Scoliosis cannot be corrected by learning to sit or stand up straight. Food or vitamin supplements and exercise programmes have not been shown to be of value in treating the condition. Although about 10% of all male and female adolescents suffer from scoliosis, less than 1% have curves that require medical attention. Scoliosis can be mild, moderate or severe and treatment may include one or a combination of the following:
This non-operative treatment of scoliosis involves observing the deformity with regular examinations and follow-up x-rays. Curves that are less than 25 degrees can be observed at 4 to 6 monthly intervals. A growing child who has a curve greater than 25 degrees will require treatment. A brace may be used to treat progressive curves or curves more than 25 degrees.
Bracing is designed to stop the progression of the spinal curve, but it does not reduce the amount of angulation already present. Thoraco-lumbar-sacral orthosis (TLSO) is one of the more commonly used scoliosis braces. Spinal bracing is recommended for growing children with progressive curves. When the curves are large, surgery is the recommended option.
Surgery is recommended for growing children with curves that are greater than 40 degrees and for curves that are more than 50 degrees at any age. It is a common misconception that scoliosis does not progress after skeletal maturity. It has now been shown that if left untreated, large idiopathic curves above 50 degrees will continue to progress in adulthood.
Surgical treatment of scoliosis may be indicated for any of these reasons:
- To prevent further progression of the curve
- To control the curve when brace treatment is unsuccessful
- To improve an undesired cosmetic appearance
- For reasons of discomfort or postural fatigue
The most common surgical treatment for scoliosis is a spinal fusion using special stainless steel/titanium rods, hooks, screws and bone graft to carefully straighten the curved portion of the spine. In suitable patients, the surgery can be achieved through thoracoscopic “keyhole” techniques that require only 4 to 5 small openings on the side of the chest. Using modern spinal instrumentation, scoliosis patients who have undergone surgery lead normal and independent lives and can participate in most, if not all forms of sports. However, in the first few months after surgery, they need to be careful with physical activities.
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