Often we are faced with a health challenge that we seek out care for and in return get multiple differences of opinion. Sometimes a family member may push us one way or the other based on their personal life experience. Other times it may be a friend in the medical field that guides us to a specific specialist to help steer the ship in the right direction towards a potential remedy. Unsure of what exact treatment is needed, we try to make the best decision with all of the collected information and hope and pray that it will have a positive impact on treating the condition.

When treating scoliosis there are multiple approaches to go about it and I, the writer, will not be recommending one. This is due to the fact that I never went to medical school and have never treated a patient with scoliosis. I leave that up to licensed orthopedics, surgeons, and doctors. However, I would like to lay out what a caregiver may hear when searching for a scoliosis treatment regimen in order that when riding atop the ship of scoliosis treatment options, you have just a little clarity and are able to make a more educated decision.

Why Can’t Scoliosis Just Heal Itself?

Assuming that the scoliosis is significant enough that you are reading this article, you need to know that it will not simply correct itself. Every healthy human being has some spinal asymmetry that gives a slight curve to a healthy spine. We were made that way in order for us to be more flexible allowing us to be mobile with proper spinal support. The problem arises when there is a curve of +10° which means that the individual has a condition referred to as scoliosis. Anything less than 10° would be still considered normal and not require treatment. 

When the spinal asymmetry has a curve of greater than 10° there is a fundamental problem with how the spine is supporting the body. Keep in mind that the spine is the central support structure for the body’s musculoskeletal system. When the spine begins to curve beyond the normal limit it impacts the whole entire body. This might mean one leg is longer than the next or that hips or shoulders are leaning to one side. Besides the pain that is present in people with scoliosis there is a major social element of looking different. Clothes don’t fit the same, pool parties are avoided, and patients begin to have the perception that everyone is looking at them. 

The spine will not revert back to a normal curve unless it is treated. It’s like a building built on a slight angle, that all the weight is leaning to one side rather than being distributed evenly. Scoliosis is the same way and when the weight is leaning to one side those bones and muscles are more strained which can result in pain. Leaving it won’t change anything especially if the spine is not fully developed as would be in the case of a young girl or boy. As a matter of fact, the curve could worsen and make it more difficult for them to do the basic activities kids love to do like playing sports. Finding the right treatment regimen may take some time but it must be addressed for the child’s well being. 

Are All Scoliosis The Same?

Not all scoliosis is the same. Some are flexible and not rigid while others are structural with rigid curves. Flexing out the scoliosis when the curve is set structurally won’t really do much. Pulling on the spine will not correct a person’s scoliosis because that is the makeup of the patient. It’s almost like trying to straighten out a warped piece of wood. If you do get it to straighten out with force it will revert to its original curve with little to no impact and change to its shape. Often chiropractors will implement a treatment regimen which includes laying the patient down on a therapy table and pulling their head while keeping the body in place. In theory what is supposed to happen is that the spine is supposed to get flexed and begin to straighten itself out. However, the makeup of the spine is to flex, rotate, and absorb impacts. This can include jumping, falling, or getting tackled in a football game. With each impact the spine will naturally flex in different ways to protect itself and the body it supports. Having a chiropractor pull on it might feel good but chances are that it will have little to no impact on treating the scoliosis. 

When Is It Necessary To Have Surgery To Treat Scoliosis? 

According to the American Academy of Orthopedic Surgeons most scoliosis surgeons will agree that when there is a spinal curvature between 45° to 50° or higher surgery would be required to lessen the curve. Surgery will realign the vertebrae in the spine by fusing them together and create a more normal spinal asymmetry. The recovery for such a surgery is usually three to six months but the way each patient takes to the surgery may be different. In the end of the day it’s surgery and the body undergoes significant trauma to get back to itself. Many young athletes that have scoliosis will opt in for such a surgery as they are looking for a quick fix in order that they get back to a sports program. However, patients and caregivers need to know that not always does surgery fix the problem. The objective is to fix the curvature of the spine which should result in less pain and a better quality of life but not always that is the case. Surgery needs to be taken seriously and patients who go through surgery need to hope for the best and give themselves proper time to heal prior to getting back into a normal routine. 

Treating Scoliosis Through Bracing Therapy

Before opting in for scoliosis surgery it would be worth your while if you spend some time researching if scoliosis therapy is right for you. The good part about it is that it is non-invasive and won’t require a long recovery time. However, it will require the patient to be fitted with a brace that will help realign the spinal structure. The brace will be worn around the clock until the therapy is complete and the spine reverts back to a normal curve. 

