Non-surgical treatment options for idiopathic scoliosis

Treatment decisions are primarily based on the skeletal maturity of the patient (or rather, how much more growth can be expected) as well as the degree of curvature. The cause of idiopathic scoliosis is unknown (idiopathic literally means "cause unknown"), but the way curves behave is fairly well understood. The younger the patient and the bigger the curve, the more likely the curve is to progress.

There are essentially three treatment options for adolescents with scoliosis: observation, bracing, and scoliosis surgery. There have been large trials of other forms of treatments, none of which have been shown to be effective. Electrical stimulation, physical therapy, chiropractic manipulation, osteopathic manipulation, or other manual treatments have not been shown to reduce the curvature or to prevent progression.

There is no reason to require a child to modify their activities, such as wearing their book bag on one shoulder or another, or to limit their activities, since activity does not affect the curve.

Because idiopathic scoliosis is considered a deformity, scoliosis treatment is largely centered on reducing or limiting the progression of the deformity and is not focused on treatment of pain.

Observation
The curvature is measured on x-rays by what is known as the Cobb method, and this form of measurement is accurate to within 3 to 5 degrees.

Curves that are less than 10 degrees are not considered to even represent scoliosis but rather spinal asymmetry. These types of curves are extremely unlikely to progress and generally do not need any treatment. If the child is very young and physically immature, then the progress of the curve can be followed during the child's regular check up with his or her pediatrician. If the curve is noticed to progress beyond 20 degrees, then the child should be referred to an orthopedic surgeon for continued treatment.

Curves that are between 20 to 30 degrees in a growing child can be observed at 4 to 6 month intervals. Any progression that is less than 5 degrees is not considered significant. If the curve progresses more than 5 degrees, then the curve will need treatment. Any curve over 30 degrees in a skeletally immature patient (child who is still growing) will need treatment.

Treatment for patients with progressing curves, or curves over 30 degrees in a skeletally immature patient, is usually centered on use of a back brace.

Back braces
Bracing is designed to stop the progression of the spinal curve, but it does not reduce the amount of angulation already present. The majority of curve progression happens during a child's growth phase, and once the growth has ended, there is little likelihood of progression of a curve. Therefore, bracing is continued until the child is skeletally mature and finished growing.

The only curves that tend to continue to progress after skeletal maturity are those that are greater than 50 degrees in angulation, so the treatment objective is to try to get the child into adulthood with less than a 50 degree curvature.

There are two types of commonly used scoliosis braces: a thoracolumbar sacral orthosis (TLSO) and a Charleston bending brace.

The TLSO is a custom molded back brace that applies three-point pressure to the curvature to prevent its progression. It can be worn under loose fitting clothing, and is usually worn 23 hours a day. It can be taken off to swim or to play sports.
A Charleston bending back brace applies more pressure and bends the child against the curve. It is worn only at night while the child is asleep.

Since bracing only works to stop the progression of the curvature in a growing child, it is not used for those children who are already skeletally mature or almost mature. It is only used for younger children (girls who are about 11 to 13 years old, and boys who are about 12 to 14 years). If an older child has a curve greater than 30 degrees and is almost mature, his or her curvature will be treated with observation only, as there is little growth left and bracing will be unlikely to do much good.

Unfortunately, even with appropriate bracing, some spinal curves will continue to progress. For these cases, especially if the child is very young, bracing may still be continued to allow the child to grow before fusing the spine. Many times it is very difficult to predict which curves will continue to progress and need surgery later, especially if the child is young and skeletally immature. When in doubt, many physicians will recommend treatment with a brace.