The two main treatment approaches for scoliosis are the traditional and conservative approach. The former is characterized by passively monitoring for progression and likely spinal-fusion surgery, while the latter involves proactive treatment started as close to the time of diagnosis as possible. When successful, both options can result in having a straighter spine, but the way that straighter spine is achieved affects the spine’s overall health and function differently; keep reading to understand the different treatment outcomes.
As a progressive and incurable spinal condition, scoliosis won’t go away on its own, and if left untreated, it can get worse. Choosing how to treat scoliosis will have far-reaching effects; different treatment options have different outcomes, which is what every patient needs to understand.
Scoliosis is a complex condition with a lot of important characteristics. Before we move on to the different treatment approaches and the means by which they reach their end goals, let’s talk generally about scoliosis for a more comprehensive understanding of the condition.
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Scoliosis is a progressive spinal condition that is incurable and involves having an abnormal sideways curvature of the spine that also rotates.
As the nature of scoliosis is progressive, this means that if left untreated, or not treated appropriately, it will get worse over time.
Progression is an extremely important condition characteristic as it, among other variables, drives the treatment approach moving forward.
Patient age is a big factor when it comes to determining a patient’s likeliest progressive rate, which is important because as one of my treatment goals is to help patients avoid reaching the higher stages of progression, constant effort has to be made to monitor for, and respond proactively to, how a patient’s curvature is progressing.
For young patients who have not yet reached skeletal maturity, we know they are at risk for rapid-phase progression, and this is because their spines are still growing, and we know that growth is the condition’s number-one trigger for progression.
The condition’s most prevalent form is adolescent idiopathic scoliosis (AIS), diagnosed between the ages of 10 and 18, and as we know this age group is going to experience the rapid and unpredictable growth spurts characteristic of puberty, managing progression is an important focus of treatment.
In fact, 80 percent of known scoliosis cases are classified as ‘idiopathic’, meaning the condition is not associated with any single-known cause, and is, instead, generally considered to be ‘multifactorial’, meaning caused my multiple factors that can vary from one patient to the next.
The remaining 20 percent of scoliosis cases have known causes and are classified as neuromuscular, congenital, degenerative, or traumatic scoliosis.
With adults who have reached skeletal maturity, the big trigger of growth is removed, but as scoliosis is progressive at any age, even if at a slower rate, adults will still progress, and over time, even with a seemingly-minor progressive rate of 1 degree a year, that can have the cumulative effect of a large curvature over 10, 15, 20 years.
So now that we have touched on the nature of scoliosis as treatable, progressive, and the different types that can develop, let’s move on to the benefits of early detection, before moving on to the different treatment options.
Early detection is an important topic when it comes to scoliosis treatment, especially in cases where rapid progression is likely due to skeletal immaturity.
As scoliosis is progressive, even if it starts as a very-mild curvature, it will, at some point, increase in size, and this is what proactive treatment wants to avoid. Let’s take a minute here to explain why this is important in terms of how much variance there is within the condition, and this is based largely on condition severity.
Condition severity is determined by the size of the abnormal spinal curvature. As the bones of the spine (vertebrae) bend and twist into an unnatural curvature, this throws the entire spine out of alignment, impacting it on a structural level.
Part of the parameters that have to be met for a scoliosis diagnosis to be given is that the spinal curvature is of a minimum size, and includes rotation; a scoliotic curve has to have a Cobb angle measurement of at least 10 degrees.
While every case is different, generally speaking, the higher the Cobb angle, the more severe the condition.
Cobb Angle and Condition Severity
A patient’s Cobb angle is obtained via X-ray, and by drawing intersecting lines from the tops and bottoms of the curvature’s most-tilted vertebrae, the resulting angle tells me how far out of alignment a patient’s spine is, and this places the condition on its severity scale of mild, moderate, severe, or very severe:
As you can see by the large range of numbers, scoliosis varies greatly in severity, which is why the nature of scoliosis necessitates a customized treatment approach; it’s also why early detection, while important, is not always easily achieved.
Cases that are mild are not always easy to spot, other than for specialists who can recognize the condition’s early signs: uneven hips and shoulders.
