Conditions + Treatments

Scoliosis | Treatments

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What are the non-surgical treatment options for scoliosis?

Observation and monitoring

Once an abnormal spine curve has been detected, it's important to monitor the curve as your child grows. In many cases, your child's curve may require only close monitoring during skeletal growth. Your physician will determine your treatment plan and follow-up based on your child's X-rays and physical exams.

Physical therapy

Physical therapy often can help scoliosis. The goal of our physical therapy team is to maximize your child's physical functioning. Our therapists work closely with the Spinal Program to provide exercise programs and additional therapies to address any pain and the muscular imbalance that can be associated with spinal abnormalities.

Bracing

If your growing child's curve shows significant worsening or is already greater than 30 degrees, your physician may recommend a bracing program, in which a scoliosis brace is specifically designed for your child's particular curve. The brace holds your child's spine in a straighter position while she's growing to partly correct the curve or prevent it from increasing.

Casting

In certain situations — as in some cases of early-onset (infantile) scoliosis — body casting is indicated.

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What are the surgical treatment options for scoliosis?

Despite everyone's best efforts, some curves do not respond to bracing or are too large to respond to the brace. Surgery is required for these patients.

Posterior fusion

Posterior fusion with instrumentation is the most common operation done for idiopathic scoliosis. In posterior fusion, the spine is operated on from behind with an incision straight down the back.

Various types of instrumentation are used to partially straighten the spine and hold it secure while the bone fusion occurs. For most operations for idiopathic scoliosis, no brace or cast is used postoperatively. In congenital scoliosis or spondylolisthesis, posterior fusion is usually done without instrumentation, and a cast or brace is needed postoperatively.

Spinal fusion

The goal of a spinal fusion is usually a solid join (solidification) of the corrected, instrumented part of the spine. A fusion is achieved by operating on the spine, adding bone chips and allowing the vertebral bones and bone chips to slowly heal together to form a solid mass of bone called a fusion. The fusion process replicates the natural process of healing a broken bone for injury.

The bone chips (bone graft) may come from your hip or from the hospital's bone bank. Often, the spine is partially straightened with metal rods and hooks or wires (instrumentation). A brace or cast holds the spine in place until your fusion has a chance to heal.

Once the fusion has healed, which usually takes six to 12 months, the abnormal section of the spine will not curve more. The instrumentation can usually be left in your back without causing any problems.

Anterior fusion

Anterior fusion is used in special instances of idiopathic scoliosis, and commonly used in other spinal deformities such as congenital scoliosis, kyphosis or myelomeningocele.

An incision is made along a rib and/or down the flank of the abdomen to obtain access to the front of the spine. A bone graft from hip, rib or bone bank is used for the fusion. Screws and washers attached to a rod may be used to straighten the spine. Fusions of this type usually require a postoperative brace.

Anterior and posterior fusion

Some special cases of spinal deformity require both an anterior (front) and posterior (back) operation. Usually, these can be done on the same day, but sometimes they must be completed during separate operations spaced one to two weeks apart.

Osteotomy

An osteotomy is a surgical procedure that entails controlled breaking or cutting of the bone(s) and realignment into the correct position. A spinal osteotomy may be performed in cases where there is significant rigid deformity, and increased flexibility is desired before the stabilization with instrumentation and fusion.

Vertebral growth modulation

Vertebral growth modulation attempts to maintain spinal motion while preventing progression of the curve and possibly improving the curve with growth. Growth modulation by use of tether or vertebral staple may be possible when significant growth remains. 

For younger, growing children:

  • dual posterior growing rods (for early-onset scoliosis): control spinal deformity while allowing spinal growth with periodic lengthening
  • expansion thoracostomy/VEPTR™ (titanium rib) procedure to control chest and spine deformity while permitting
  • growth of both chest and spine
  • vertebral stapling (a minimally-invasive surgical alternative to bracing for scoliosis in some circumstances)
  • MAGEC (MAGnetic Expansion Control) System, an adjustable growing rod system that uses magnetic technology and a remote control to non-invasively lengthen the device

What is the long-term outlook for children with scoliosis?

Most children and teens diagnosed with scoliosis can look forward to normal, active lives. The outlook for your child greatly depends on the nature and severity of the scoliosis and the child’s age, since the amount of time remaining to achieve complete bone growth plays a big factor. Early diagnosis and early treatment can improve the outlook for children with many types of scoliosis.

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