Bracing is not a new orthopedic device that is used to help treat scoliosis. In fact, the first scoliosis brace was created by a French army surgeon by the name of Ambrose Paré in the 1500’s. He developed supportive braces that were used to treat spinal deformities for soldiers in the French army. The method of treatment was to use pressure from the braces to reduce the dislocation of the spinal asymmetry. 

Over the course of time bracing for scoliosis became more prevalent and the Milwaukee Brace, Wilmington Brace, and the Boston Brace were introduced to patients through the twentieth century. Each had their pros and cons but were rather bulky and hard for patients to wear for the 23 hour a day brace treatment regimen. With time brace creators had begun to make the brace sleeker, lighter, and perfectly formatted for the patient that helped making wearing the brace easier throughout treatment. In 1970, Dr. Jacques Cheneau of France and Dr. Emanuel Rigo of Barcelona, Spain introduced the Rigo-Chêneau Brace. This brace was designed according to each patient’s specific pressure points and allows many breathing points for comfort. The duo of a highly effective brace while keeping the patient comfortable would make it easier for an effective and shortened treatment plan for scoliosis. Bracing might not be for everyone but it’s worth discussing with your pediatrician to see if it might be an effective way to help treat your boy or girl’s scoliosis. 

Final Words

Seventy to eighty percent of scoliosis is referred to as “idiopathic scoliosis” which means that there is no common cause for the scoliosis. There are other types of scoliosis which we do know the cause of like neuromuscular scoliosis, degenerative scoliosis, adolescent idiopathic scoliosis, and congenital scoliosis. When a child has a spinal curve of 10° or higher it needs to be addressed and monitored to make sure if it does not worsen. Always ask the patient how they feel because scoliosis can sometimes be painful and make it difficult to treat. If the patient is treated with bracing therapy it may be difficult at first to get used to wearing the brace but keep in mind that it won’t be forever. As per the Rigo-Chêneau Brace most patients will get used to it within a week and can complete the therapy in about 12 to 16 months. 

If there is a significant curve in the spine of greater than 50° surgery might be the only option. Caregivers need to know that living with scoliosis is painful and it will not change by itself unless it gets treated. The spinal structure needs to be attended to and until then your loved one will be living in pain and that’s quite unfortunate. Be smart and get it checked out while it can be treated. Once the spinal growth is complete it’s much more challenging to straighten out the spine.

“How’s your granddaughter feeling?” I inquired from my close friend Brenda when meeting her on the avenue. “The operation went well but after two weeks she is still in a lot of pain. My daughter, her mom, is trying to keep her pain tolerable with Motrin but she ends up having to go back to the stronger prescription that was given to her originally in the hospital post-operative.”

It’s such a struggle to come to terms with a diagnosis that your child will need surgery for correcting a severe scoliosis condition. Another example of a teen who underwent scoliosis surgery recently was a close relative of mine and her mother claimed that the operation was quite successful, and I am certainly a witness to the acute transformation from a slouchy kid to a teen who looks a couple of inches taller. When I asked her mom if there were any side effects from her surgery she answered, “Just one, she can’t bend her back”. Now we know that squatting is much healthier for the back than bending but practically speaking, this limitation can have great ramifications for a girl just beginning high school. Gym and sports are enjoyable pastimes and classes and I wonder how she is managing her restriction.

Most scoliosis surgeons believe that only a minute number of severe scoliosis conditions are dangerous from a life-threatening point of view. Included in this view are children under the age of five who have inborn spinal curves that would affect the performance of the heart and lungs. When the lungs are not fully developed there is a slight danger that a severe scoliosis curve could cause the heart to stop beating. However, most surgeons are in agreement that past the age of five, it is not life- threatening except in extraordinary situations.

Often, teenagers are put to surgery prematurely when their scoliosis curve measures over 50 degrees or when the child stops growing. When a doctor says, “surgery must be done immediately” does this announcement leave no other option? Let us explore the facts, benefits and risks of spinal surgery to correct scoliosis.

There are generally two types of scoliosis surgeries which are being used and have been used in the past. The first, posterior (patient lying face down) is when the patient’s curvature involves the upper thoracic spine. The second type of surgery is anterior surgery which involves a cut that follows the bottom ribs ending in an up-down direction above the navel which accesses the lower spine in an easier manner.

Another newer method of surgery that has been recently developed called Tethering uses “growing rods”. Other recent advances include fusionless procedures such as VEPTR – vertical expandable prosthetic titanium ribs (Invented by Dr. Robert Cambell of Children’s Hospital of Philadelphia). This system uses a curved metal rod that is surgically attached to a child’s spine or ribs hooked up on both ends of the device. This method is usually used to treat a congenital condition that prevents normal lung development).