In mild forms, the condition also isn’t known to produce noticeable functional deficits, and in patients who have not yet reached skeletal maturity, as in the condition’s most-prevalent form, the condition is rarely painful, so it’s not uncommon for patients to progress through adolescence with scoliosis undiagnosed and untreated; obviously, the real danger to this is that it will mean, by the time the condition has progressed to the point of producing overt symptoms like pain and noticeable postural changes, the spine is in far worse shape than if those same patients had had their conditions diagnosed and treated during adolescence.
Early detection means diagnosing and treating a condition while the curvature is at its smallest, is more flexible, and the body has not had ample time to adjust to its presence.
Treating a smaller curvature is far simpler than treating one that’s larger, and there are numerous treatment benefits related to early detection; however, those benefits are only available to those following a certain treatment approach that values and applies proactive treatment.
Let’s move on to exploring the two main treatment approaches for scoliosis: traditional and conservative.
As mentioned earlier, different treatment approaches offer different outcomes as they have different end goals, and how those end goals are achieved affect the spine in different ways.
I fully encourage that all patients, and their families, do their own due diligence in researching potential treatment options, to ensure their expectations are aligned with the realities of what their chosen treatment approach offers.
There are two main treatment approaches for people to choose between: traditional and conservative.
As the traditional approach has been in place for many years, let’s start there.
While the traditional scoliosis treatment approach has been the dominant approach for many years, newer dynamic options have evolved that reflect our growing understanding of the condition.
The traditional approach involves passively monitoring for progression, meaning that doctors using this method don’t initiate proactive treatment until the condition has progressed to a certain point.
In a typical case of AIS, if an adolescent presented with mild scoliosis, traditional guidance would likely tell the patient, and their family, that as the case is mild, it needs to be observed to monitor for progression; this is a fork in the road of deciding whether to proactively treat the curvature while it is still small, or to wait and see if it gets larger, at which point valuable treatment time has been wasted.
The thing is, we know scoliosis is progressive, meaning we know it’s going to get worse at some point, so why sit back and wait for it to happen?
Most likely, that young patient would be told to return every 3 to 6 months, sometimes 12, (depending on the doctor) for X-rays to be done to assess changes to the curvature. If progression is not observed, no treatment will be applied, other than continued monitoring; if progression is occurring and that patient has moved into the ‘moderate’ stage, the only form of treatment recommended by the traditional approach would be bracing.
Treatment approaches are mainly governed by two things: their end goal and the methods they use to reach that end goal. In the traditional approach, the end goal is not correction, but stopping/slowing progression, and while that might seem like the same thing, it’s not.
‘Correction’ means reducing the curvature on a structural level, and increasing core strength, so the reduction can be sustained and the spine is adequately supported and stabilized. When stopping progression is the end goal, this means that treatment disciplines like bracing are applied in an attempt to control progression; this is done by ‘squeezing’ the spine into a corrective position, but not actually correcting it on a structural level. Just as there are never treatment guarantees, there is also no guarantee that bracing will stop progression.
Once a condition has progressed and traditional bracing is recommended, the idea is to squeeze the spine into a straighter alignment, and this is achieved through the use of traditional braces like the Boston brace.
Traditional Bracing Options: Boston Brace
So once a patient has shown progression and moved into the ‘moderate’ classification, along the traditional treatment route, bracing is likely to be recommended.
As is the overall goal of traditional treatment, the goal of traditional bracing is to control progression, not to actually correct the structural abnormality within the spine, which is the scoliosis itself.
The most commonly-used traditional brace in the United States is the Boston brace, and this is a type of hard-plastic brace that’s designed for full-time wear, which can mean anywhere from 18 to 23 hours a day; as you can likely imagine, considering the main age group of people diagnosed with scoliosis (adolescents), compliance can be a big challenge, especially as the brace is difficult to hide under clothing, restricts activities, and is uncomfortable to wear.
The design of the Boston brace has not changed much over the years, is mass-produced, cumbersome to wear, and uses strategically-placed pressure pads to squeeze the spine, from the sides, into a straighter alignment.
Remember, squeezing the spine into a better position is not the same as correcting it on a structural level, which we’ll come back to later. In addition, the Boston brace does not address the 3-dimensional nature of scoliosis (its rotational component), so its effectiveness can be limited.
