Lately I have had multiple inquiries regarding what treatment options are available for management and or correction of scoliosis. I have gathered some information here to help answer such questions in an easy and understandable way.
The basic objectives of comprehensive conservative treatment of Idiopathic Scoliosis are:
1. To stop curve progression at puberty (or possibly even reduce it),
2. To prevent or treat respiratory dysfunction,
3. To prevent or treat spinal pain syndromes,
4. To improve aesthetics via postural correction
1. To stop curve progression at puberty (or possibly even reduce it)
It is believed that it is impossible to fully eradicate idiopathic scoliosis with conservative treatment techniques available at present. It is possible and usually sufficient to prevent further progression, even if recent research papers conducted have shown that it is also possible to obtain some amount of curve correction.
2. To prevent or treat respiratory dysfunctions
The morphological aspect of the deformity is closely related to the functional aspect. Depending on its degree and location, the curvature affects respiratory function. The most prominent changes within the respiratory system are produced by curvatures of the thoracic spine.
3. To prevent or treat spinal pain syndromes
Adult patients with scoliosis in varying degrees suffer from spinal pain. In a follow-up study of over 40 years duration, three-fold higher prevalence of chronic pain-related complaints and over twenty-fold higher incidence of severe pain in a group of people with untreated idiopathic scoliosis compared to a control group was noted.
4. To improve the appearance via postural correction
Quality of life is significantly affected by aesthetic sensation and acceptance of one’s appearance. Therefore, visual correction of a scoliosis related external trunk deformity is an important issue in conservative treatment.
All these treatment approaches will be presented from the less to the most demanding and possibly efficacious.
• Observation. It is the first step of an active approach to idiopathic scoliosis and it is constituted by regular clinical evaluation with a specific follow-up period. Timing of this follow-up can range from 2-3 to 36-60 months according to the specific clinical situation. Clinical evaluation does not mean performing x-rays every time: x-rays are usually performed during alternate clinical evaluations.
• Therapeutic Specific Exercises. They include all forms of outpatient therapeutic exercises that have proven efficacy. The frequency of therapeutic sessions depends on the techniques, cooperation and the ability of the patient to carry out the treatment. At times, it can be conducted daily or several times a week. Long-term outpatient therapy sessions most often take place 2-4 times a week if the patient is willing to co-operate fully. The actual form of exercise depends mainly on the character of the selected therapeutic method.
• Chiropractic, physiotherapy, and Massage Therapy. These treatments should complement the exercise programs to avoid further injuries and keep the structures involved as mobile and healthy as possible. Joint mobility and muscle balance is one of the most important aspects of treatment programs for scoliosis.
• Bracing: using a brace (a corrective orthosis) for a specified period of time each day to correct scoliosis in three planes (3D). It is used for a period necessary to obtain and maintain the therapeutic outcome. The therapeutic outcome is mainly the halting of scoliosis progression. In some cases it is possible to correct the scoliosis while in others the progression rate can only be slowed down before elective surgery. The use of a rigid brace always implies the additional use of exercises when out of the brace. Bracing includes:
. Night Time Rigid Bracing (8-12 hours per day): wearing a brace mainly in bed.
. Soft Bracing: it includes mainly the SpineCor brace, but also other similar designs
. Part Time Rigid Bracing (12-20 hours per day): wearing a brace mainly outside school and in bed.
. Full Time Rigid Bracing (20-24 hours per day) or cast: wearing a brace all the time (at school, at home, in bed, etc.). Casts have been included here as well. Casts are used by some schools as the first stage to achieve correction to be maintained afterwards with rigid brace; others propose casting only in worst cases; a cast is considered a standard approach in infantile scoliosis. Recently, a new brace has been developed that has been claimed to achieve same results as casting.