DescriptionAn in-depth report on the causes, diagnosis, treatment, and prevention of scoliosis.
The treatments for scoliosis are not always straightforward. For one, some young people do not treatment at all--only careful observations. When treatment is warranted, then there are a number other options, including braces and different surgical procedures.
Decision to Treat or Wait
The general rule of thumb for treating scoliosis is to monitor the condition if the curve is less than 20 degrees and to consider treating curves greater than 25 degrees or those that progress by 10 degrees while being monitored. Whether scoliosis is treated immediately or simply monitored is not an easy decision, however. The percentage of cases that will progress more than 5 degrees can be as low as 5% in certain cases or as high as 50% to 90%, depending on the severity of the curve or other predisposing factors:
Age. In general, the older the child the less likely the curve will progress. Scoliosis in a child under 10, for example, is more likely to progress than scoliosis in an adolescent. Experts estimate that curves less than 19 degrees will progress 10% in girls between ages 13 and 15 years and 4% in children older than 15. (In some rare, severe cases, a curve may worsen even after a child has received treatment and stopped growing because of the weight of the body pressing against the abnormal curve.)
Gender. Girls have a higher risk for progression than boys.
Location of the Curvature. Thoracic curves, those in the upper spine, are more likely to progress than thoracolumbar curves or lumbar curves, those of the middle to lower spine.
Severity of the Curvature. The higher the degree of curvature the more likely the chance of progression and the more likely the lungs will be affected. Some experts argue that the degree of the curve alone may not identify patients with moderate and severe scoliosis who are at greatest risk for complications and therefore need treatment. For example, spinal flexibility and the extent of asymmetry between the ribs and the vertebrae may be more important than the curve degree in predicting severity in this group.
Presence of Other Health Conditions. Children in poor health may suffer more from stressful scoliosis treatments than other children. On the other hand, children who have existing conditions that predispose to lung and heart problems may warrant immediate, aggressive treatment.
For example, a young man of 18 who has a curvature of 30 degrees may require no treatment because his growth has probably almost stopped and his gender puts him at lower risk. A young girl of 10, however, with the same curvature requires immediate treatment.
Choosing Braces or Surgery
In general, the following criteria are used to determine whether a patient should be given braces and conservative therapies or surgery:
The choice may not be so straightforward in certain cases and patients should discuss all options carefully with their physician.