So while the Boston brace does have the potential to make a scoliotic spine straighter, the way it achieves that end goal, by squeezing the spine into a healthier alignment, puts a lot of pressure on the already-compromised vertebrae, and this can actually lead to a weaker spine, increased rotation and a larger rib arch, and potentially lead to other problems down the road.
Now, let’s say, the Boston brace doesn’t succeed in stopping a patient’s scoliosis from progressing into the ‘severe’ or ‘very-severe’ classification, this means the condition has passed the surgical-level threshold, and most often, spinal-fusion surgery is recommended as the best remaining option.
Let’s talk about the process of spinal fusion, the risks that it carries, and the potential outcomes it offers patients.
The process of scoliosis surgery is lengthy and invasive, and spinal fusion is neither the only, nor the best, option available.
While any surgical procedure comes with risks, scoliosis surgery comes with some significant ones, both in the short and long term, which is why I encourage patients to fully research what living with a fused spine is like.
Scoliosis surgery involves fusing the most-tilted vertebrae of the curvature into one solid bone, and while there are different types of spinal fusion, most involve attaching rods to the spine with screws to hold it in place throughout the fusion process.
What this does is attempt to control progression by eliminating movement in that area of the spine; as the vertebrae are fused into one bone, there is a loss of flexibility at the site of fusion, so depending on how many vertebrae are fused and the site of the fusion, the resulting loss of spinal flexibility can be disappointing for patients, with some finding they can no longer enjoy the activities they could pre-surgery.
Some patients also experience an increase in scoliosis-related pain, particularly at the fusion site. Once a spine is fused, it’s quite simply not as strong as it once was. The spine’s natural curvatures and alignment give it added strength, flexibility, and allow the spine to evenly distribute stress and weight throughout.
A spine that is being held in position is more prone to injury than a spine that, through functional treatment, has been impacted on a structural level so as much of the spine’s natural biomechanics as possible are restored.
In addition, many people choose spinal fusion for cosmetic reasons. They think that surgery is the only way to get their pre-scoliosis bodies back, and while the surgery can produce some postural changes, many patients are disappointed that their body, post-surgery, is still not fully symmetrical.
Scoliosis surgery itself comes with risk of infection, nerve damage, adverse reaction to the hardware used, blood loss, and there is no guarantee that the surgery will stop progression.
If the surgery is deemed unsuccessful, there is no recourse other than subsequent surgeries. A fused spine is a fused spine; there is no unfusing it.
Another fact I think patients should be aware of is that there is a lack of long-term data on the effects of living with a fused spine 15, 20, 30 years down the road. Hardware can fail, break, need to be replaced, and quite simply, we just don’t know how long the hardware used for the procedure will remain optimal inside the body.
So can scoliosis surgery make a crooked spine straighter? In simple terms, yes, it can, but at what cost? We know that fusing the spine is not the same as attempting to re-align it by more natural disciplines on a structural level, and we know that an unnaturally-fused spine is not as strong and flexible as a spine that relies on its own strength and surrounding muscles for optimal alignment.
Here at the Scoliosis Reduction Center, I offer patients, and their families, another option: scoliosis treatment without surgery through a conservative approach that prioritizes the spine’s function and overall health.
So here at the Center, for those who have chosen to forego a surgical recommendation, or are simply interested in exploring a more natural and less-invasive treatment option first, my chiropractic-centered approach offers patients a different potential outcome.
As mentioned, I believe in being proactive. As soon as I have diagnosed a patient with scoliosis, or have assessed a patient’s previously-diagnosed condition, I start treatment as soon as possible.
I want to spare my patients the hardships associated with the condition’s increasing severity levels, and I want to achieve this through integrating multiple treatment disciplines that complement one another in such a way that the spine’s overall health and function are preserved throughout treatment and beyond.
My approach can also be referred to as ‘functional’, because the end goal is to preserve the spine’s optimal function, as I believe this gives my patients the best possible quality of life moving forward.
While I’m always working towards achieving a curvature reduction on a structural level, first and foremost, I want to achieve this in such a way that the strength of the spine, and its surrounding muscles, are preserved and improved upon.
