Scoliosis Treatment

Scoliosis is a type of spinal deformity characterized by an abnormal lateral (side-to-side) curvature of the spine, typically forming an “S” or “C” shape when viewed from the back. Scoliosis is not merely a postural issue; it is a complex three-dimensional deformity of the spine that can occur in different age groups. Curvature can occur in the thoracic (mid-back), lumbar (lower back), or both regions. The severity of scoliosis varies, with mild cases often being asymptomatic and severe cases potentially causing pain, reduced mobility, and respiratory issues due to the spine’s impact on the rib cage and internal organs.

Treatment options range from observation and physical therapy to bracing and surgical intervention, depending on the degree of curvature and progression.   If scoliosis is left untreated, several complications can arise, including:

• Progression of curvature.
• Chronic pain.
• Respiratory issues.
• Cardiovascular problems.
• Reduced mobility.
• Degenerative change.
• Psychological impact.

Types and Causes of Scoliosis:

There are several types of scoliosis, each with distinct features and may require different management and treatment approaches.

• Idiopathic Scoliosis: Curvature of the spine with no known cause, most commonly occurring in adolescents.
• Congenital Scoliosis: Spinal abnormalities occur during embryonic development when vertebrae could be misshapen or fused.
• Neuromuscular Scoliosis: Abnormalities in the muscles and nerves that support the spine are weak or imbalanced. This usually occurs alongside neurological or muscular conditions such as an injury, cerebral palsy, spina bifida or muscular dystrophy.
• Degenerative Scoliosis: Also known as adult-onset scoliosis, this type of scoliosis is due to age-related degeneration of spinal discs and joints.
• Functional Scoliosis: Caused by a secondary problem or an external factor, such as muscle spasms or leg length discrepancy, rather than a structural spinal abnormality.

Symptoms of Scoliosis

Symptoms vary depending on the degree of scoliosis. Common symptoms associated with scoliosis include:

• One shoulders higher than that other
• One shoulder more prominent than the other
• One hip higher than the other
• Asymmetrical waist
• One side of the rib cage jutting forward.
• Twisting or rotation along the vertical axis of the spine
• Core muscle weakness.
• Back pain
• Difficulty standing upright.
• Leg pain, numbness or weakness.
• Problems breathing because of reduced area in the chest for lungs to expand

Diagnosis of Scoliosis

Diagnosing scoliosis involves a combination of medical history, physical examination, and imaging to assess the type, severity, and potential progression of the spinal curvature

• Medical History Review: This includes family history, onset of symptoms, associated pain or discomfort, and the presence of underlying conditions that might contribute to spinal curvature.
• Physical Examination: Included is visual inspection, palpation, leg length measurement, and neurological examination.

• Imaging Studies:
  • X-rays: The primary tool for diagnosing scoliosis. Anteroposterior (AP) and lateral X-rays of the spine are taken while the patient is standing to measure the curvature’s degree and determine the Cobb angle.

• • MRI (Magnetic Resonance Imaging): Used if there are atypical features, neurological symptoms, or if a congenital or underlying condition is suspected.

• • CT Scan (Computed Tomography): Sometimes used to get detailed images of the bones if more precise information is needed, particularly before surgery.

Scoliosis Measurements:

• Less than 10 degrees – No scoliosis diagnosis.
• Between 10 to 24 degrees – Mild scoliosis.
• Between 25 to 39 degrees- Moderate scoliosis.
• More than 40 degrees – Severe scoliosis.

Treatment Options for Scoliosis

 Scoliosis treatment is highly individualized, considering each patient’s specific needs and circumstances. When developing a treatment plan for scoliosis, the following factors are taken into account:

• Age of the patient
• Degree of curvature
• Type of scoliosis
• Location of the curve
• Progression of the curve
• Symptoms and impact on quality of life
• Skeletal maturity
• Patient’s overall health
• Response to previous treatments.

Non-surgical Options: 

• Bracing: Bracing is an effective treatment option for both adults and children.

• For children: Bracing focuses on preventing curve progression during growth which is designed to stabilize the spine until skeletal maturity is reached.
• For adults: Some adults with scoliosis may use a brace to alleviate pain, symptom management or for support in daily activities.
• Physiotherapy: Physiotherapy for scoliosis involves specific exercises tailored to the individual’s spinal curvature with the aim of:
  • Improving posture.
  • Enhancing muscle strength.
  • Increasing spinal flexibility.
  • Manage symptoms and improve overall function.
  • Maintaining proper body mechanics during daily activities.

Surgical Options

Surgery may be an option to treat some types of scoliosis that do not respond to conservative treatment.

• Spinal Fusion: This procedure is performed on children and adults with scoliosis. It involves fusing two or more vertebrae together to form a single, solid bone. Metal rods, screws, and hooks are used to hold the spine in the correct position during the fusion process.
• Growing Rods: Growing rods are a surgical treatment for scoliosis in young children with severe spinal curves who are still growing. This procedure involves the implantation of adjustable rods along the spine, which can be periodically lengthened to accommodate the child’s growth. The rods help control the curvature of the spine while allowing the spine and thorax to grow. The rods are typically lengthened every six months through minor outpatient surgeries or non-invasive methods, depending on the system used.
• Decompression Surgery (or adults): Decompression surgery for scoliosis is typically performed in adults who experience nerve compression due to spinal curvature. This surgery involves removing portions of bone or thickened tissue that are putting pressure on the spinal nerves, which can alleviate symptoms such as pain, numbness, and weakness in the legs.
• Osteotomy (for adults): Osteotomy for scoliosis is primarily to correct severe and rigid spinal deformities by cutting and realigning the bones of the spine. This operation is typically reserved for patients whose curvature cannot be corrected by other methods such as spinal fusion.
• Post-Surgical Rehabilitation: Physical therapy and pain management is an essential part of recovery after surgery with a focus on regaining strength, flexibility, and function.