What is Scoliosis?
Scoliosis is a curve of the spine. Usually the curve progresses (gets more severe) during a growth spurt. It often progresses significantly during puberty which is why many schools do scoliosis checks in late Elementary or Early Middle School years. Ideally, if scoliosis is identified early enough it can be treated without surgery.
During the initial screening kids may appear to have one shoulder higher than the other. Also, when your child bends forward, you may notice a rounded part, or hump, -for lack of a better word- sticking out higher on one side than the other.
It is often defined as a “C curve”, meaning only one major curve, or an S” curve” which is 2 separate curves. Curvature is the amount of “curve” seen on an Xray, and is also known as the Cobb Angle. Rotation is usually seen in the size of the “hump”.
How is Scoliosis Treated?
Observation
If your child has a positive scoliosis screen, your healthcare provider will order an x-ray to measure the size of the curve. Curves less than 20 degrees are usually monitored every 4-6 months to see if the curve starts to progress (get bigger) or stays the same.
Bracing Curves in the 20-40 degree range are generally treated with a back brace. The back braces are made of hard plastic on the outside with some type of foam padding on the inside. Bracing will not correct the curve. The purpose of the brace is to keep the curve from getting worse as the patient grows. The goal is to have the curve decrease to about 1/2 of what it was before the brace.
Two common braces are the Boston Brace and the Providence Brace.
Boston Brace on Bottom
Providence Braces are worn at night because the way they fit to hold the spine works better laying down and makes it difficult to stand up. They are worn 8-12 hours a night. Boston Braces are worn day and night for at least 16 hours a day and up to 23 hours.
Both braces should be worn with a thin layer such as a tank top or a seemless T-shirt. www.bracebuddies.co is a website featuring liners that fold back over the brace for more comfort and style.
Shroth Physical Therapy is a special series of stretching and breathing exercises to help elongate the spine and decrease the curvature. It is performed by a licensed Physical Therapist certified in the Shroth Method. Some patients report great results in reduces their curve and avoiding surgery. However it is hard prove how well it works because it is difficult to know how much home based exercise each patient does.
Surgery
Fusion surgery is used for patients with a curve greater than 45 degrees after the patient stops growing. It can also be used for a patient whose curve is not responding to bracing.
During Fusion metal rods are attached to either side of the spine to straighten the spine and realign the rotation. Then the vertebrae are grafted together, with bone material from the patient or a bone bank. The rods serve as a splint while the bones fuse together. It takes about 3-6 months for the initial fusing process and up to a year, depending on the patient, for the spine to be completely fused. The rods are not usually removed because it would be an unnecessary major surgery.
Vertebral Body Tethering – VBT surgery is generally used for patients with a curve between 35-70 degrees who still have growth left. Although some doctors will do surgery on patients outside of this range. Doctors determine how much growth a patient has left based on x-rays of either their hip bone (Risser Scale) or or their wrist (Sanders Score).
During VBT, Titanium screws are attached to the patients’ vertebrae on the convex side of the curve. A tethering band is attached to these screws to straighten the spine as the patient grows. At this time, the Zimmer system for VBT has been FDA approved under a Humanitarian clause. The Globus VBT system is in the process of getting VBT approval. VBT has been performed by many surgeons on many patients over the last 8 years. However it is still considered experimental surgery since it has not been used long enough to have the long term data success and/or complications that fusion surgery does.
The spine is accessed from the anterior approach, which means there are small incisions on the patient’s side as opposed to a long incision on the patients back. However, because the spine is accessed from the side, the patient’s lung needs to be deflated in order for the surgeon to put the screws into the spine. This is managed by the anesthesia provider working during the surgery. Also, because the VBT surgery is less invasive (think several small incisions as opposed to long open incisions), patients recover faster. Most patients are healed and off spinal precautions (No Bending, Twisting, Lifting more than 10 pounds) in about 6 wks and can slowly ease into regular activities and sports after that.
Anterior Scoliosis Corrective Surgery – ASC is another surgery that uses the same principles of VBT but can be used on scoliosis patients who have stopped growing.