While I do value curvature reductions, I don’t hold its importance above the spine’s overall health and function; if a scoliotic spine is made straighter with a big reduction, but that reduction was achieved by a means that sacrificed the spine’s function and health, to me, this does not give patients the quality of life I want for them as it can mean discomfort, mobility issues, and activity restrictions.
As mentioned earlier, scoliosis is not curable, meaning a person who has scoliosis will have it for the duration of their lives; this means that even once a treatment plan has been successful at managing the condition, work will still have to be done to sustain those results.
This is another reason choosing how to treat your scoliosis moving forward is such an important decision: because how the scoliosis is addressed and treated will have life-long consequences.
Here at the Center, I combine multiple treatment disciplines for a customized approach. As every case is different, each corresponding treatment plan should also be unique. Integrating multiple forms of treatment that complement each other produces the best possible results by allowing me to apportion each discipline accordingly; that way, the specifics of each patient and their condition are addressed.
My treatment disciplines are scoliosis-specific and include chiropractic care, in-office therapy, custom-prescribed home exercises, and specialized corrective bracing.
In the conservative approach, we also rely on bracing as part of our treatment for certain patients, but scoliosis braces, like most things, are not all created equal.
As we discussed the Boston brace that’s commonly used in the traditional approach, we’ll now explore the ScoliBrace, a modern corrective brace that offers patients a different outcome.
The ScoliBrace represents a new era for bracing as a scoliosis treatment option: one that evolved alongside our understanding of the condition.
The ScoliBrace is not as cumbersome as its predecessors, nor is it mass produced; it’s custom designed to suit each patient’s body type, curve type, and spinal flexibility using 3-D imaging software, X-ray images, and postural photos.
As each ScoliBrace is bespoke to its wearer, it’s more comfortable and poses fewer activity restrictions. As correction is its goal, the ScoliBrace is designed to position the patient’s body in an over-corrected mirror image of their spinal misalignment; over time, and when combined with other forms of treatment, this can lead to a curvature reduction and decreased postural distortions caused by the abnormal curvature’s presence.
So to summarize, the ScoliBrace is super corrective, addresses the 3-dimensional nature of scoliosis, is patient-friendly, and isn’t associated with weakening the spine and muscle-wasting due to strict activity restrictions.
What makes a brace truly effective as a scoliosis treatment option is its design, which is determined by its end goal. A brace’s design will determine how well the brace functions and the type of results it can achieve.
However, a poorly-designed brace, or one that does not address the 3-dimensional nature of scoliosis, is not only unlikely to be an effective form of treatment, but can also hinder the effectiveness of other facets of treatment.
While no treatment results are ever guaranteed, in general, the more corrective potential a brace has, the better treatment results it can produce.
To summarize the difference between a typical traditional brace and a corrective brace, remember that the Boston brace does not have a lot of corrective potential because it’s designed to stop the curvature from getting worse by squeezing it from the sides, while a corrective brace, like the ScoliBrace, pushes (not squeezes) the spine into an ultra-corrective position: two very different methods that affect the spine differently.
By positioning a patient’s body and spine into an overcorrected mirror-image position, a super-corrective effect can be achieved, and this is why we favor the use of the ScoliBrace here at the Center.
So now that we have talked generally about scoliosis, the difference between the two main treatment approaches and the different results they offer, including different bracing treatment options, let’s move on to the topic of adult scoliosis.
Through the bulk of this article, and indeed other content you’re likely to encounter on your scoliosis-research journey, the focus is on scoliosis in young children and adolescents; this is because, as mentioned, scoliosis is most prevalent in these age groups, but adults can develop it too.
For adults, the two main types of scoliosis that affect them are idiopathic and degenerative.
Adults diagnosed with idiopathic scoliosi are cases of adolescents who developed the condition, but progressed with it into maturity undiagnosed and untreated. In these types of cases, it’s likely that the condition was mild during adolescence, and as it’s rarely painful at that age and isn’t commonly associated with producing functional deficits at this stage, it went unnoticed.
It’s quite common that once a patient reaches skeletal maturity and is vulnerable to compression, the condition becomes painful, bringing adults in for a diagnosis and treatment.
The unfortunate reality is that had these patients been screened and/or assessed during adolescence and received proactive treatment, their spines would be in far better shape than they are by the time I see them; that being said, however, it is never too late to seek out treatment and work towards varying levels of improvement.
