There are three main approaches to the care of scoliosis
patients: observation, bracing, and surgery. The doctor
considers several factors (the patient's age, the type
of scoliosis, the curve's severity, and whether the
patient has finished growing) to determine the best
treatment plan. Here, the two non-surgical methods of
treatment-observation and bracing-are discussed.
Observation
In some mild cases of scoliosis, tracking a patient
over time with X-rays and physical examination is all
that is necessary. When the patient is in his or her
growth years, spinal curvage of 10 degrees to 20 degrees
bears watching to see if the curve progresses. The doctor
will examine the patient every four to six months. If
there is no worsening of the curve, then further treatment
is not required. Many people with mild spinal curvage
function well and normally. When the curve does become
more severe, then bracing or surgery may need to be
considered.
It is important that patients keep up with observation
appointments for as long as their doctor recommends.
Scoliosis is generally a painless condition, and during
the growth years, a curve can "silently" worsen.
Bracing
The patient can wear an orthotic brace to stop a curve
from getting worse. However, bracing does not cure a
scoliotic curvature.
Bracing is most commonly used for patients with adolescent
idiopathic scoliosis who still are growing and have
a curvature between 25 degrees and 40 degrees. Several
factors enter into a doctor's recommendation to use
a brace, including the severity of the curve, the type
of scoliosis, and the child's age. Bracing is not usually
a treatment option for adults.
The braces used today are made of lightweight plastic
with a foam lining and Velcro closures. They can be
worn under clothing and are more comfortable than the
heavy braces commonly used several years ago. There
are two major types of braces: the full-torso Milwaukee
brace, which has a neck ring, and the thoracolumbar-sacral
orthosis (TLSO), or Boston, brace, which comes up to
the underarms. The location of the spinal curvature
determines which of these braces is worn: Generally,
the Boston brace is selected for curves in the lower
back, or lumbar region, and the Milwaukee brace is selected
when the curve is higher up on the spine.
For this treatment to achieve its best possible outcome,
the patient must wear the brace as directed by the doctor.
This could mean wearing the brace for 16-23 hours a
day for two to three years. Over time, the hours of
bracing will gradually taper off until the brace is
no longer needed.
Patients are encouraged to participate in an exercise
program while wearing a brace. Exercise helps the patient
maintain muscle strength and spine flexibility and promotes
proper breathing and chest mobility.
Bracing is a successful treatment about 90 percent of
the time. But whether because of non-compliance by the
patient or other factors, sometimes the brace does not
stop the curvature's progression. At that time, surgery
may be needed to repair the curvature.
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Treatments
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