When it comes to scoliosis treatment options, patient education is important; they need to understand that the way they choose to address their scoliosis can shape their life-long spinal health and function. Different treatment approaches offer different potential results, and there are different types of surgical treatment.
Traditional scoliosis treatment involves a surgical response, and this can include a common posterior approach that involves attaching rods to the spine with screws, or a less-invasive surgical procedure known as an anterior approach, also known as vertebral body tethering.
Scoliosis patients have to decide whether they are going to attempt to treat their scoliosis with or without surgical treatment, so let's discuss why treatment response is so important.
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Being diagnosed with scoliosis means an unnatural sideways-bending and rotating spinal curve has developed, and a single unnatural spinal curve disrupts the alignment and biomechanics of the entire spine.
A scoliosis diagnosis also means being diagnosed with a progressive spinal condition whose nature is to get worse over time, and while we don't always know what triggers the initial onset of scoliosis, we do understand what triggers it to progress: growth.
There are also different types of scoliosis a person can be diagnosed with. The most common type overall to affect all ages is idiopathic scoliosis, meaning not clearly associated with a single-known cause, and adolescent idiopathic scoliosis is the most prevalent type overall, diagnosed between the ages of 10 and 18.
Scoliosis ranges widely in severity from mild scoliosis to moderate scoliosis and severe to very severe scoliosis, and scoliosis progressing means the condition is becoming more severe, the size of the scoliotic curve is increasing, as are the condition's uneven forces, and their effects.
As scoliosis progresses, it gets more complex to treat; the spine becomes more rigid, making it less responsive to treatment, and making it difficult for some patients to perform certain therapeutic exercises as part of treatment.
It's far more effective to proactively work towards preventing progression, increasing condition effects, and the need for surgery, than it is to attempt to reverse the condition's increasing effects once they're established.
When it comes to childhood scoliosis, the most noticeable condition effect is postural deviation, and in adults, it's pain, and this is because scoliosis doesn't become a compressive condition until skeletal maturity has been reached.
Improving spinal stability is important to prevent further curve progression, and if a patient is on the path of traditional scoliosis treatment, when/if they progress to become severe scoliosis, they become a surgical candidate.
When it comes to the surgical treatment of scoliosis, we're talking about a surgical procedure with the goal of stopping progression, and this involves holding the spine in a corrective position.
Just as there are different ways to respond to a diagnosis of scoliosis, there are different surgical treatment options for patients to consider, so let's discuss the difference between what's known as anterior scoliosis correction versus a posterior approach for scoliosis.
An anterior approach for scoliosis is a less-invasive procedure than traditional spinal fusion and is also known as vertebral body tethering (VBT).
The process of vertebral body tethering involves making small incisions called portals along one side of the patient's body.
This approach has the benefit of muscle-sparing because in traditional spinal fusion that involves surgical entry through the back, muscles are cut, making recovery longer and potentially damaging muscles.
Through the portals, a tiny scope and camera are passed so the spine can be visualized, screws are attached to the vertebrae, and the screws are attached to a flexible tether; when tension is adjusted on the tether, the spine is pulled back into a corrective position and healthier alignment.
The benefit of an anterior approach to scoliosis correction is that it's better for preserving the spine's natural strength and function, it's better for the spine's surrounding muscle health, and can be ideal for patients who have growth yet to go through (adjustments can easily be made in response to growth).
However, no surgical procedure comes without risks, especially spinal surgery, and the potential complications of anterior scoliosis treatment include overcorrection, cord breakage, and the need for more surgery.
For patients having traditional spinal fusion performed, this is also known as a posterior approach.
A posterior approach for scoliosis is referring to traditional spinal fusion surgery which involves fusing the curve's most-tilted vertebrae into one solid bone, and this is done by entering the back, removing the intervertebral discs that sit between adjacent vertebrae to be fused, and attaching rods to the spine with pedicle screws to hold it in place.
Once a spine is fused in this manner, that's how it stays, unless there is a malfunction or hardware breakdown, which means more surgery and facing more risks.
Posterior spinal fusion can't be adjusted in response to growth, and a fused spine is fused for life, and while rare, screws can come loose, and rods can crack or break over time.
Traditional posterior spinal fusion has risks associated with the procedure itself:
The real risks I want patients to be aware of are those that affect long-term spinal health and function and shape a person's overall quality of life:
The truth is any type of spinal surgery carries potential risks, side effects, and complications, so should be considered carefully, and many cases of scoliosis don't require surgical treatment, so let's take a minute to discuss the benefit of a conservative non-surgical scoliosis treatment response.
Conservative scoliosis treatment is what my patients receive here at the Scoliosis Reduction Center, where the ultimate treatment goal is a better quality of life, and I believe that avoiding spinal surgery is an important part of that.
Conservative scoliosis treatment has proven results, and when it comes to treating typical cases of idiopathic scoliosis, an integrative approach that combines condition-specific chiropractic care, physical therapy and the power of scoliosis-specific exercises focus on a number of things (the schroth method and schroth exercises, corrective exercises, and a scientific exercise approach), corrective bracing, and rehabilitation treatment.
Chiropractic care can work towards adjusting the position of the curve's most-tilted vertebrae to reduce the size of the scoliotic spinal curve on a structural level, improve joint mobility, neuromuscular control, improve spinal balance, spinal stabilization, decrease cobb angle, and realign the patient's spine.
Physical therapy and corrective exercises can help strengthen the spine's surrounding muscles for optimal spinal support, stabilization, postural correction, postural control, corrective breathing, slowing curve progression, and muscle activation.
Corrective bracing can help by pushing the spine into a corrective position, and rehabilitation can involve a home exercise program for further healing and stabilizing the spine.
Conservative scoliosis treatment offers three-dimensional treatment that impacts conditions on every level for significant improvement, and scoliosis-specific conservative treatment can help reduce an unnatural spinal curvature in a way that doesn't disrupt natural spinal strength and function.
Deciding on a scoliosis approach to treatment is important because choosing to commit to one type of treatment over another can have far-reaching effects; while an anterior approach for scoliosis involves accessing the spine from the side through small incisions, a posterior approach is traditional scoliosis surgery that involves accessing the spine through the back and attaching rods with pedicle screws.
As scoliosis is the leading spinal deformity amongst school-aged children, and the Scoliosis Research Society has current estimates at close to seven million people currently living with scoliosis in the United States alone, awareness and patient education is warranted.
Scoliosis curves introduce a lot of uneven forces to the spine, its surrounding muscles and nerves, and the entire body.
As a progressive condition, if scoliosis is left untreated, it's virtually guaranteed to get worse over time, and this means the condition's effects are going to become more noticeable (uneven shoulders, shoulder blades, uneven hips, the development of a rib cage arch, and pain).
Conservative management of scoliosis involves reducing the scoliotic curve on a structural level, increasing core strength for optimal spinal support/stability, and continued rehabilitative care for long-term sustainable treatment results.
Treating patients with scoliosis involves patient education to ensure they are aware of all treatment options available to them, and that they fully understand the pros and cons of each.