Remember, even after skeletal maturity has been reached, the condition can still progress, and even at a glacial pace, over the years, the cumulative effect of incremental increases in a patient’s Cobb angle can add up to a severe scoliotic curve at some point, so why take that risk?
In addition, as natural degenerative effects of aging come into play and affect the spine, that progressive rate can also increase.
As a person ages, the body faces natural degenerative changes, including the spine. Certain lifestyle choices can also factor into this as the cumulative effect of leading a sedentary lifestyle, not maintaining a healthy weight, chronic poor posture, and repeatedly lifting heavy objects incorrectly can speed up spinal degeneration.
Most commonly, it’s the intervertebral discs that experience the bulk of the spine’s degenerative changes.
The spine is made up of bones (vertebrae) that are stacked on top of one another and are separated by discs sitting between adjacent vertebrae. These discs have a tough and durable outer layer and a soft gel-like interior.
The discs perform many important roles, both in terms of the spine’s health and function. They help cushion the vertebrae so friction is not generated during movement, provide the spine with structure by holding its parts together, help facilitate the spine’s flexibility and movement, and are instrumental in maintaining the spine’s healthy curvatures and alignment.
When one or more of the spine’s intervertebral discs start to deteriorate, they can dry out, lose height, and this can cause the spine to become misaligned and degenerative scoliosis to develop.
Treating Adult Scoliosis
When it comes to scoliosis treatment options for adults, the treatment focus can shift from controlling progression to pain management and increasing the spine’s support and stabilization.
While every case is different, the main treatment options for adult scoliosis patients include scoliosis-specific exercises, gentle chiropractic adjustments, and bracing when needed.
We still always want to work towards a curvature reduction, but sometimes with adults, initial work has to be done to help restore some of the spine’s flexibility before treatment disciplines like scoliosis-specific exercises and stretches can be integrated into the treatment plan.
With adults, pain management can be an important part of treatment, and here at the Center, we approach pain management by addressing its underlying cause: the scoliosis itself.
By working towards impacting an adult’s scoliosis on a structural level through realigning the spine as much as possible, this addresses the cause of pain, along with any other scoliosis-related symptoms and/or postural changes.
When it comes to bracing for adults, they can be used differently in terms of part-time use for the short-term effect of pain relief, and while bracing for support and pain relief can characterize adult bracing in the traditional approach, when a corrective brace is combined with other forms of treatment in a conservative approach, adults can also experience some corrective potential and results.
When it comes to how best to treat scoliosis, the answer will change from patient to patient, based on the type of outcome they want; every case of scoliosis is different.
Scoliosis can range from mild to moderate and severe to very severe. The condition can develop in different areas of the spine, affect all age groups, cause pain in some but not in others, and can develop different forms, some with known, and others with unknown causes.
An important question for patients to ask is what type of lifestyle they want their chosen treatment approach to facilitate. As mentioned, scoliosis is progressive and incurable, so ensuring that all treatment options have been explored is important as the choice can have life-long consequences.
While the traditional approach can offer people a straighter spine through scoliosis surgery, that result is never guaranteed, and its passive approach that funnels patients towards surgery is not taking advantage of the treatment benefits associated with early detection and proactive treatment.
In addition, some patients are disappointed with their scoliosis-surgery results in terms of experienced side effects, complications, increased back pain, disappointing cosmetic results, and many find their spines are no longer flexible enough to take part in the activities they love.
In the conservative and functional approach I offer patients of the Scoliosis Reduction Center, the priority is not only to manage progression, but also to impact the condition on a structural level for more corrective potential.
By being proactive and initiating treatment as close to the time of diagnosis as possible, my patients experience measurable results that help prevent them from having to face more severe symptoms and invasive forms of treatment down the road.
When it comes to scoliosis treatment options, patients have to really consider what their priorities are. Is it a straighter spine achieved by a means that makes the spine less functional, or is it an outcome that preserves the spine’s function and overall health?
Ultimately, I want my patients to have the best possible quality of life throughout treatment and beyond. I’m playing the long game with my patients as the condition will be with them throughout their lives, and when I combine different scoliosis-specific treatment disciplines that work together to impact the condition on multiple levels, that goal can become my patients’ reality.