Scoliosis Treatment and Surgery
The treatment and surgery 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 2-3% of Americans, mostly adolescents between the ages of 11 and 16, with only a 0.1% requiring surgery for treatment.
Scoliosis can significantly affect the quality of life for children, even in its milder forms. If you are concerned you or your child has scoliosis, it is important to seek medical advice. In order 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 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 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 onscreen. 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 and may be used instead to save a patient from overexposure to radiation. It requires being put in a vessel containing a magnetic field and radio waves. These waves are then aimed at your spine, which causes the vertebrae to vibrate. A computer then creates an image based on these vibrations.
Nonsurgical Treatment for Scoliosis
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, making 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 surgeries 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 add supportive metallic implants to support the curvature of the spine and prevent it from continuing to curve 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 is typically done using metal rods and bone casts taken from the patient or from a cadaver. Spinal fusion surgeries are typically done once a child’s bones have finished developing.
The primary research being conducted around scoliosis focuses on treatment options and determining the cause to help with earlier detection. Treatment options have, for a long time, been either somewhat ineffective or very invasive. For this reason, researchers have focused on creating new ways to work with the spine and slow abnormal curvature faster and more easily.
Research surrounding improving treatment options includes making advancements to 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 have also 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.
Perhaps the biggest research focus now is determining what causes scoliosis. While studies show that there appears to be a genetic cause of the disease, it is still uncertain which gene or genes cause this abnormal curvature to appear. Studies have shown that the disease is passed down throughout family members. Further proof that genetics are 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 that are causing the disease to affect the body 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.
The Rehabilitation Network of the North Shore-LIJ Health System is dedicated to providing you and your family with result-oriented, comprehensive rehabilitation services. Our goal is to help you and your loved ones find relief from pain and get moving again after an accident, illness, injury or surgery. We’re your partner in a safe, healthy, more rapid recovery.
The multidisciplinary team of orthopaedic experts at North Shore-LIJ Orthopaedic Institute in New York performs Scoliosis surgery as well as a broad range of nonsurgical and surgical treatments for conditions that affect the bones.