Scoliosis, also known as curvature of the spine, affects approximately 6 million people in the United States. Scoliosis refers to curvatures that are side-to-side and of an angle greater than 10 degrees in magnitude. Typically beginning between the ages of 10 and 15, scoliosis occurs equally among males and females, although, according to the National Scoliosis Foundation, females are eight times more likely to progress to a curvature that requires treatment.
Treatment of scoliosis depends on the angle of the curvature and whether the curve is progressing--that is, whether the bones are still growing or whether degenerative changes are occurring. According to Dr. Peter Ullrich Jr. of Spine Health, severe curvatures--those over 40 to 45 degrees and progressing, or over 50 degrees--usually require surgery; 38,000 spinal fusions for scoliosis are performed each year. However, for less severe cases there are alternatives.
Observation and Measurement
A person with a curvature less than 20 degrees may be observed annually by his regular physician for changes in the curvature with no other treatment. However, if the curvature progresses beyond 20 degrees, he should be referred to an orthopedic surgeon who has experience treating scoliosis patients.
A child who is still developing who has a curvature between 20 and 30 degrees should be seen by his pediatrician every four to six months to measure changes in the angle of curvature. This is done through a series of X-rays, though preferably no more than one per year, and an instrument that is placed along the spine. Any increase of more than five degrees during a six-month period will need further treatment.
An adult with a curvature between 20 and 30 degrees can manage her scoliosis through annual visits to her regular physician for measurement. Angles of this magnitude are not likely to progress once an individual has stopped growing at around age 18. However, as adults age, changes such as bone spurs, degenerative discs, and thickened spinal ligaments may cause the curvature to progress. These changes may sometimes lead to back and leg pain, instability of the spine, and an increasing worsening of the curve. This condition requires further treatment beyond observation.
Braces
Bracing is recommended for the child with a curvature greater than 30 degrees or greater than 20 degrees and actively progressing, or for an adult who finds relief from back pain by combining occasional brace wear with exercise. Braces cannot correct the curvature that already exists, but they can prevent further curvature.
There are two types of braces that are commonly used: the thoracolumbar sacral orthosis brace and the Charleston bending brace. The thoracolumbar sacral orthosis brace is custom-molded to fit each individual and is worn 23 hours each day. It can be removed to shower or play sports, but otherwise it is worn virtually around-the-clock. The Charleston exerts more pressure on the spine, but is worn only at night.
Adults who choose to wear a brace to ease back pain must be very careful to adhere to an exercise program as well. Wearing the brace without maintaining the muscles in the back may make the spine dependent on the brace, leading to further degenerative changes.
For a child, the prospect of wearing a brace can be traumatic. Bracing is more than just a medical treatment--it is a major commitment for both the parent and child. Kamiah Walker of Spine Universe points out that bracing can be uncomfortable, and can make a child feel awkward during a time when she wants to be just like her friends. That is why support from family, friends and health care providers is very important.
Anti-Inflammatory Medications
Scoliosis, while not typically associated with discomfort in children, can be painful for adults. The treatment of choice for pain associated with adult scoliosis is nonsteroidal anti-inflammatory drugs, or NSAIDs. These are non-narcotic, nonaddictive medications that decrease inflammation surrounding the spinal tissue. An individual considering surgery due to increasing pain would do well to try this noninvasive alternative first.
Exercise Therapy
Physical therapy, as well as formal exercise disciplines such as ballet and yoga, are an excellent way to strengthen back muscles and straighten posture, to the limit allowed by the spinal curvature. Exercise therapy is not going to directly treat scoliosis; it will have no effect on the existing curvature, and it will not impact progression. However, maintaining a healthy back is essential in working towards leading an active, pain-free life. Children and adults of all ages with scoliosis can benefit from exercise, combining it with other treatments to meet individual needs.
