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Management and treatment of scoliosis

By James F. Mooney, III, M.D., chief of staff

Scoliosis is a complex deformity that affects the alignment of the bones of the spine. Some cases of scoliosis are associated with underlying muscle or neurological abnormalities or defects in bone formation. However, most scoliosis is termed "idiopathic," or of unknown origin. Idiopathic scoliosis affects girls more frequently than boys and tends to develop most commonly in the early teen years. When idiopathic scoliosis is diagnosed at this age, it is termed "adolescent idiopathic scoliosis" or AIS.

Nonoperative management of AIS

In a growing patient, progression of idiopathic scoliosis may be prevented from worsening by wearing a brace, and multiple types of braces exist. The most common type of brace is the Boston Brace, which is worn for 18–20 hours per day. Another common brace is the Charleston Bending Brace. The Charleston Brace is most effective on certain types and magnitudes of scoliotic deformities and is worn only at night. Bracing is indicated in patients with at least 1.5–2 years of spinal growth remaining, and curves of specific location and magnitude. Other facts about bracing in AIS include:

  • Bracing may be combined with types of scoliosis-specific exercises
  • May be effective in stopping or slowing the progression of the curve, and thus prevent the need for surgery
  • Wear schedule and type of brace will depend on location and magnitude of the curve
  • Compliance with wear schedule is essential to the possible success of bracing treatment
  • Many of the braces can be measured, fitted and manufactured within the Shriners Hospitals system

Surgical options for AIS

Unfortunately, some patients will present with curvature that is too large to respond to bracing, or will fail bracing for a number of reasons. In those patients, surgery is generally recommended to correct some portion of the deformity, but most importantly to minimize the risk of progression of the deformity through the remainder of life. Very large curves may be deforming, may be associated with back pain later in life, and in rare cases may affect heart and lung function. Other facts about surgical treatment of AIS include:

  • Surgery is generally recommended for AIS patients with deformities greater than 50–55 degrees, particularly in patients who are still growing.
  • Spinal correction surgery may be done with the placement of rods, screws and hooks that attach directly to the bones within the curved portion of the spine. These implants act to help correct the deformity to some degree, but also to hold the spinal deformity still while the area fuses solidly.
  • Bone graft is added after the correction to help fuse the area of correction and will aid in preventing the deformity from recurring.
  • Surgery may be recommended through an incision in the back or the front of the spine, depending on the deformity location, and the opinion of the treating surgeon. Most surgery is performed through the back.

Of course, not all idiopathic scoliosis occurs in adolescents. A smaller percentage of younger patients will develop idiopathic spinal deformities as well. In those patients, bracing or casting may be options. Other types of spinal instrumentation are utilized in these younger patients, when surgery is indicated. Spinal fusion, as performed in adolescents, is generally avoided in the younger population due to the possible effect on development of the heart and lungs. In these patients, specialized rod, hook and screw systems (including magnetic lengthening rods in some cases) can be used to correct the deformity, yet still allow growth of the spine in these younger patients. Management of patients with all forms of idiopathic scoliosis is available at Shriners Hospitals for Children — Springfield.

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