Scoliosis is an abnormal curvature in the spine that some children, mostly girls, develop around 10 to 12 years old. It is almost never painful, except for perhaps a slight ache. Most of the time, it is discovered during a school screening.
I’ve noticed that most of the time, the patient and her parents are somewhat unsure why they’ve been sent to me. I thought that I would describe what happens once scoliosis is discovered.The size of the abnormal curvature is measured by what angle the top and bottom vertebrae make with each other. This is measured on an x-ray of the spine. The way we treat the scoliosis depends on several factors: the age of the patient, the size of the curvature, and where on the spine the curvature is located. Most curvatures stop getting bigger after a patient finishes her growth. However, if a girl reaches adulthood with a curvature over about 50°, she has a risk that the curvature will continue to get bigger throughout adulthood. If it gets too big it can lead to a chronic painful back or disfiguring deformity. The aim in treating scoliosis is to have a patient finish her growth with a curvature of under about 50°.
The following is a simplification, but it does describe the basic rules: if the size of a curve is under 20° (no matter how old the patient is) then we simply observe the patient over several months to see if it gets bigger. If the curve is between 20-25°, patients 10 to 12 years old would probably get a brace, while older patients would be observed. Curves of 25°-35° will in most patients require a brace. Curves between 35- 45° can be braced, but the effectiveness of treatment is somewhat less than optimal.
Curves higher than 45° are somewhat worrisome, because they are reaching that zone where progression during adulthood may be likely. In patients close to adulthood (usually over 14 years old) we will observe these curvatures closely. If the patient is younger and still looks like she has some growing to do, surgery may be necessary to halt the progression of the disease. This is because bracing curves so large is usually ineffective. Years of research have determined what prevents scoliosis from worsening and what doesn’t. The only two treatments that have been proven to work are bracing and surgery. There has been absolutely no evidence supporting the effectiveness of exercises, stretching, electrical stimulation, or chiropractic manipulation.