Scoliosis - Treatment

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Presence of Other Health Conditions. Children in poor health may suffer more from stressful scoliosis treatments than other children. On the other hand, children who have existing conditions and are predisposed to lung and heart problems may warrant immediate, aggressive treatment.

Choosing Braces or Surgery

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

• Braces tend to be used in children with curvatures between 25 - 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 the scoliosis causes neurological problems.

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

Predicting the Extent of Curvature Progression

In Children and Adolescents. After a mild curve is detected, a more difficult step is required: predicting whether the curve will progress into a more serious condition. Although as many as 3 in every 100 teenagers have a condition serious enough to need at least observation, progression is highly variable and individual.

Doctors cannot rely on any definitive risk factors for curve progression to 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:

• 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.)