Childhood Scoliosis: Treatment and Recovery

In the past, plaster casting was routinely used to treat scoliosis. Today plaster jackets are used to treat some cases of infantile scoliosis. Casting is generally not used today except in countries where bracing is not available. Bracing is the standard treatment today used to prevent curve progression and improve deformity.

Typically bracing is prescribed for children with smaller curves ranging from 20 to 40 degrees. Bracing may temporarily correct the scoliosis but does not cure the disease. Children and teenagers may find bracing difficult because the brace can be uncomfortable, hot, rigid, unattractive, and must be worn 16 to 23 hours a day. Although well disguised under clothing, it can make a child self-conscious.

Bracing is usually not prescribed when the curve is greater than 40 degrees. Certain types of curves do not respond to bracing, such as high thoracic curves. In those situations, surgical intervention may be warranted.

Surgery
Scoliotic curves greater than 45-50 degrees are usually treated surgically. Rods, bars, wires, screws, and other types of medically designed hardware are used to surgically control and correct scoliosis. These procedures may enable the child to sit upright thereby reducing the risk for cardiopulmonary complication. Furthermore, instrumentation (hardware) may increase the child's ability to be mobile. These devices are meant to hold the spine straight while the process of fusion occurs.

In infantile and juvenile scoliosis, rods may be implanted without bone grafts. Bone grafts facilitate fusion. Later in life, spinal instrumentation and fusion provide a more permanent treatment. Adolescent scoliosis may be treated surgically using spinal instrumentation and fusion, when necessary.

The goals of spinal instrumentation include stabilization of spinal segments, deformity correction within safe parameters, and to enhance spinal fusion. This type of surgery can be performed safely on adults with spinal deformity, usually with excellent results.

Scoliosis: Preoperative and Post-Operative X-Rays

Recovery
Whether the treatment course is conservative or surgical, it is important to closely follow the physician and/or physical therapist's instructions. Discuss any concerns about activity restrictions. They will be able to suggest safe alternatives.

Physical therapy may be incorporated into the treatment plan to build strength, flexibility, and increase range of motion. The therapist may provide the patient a customized home exercise program.

If the patient undergoes surgery, written instructions and prescriptions for necessary medication are given prior to release from the hospital. The patient's care continues during follow-up visits with their surgeon.