The current treatment model for Scoliosis is Observation, Bracing and Surgery. However, the current model is also known the 'old model'. In the last decade, new non-invasive fusionless treatments were developed. These treatments focus on CAUSE of Scoliosis rather than the curvature itself (symptom). Scoliosis in Oman have tried one of the new alternative treatment (Scoliosis Bootcamp) for Scoliosis with positive results.
At this stage, no treatment is prescribed to the patient. The curvature is monitored to observe if its is progressing.
If the patient crosses the 20 degrees mark, they are usually prescribed a brace.
Bracing is normally done when the patient has bone growth remaining and is generally implemented to hold the curve and prevent it from progressing to the point where surgery is recommended. Hence, bracing is not used to improve the curvature.
The brace is usually worn 22–23 hours a day and applies direct pressure on the curves in the spine. The effectiveness of the brace depends not only on brace design and orthotist skill, but on patient compliance and amount of wear per day.
Bracing may cause emotional and physical discomfort. Physical activity may become more difficult because the brace presses against the stomach, making it difficult to breathe. Children may lose weight from the brace, due to increased pressure on the abdominal area.
The Scoliosis Research Society's recommendations for bracing include curves progressing to larger than 25 degrees, curves presenting between 30 and 45 degrees, Risser Sign 0, 1, or 2 (an x-ray measurement of a pelvic growth area), and less than 6 months from the onset of menses in girls.
Surgery for scoliosis is performed by a surgeon who specializes in spine surgery. For various reasons it is usually impossible to completely straighten a scoliotic spine, but in most cases significant corrections are achieved.
There are two main types of surgery:
One or both of these surgical procedures may be needed. The surgery may be done in one or two stages and, on average, will take four to eight hours.
Spinal fusion with instrumentation:
Spinal Fusion is the most widely performed surgery for scoliosis. In this procedure, bone (either harvested from elsewhere in the body autograft or from a donor allograft) is grafted to the vertebrae so that when it heals they will form one solid bone mass and the vertebral column becomes rigid. This prevents worsening of the curve, at the expense of some spinal movement. This can be performed from the anterior (front) aspect of the spine by entering the thoracic or abdominal cavity or, more commonly, performed from the back (posterior). A combination is used in more severe cases.
Originally, spinal fusions were done without metal implants. A cast was applied after the surgery, usually under traction to pull the curve as straight as possible and then hold it there while fusion took place. Unfortunately, there was a relatively high risk of pseudarthrosis (fusion failure) at one or more levels and significant correction could not always be achieved.
Risks & Complications:
Surgery without fusion
One of the biggest issues with the traditional surgery is the requirement to fuse the spine which does not only limit the flexibility of the spine it also limits the effectiveness off alternative treatments later on. Spinal fusion is irreversible. Fortunately, they are new surgical treatment that do not require fusing spine. Click here for more information.