Is Surgery the Best Scoliosis Treatment Option?

Early Detection is Key to Keeping Your Child Out of the Operating Room

Question: What happens if scoliosis is not treated? Is surgery the best option to treat scoliosis?
—Omaha, NE

Answer: Scoliosis is an abnormal curvature of the spine that affects approximately 7 million people in the US. Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis (idiopathic means it has no known cause), so I'll refer specifically to that type throughout this article.

Child looking at a tablet computer in medical officeFor patients with AIS, a parent or the child typically notices the abnormal curve, but sometimes it's not discovered until a school screening or doctor visit. If a child is between the ages of 10 and 12, it's important to get regular check-ups because that's the most common age range for adolescent idiopathic scoliosis.

AIS does not always cause significant symptoms for the patient, but larger curves may cause outwardly noticeable deformities (such as a rib hump) and significant pain. In severe cases, the curve may even begin impacting the lungs and cardiac function. When scoliosis is present, it is important to detect scoliosis early on in order to decrease the chance of the curve progressing.

Risk Factors for the Progression of the Curve
There are a number of factors that may be related to the risk for AIS curve progression. They include:

  • Age
  • Pattern of the scoliosis curve that is present (meaning the type or shape of the curve)
  • Gender (girls are much more likely to have scoliosis curves that progress to the point that treatment is required)
  • Skeletal maturity

Treatment for Adolescent Idiopathic Scoliosis
Treatment options for AIS include observation, bracing, and surgery. In most cases, only observation is needed. This includes following up with periodic physical examinations and x-rays until the patient finishes growing.

The majority of patients with small curves will have little, if any, progression. For patients with small scoliosis curves (those between 25° and 30°) who are undergoing observation, full activities are allowed (including playing competitive sports).

Patients with curves that are at risk for progression during periods of rapid growth (such as puberty) may need to be treated with a brace. In general, bracing is recommended for scoliosis curves between 25° and 30º in patients who have significant growth remaining.

I recommend wearing the brace 22 to 23 hours a day. This maximizes the positive effect of wearing the brace, while still allowing the patient to remove the brace for social activities and sports. The patient wears the brace until he or she completes growing, which is usually for two to three years.

As far as scoliosis surgery being the best treatment option, it's difficult to say because there are so many factors that are specific to each case that the doctor must take into account. For instance, surgery is generally reserved for patients with progressive scoliosis curves greater than 45º, or curves that do not respond to bracing treatment.

The goal of scoliosis correction surgery is to correct the spinal curvature and prevent the curve from progressing further during the patient's life. For patients with large scoliosis curves or significant growth remaining, surgery is the best option in order to prevent further progression of the curve.

A number of surgical advances allow for greater curve correction and spinal stability. Because of these advances, most patients undergoing corrective surgery for AIS don't need to wear a brace after surgery, and typical hospital stays are less than a week. Patients begin walking immediately after surgery and can resume activities over the following months.

The decision to undergo scoliosis surgery should only be made after a very careful evaluation and detailed discussion with the patient, family, and surgeon.

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