Scoliosis - Treatment

Choosing Braces or Surgery

In general, the following criteria are used to determine whether a patient should be given braces and conservative therapies or surgery:

Braces tend to be used in children with curvatures between 25 and 40 degrees who still will be growing significantly.
Surgery is suggested for patients with curvatures over 50 degrees, in untreated patients, or when braces have failed. In adults, scoliosis rarely progresses beyond 40 degrees, but surgery may be required if the patient is in a great deal of pain or if it is causing neurologic problems.

The choice may not be so straightforward in certain cases and patients should discuss all options carefully with their physician.

Predicting the Extent of Curvature Progression

In Children and Adolescents:

Once a mild curve has been observed, the next step is more difficult: predicting whether the curve will progress into a more serious condition. Although as many as three in every 100 teenagers have a condition serious enough to need at least observation, progression is highly variable and individual. In a study of patients whose curves did progress after diagnosis, 34% progressed more than 10 degrees, 18% progressed more than 20 degrees, and 8% progressed more than 30 degrees. There are no definite risk factors for curve progression that help physicians predict with any certainty which patients will need aggressive treatment. Some evidence suggests the following factors may help determine patients at lower or higher risk:

Being female, particularly if taller than average.
Being younger at the onset of scoliosis.
Having a greater angle of curvature. For example, at 20 degrees, only about 20% of curves progress. Young people diagnosed with a 30-degree curve, however, have a risk for progression of 60%; with a curve of 50 degrees, the risk is 90%.
Curvatures caused by congenital scoliosis (spinal problems present at birth). These may progress rapidly.
Treatment with growth hormone. (Studies are mixed on whether this treatment poses any significant risk, although strict monitoring is still essential in young patients being given growth hormone.)

Curvatures may be less likely to progress in girls whose scoliosis was low in the back and whose spine was out of balance by more than an inch. Height also comes into play. For example, a shorter-than-average girl of 14 with low-back scoliosis of 25 to 35 degrees but whose spine is imbalanced by over an inch would have almost no risk. The same degree of curvature in the chest region of a tall 10-year old girl whose spine was in balance, however, would almost certainly progress.

In Adult-Onset Scoliosis:

In rare cases, unrecognized or untreated scoliosis in youth may progress, with the following curvatures posing low to high risk: