disease. However, researchers are still struggling to determine which gene causes this condition. Many hypothesize that there could be multiple genetic factors that trigger it. Once these are found, treatment options have more potential to advance because the genes causing the disease can be targeted directly.
As research on causes and treatments is ongoing, it is a good idea for your conversation about it with your doctor to be ongoing as well.