Is non-surgical treatment of scoliosis possible?
Non-surgical treatment of scoliosis is possible in various ways. Follow-up is advised for the mild curves, meaning routine controls, examinations, and X-rays of the patients in particular time periods to define whether or not a curve is progressing. Exercise, physical therapy, and bracing can be applied for moderate curves. Permanent curve correction is not expected in bracing, however. Well-applied brace treatment is expected to prevent or decrease curve progression, so that the curves will not exceed the surgical limits.
How is scoliosis corrected? How does it heal?
The only proven way to correct scoliosis is surgery. However, because of the risk of potential complications, not all scoliosis patients are candidates for surgery.
When is scoliosis surgery necessary?
Surgical decision is typically based on the degree of the curvature. The main consideration is whether the curve will progress. Curve progression in skeletally immature patients necessitates surgery to correct the curve and prevent further progression.
The treatment scheme for the skeletally immature patients are as follows;
- 0-20 degrees is observation with follow-up controls
- 20-40 degrees is bracing
- And >40 degrees is surgical treatment
Skeletally mature patients and adults do not have the same risk of curve progression between 0-40 degrees. Hence, the surgical decision for adults is given when the thoracic curves are >45-50 degrees and lumbar curves are >40 degrees.
What are the other factors affecting the surgery desicion?
- The affected part of the spine
- The presence of increased or decreased kyphosis
- Residual potantial for growing
- Patient’s alignment and balance
- The HQRoL scores of the patients
- Pain (Rare in adolescents, more common in adults)
- Personal factors
What is the important of balance and off-balance in scoliosis?
The treatment algorithms for balanced and off-balanced scoliosis can differ. A curve causing serious off-balance might require surgery to maintain balance even below the surgical threshold degree of 40-50 degrees. Balance is important. A balanced gait is necessary for minimal energy expenditure during movement. For instance, an off-balanced person spends more energy to walk 100 meters than a balanced person. An off-balanced person will more quickly and easily become exhausted during the activities of daily living.
What hapens if surgery is not performed to a scoliosis that reaches or passes surgical threshold degrees?
Children or adolescents having a curve degree >40 degrees tend to progress with growth, and may reach to a severity that can cause lung and heart problems, decrease the quality of life, and shorten the lifespan.
Even in skeletally mature individuals, thoracic curves of >50 degrees and lumbar curves of >40 degrees tend to progress with time. This progression rate is not as fast as in the skeletally immature. Spinal degenerative changes will be absent or few in young adults. Likewise, comorbidities such as diabetes, hypertension, cardiovascular diseases, etc., will be less frequent. Therefore, surgical deformity correction for young adults may be more beneficial and easier than later adulthood and for the elderly.