25 Sep Scoliosis: Conservative Management Versus Surgery
Scoliosis is a condition where the spine is rotated and curved sideways. It usually occurs during the growth spurt of puberty. Although there are many causes of scoliosis, such as cerebral palsy and muscular dystrophy, most cases of scoliosis have an unknown cause. However, idiopathic scoliosis has a tendency to run in families but the specific genes involved have yet to be identified. Approximately 3% of the world’s population is estimated to have idiopathic scoliosis. Symptoms may include physical deformity and pain.
The management for scoliosis aims to reduce pain and neurologic symptoms. It also focuses on improving the functionality of patients to enhance their quality of life. The treatment differs according to the severity of scoliosis: mild, moderate, and severe curves of the spine. It is tailored based on each individual’s needs.
- Observation – 90% of cases are mild and only require observation by a doctor every four to six months.
- Braces – are typically used for children or adolescents who are still growing if they have moderate scoliosis. It is considered if the curve is past 25 to 30 degrees or if the curve progresses at least 5 degrees in a 4 to 6-month period. A brace does not cure or correct scoliosis but it can prevent the progression of the condition. It is most commonly made of plastic and contours to fit the body. It has to be worn throughout the day as the effectiveness increases the more it is worn. Braces can be worn for most activities as it has few restrictions.
- Full-time: braces are worn 16 – 23 hours a day.
- Night-time: Hyper-corrective forces are used and restrict activities. It is worn at least 8 hours every night.
- Other methods – Other methods do not have much scientific evidence to support the effectiveness of it. These include electrical muscle stimulation, physical therapy, spinal manipulation, and nutritional therapies.
Surgical Management – it has been found that despite surgical correction, approximately 38% of patients still experience back pain. The main goal of surgery is to use the affected vertebrae. Surgery is only considered for patients with severe scoliosis or in cases where the condition is progressing fast.
- Minimally invasive spinal surgery for scoliosis has been available since 1993. It aims to decrease surgical complications and improving recovery rates. Minimally invasive spinal surgery requires smaller incisions and causes less scarring compared to traditional open surgeries. There is also less blood loss, shorter hospital stays, lower infection rates, fewer complications, and faster recovery rates.
- After surgery, the patient is monitored closely, initially in the intensive care unit. Postoperative bracing may be required, according to surgeon preference. Activities are limited up to 6 months. Strenuous activities may be restricted for a minimum period of one year.
The treatment for scoliosis aims to reduce symptoms such as pain and improve the functionality of patients to enhance their quality of life. The majority of patients can be managed conservatively. However, in severe cases of scoliosis, patients can be managed surgically by fusing the vertebrae.