Another novel technique, vertebral body spinal stapling, is a possible alternative to bracing for patients who are at risk for a speedy progression of the curve, and who may need a spinal fusion in the future.

One Person Who Defied the Odds

Meaghan Duggan was diagnosed with major advanced double curve idiopathic scoliosis when she was fourteen years of age. Meaghan was put into a brace immediately. Meaghan learned that 90% of patients with as severe a curve as hers need a spinal fusion operation. Being in a lot of pain along with the normal pressures of teenage life turned her into a real fighter. Keeping herself braced for twenty-three hours of the day, Meaghan defied all odds and her stats changed remarkably and there is essentially no probability that she will ever need surgery. Meaghan beat the odds and she is now giving other girls with her condition the strength and confidence to work hard and show the world that there is an alternative.

Meaghan must have amazing parents who did not listen to the experts and tried bracing and won. There must be lots of determination to beat the odds when you are in pain both physically and emotionally.

A Surgery Survivor

When beautiful Katie Fitzpatrick, was eleven years old she was examined for scoliosis at an annual school checkup as required at that age. After rechecking her back a few days later, the nurse sent Katie home with a letter for her parents with Katie trembling with fear that something was terribly wrong with her. When her parents finally revealed to her that she probably suffered from scoliosis, Katie then noticed that night that her shoulder blades and hips were uneven. Wow was Katie upset!

At an appointment at the pediatrician a few days later, Katie was informed that she did have a curvature of the spine and only x rays could determine the severity of the curve. A specialist at Children’s Hospital in Philadelphia informed her a week later after reading her scans that she was a candidate for surgery and at this point bracing was not an option!

Although Katie’s curvature was about 43% (much less than Meaghan’s) she was not given the option of bracing. Dr. Amar Samdani of Shriners Hospital for Children in Philadelphia was chosen as her surgeon.

The Tether-Vertebral Body Tethering Surgery

Dr. Samdani prescribed Verbal Body Tethering (VBT), at the time, (2014) an experimental procedure that had the distinct advantage of leaving the patient with almost total flexibility.

In the past if bracing did not work the next step was spinal fusion surgery. Metal rods are implanted along either side of the spine to correct the curve. Although spinal fusion is a good choice, patients find that tethering maintains the natural motion of the spine optimally.

By using the patient’s own growth process, the Tether straightens the spine. This is called “growth modulation”. The tether has the exclusivity of being the only process that treats scoliosis while the child is still growing and the growth itself is what repairs the curve. It’s sort of like an “internal” brace for your spine. As opposed to spinal fusion, tethering uses no metal rods. Katie was young enough to take advantage of this surgical method since she was still growing.

Katie’s Recovery From Surgery

Although Tethering sounded like an amazing improvement over spinal fusion, Katie’s recovery was far from uneventful. Leaving the hospital after five days, Katie needed to be homeschooled since she could not do much physically. After six weeks she was practically 100% recovered and was able to go back to school and partake in all school activities including her favorites volleyball and swimming.

Wait! Katie’s challenges were not quite over. In fact, the worst was yet to come. Six months after her first surgery, Katie was informed that she needed additional surgery to correct spondylolisthesis (slip-disk). Although they knew before her first surgery about this second condition, the doctor did not think she would need correctional surgery for the slip-disk. The second surgery was a mini fusion in the lumbar section of the spine.

Two months later, Katie’s second surgery was performed and the recovery from this surgery was much harder than the first. Our heroine had to endure both types of surgery within a year, Tethering and spinal fusion, nevertheless, Katie recuperated completely and was able to return to school the following year.

The Harm Study Group

The treatment of Idiopathic Scoliosis is a constantly changing field. Therefore, Professor Jeurgen Harms, a spinal deformities surgeon came up with the idea of having the most trusted surgeons pool their resources and knowledge to help each other and their patients. In 2011, a handbook was published titled, Adolescent Idiopathic Scoliosis which was translated into several foreign languages presenting completely unbiased research in the field. Dr. Peter Newton, one of the physicians in the group says that their goal is find a cure for scoliosis and the be a think tank for professionals to share their different medical strategies.  

Final Words

We have attempted to give you a glimpse into the complicated world of scoliosis surgery. Surgery for scoliosis is not a medical emergency the same way that a ruptured appendix must be dealt with. If your child has a serious cobb spine curvature and surgery is recommended you should try to avoid it if possible. Sometimes trying even harder with physical therapy and more serious bracing might be the difference between surgery or not. Unless your child is suffering from a severe spinal deformation from birth that affects their breathing and heart, please check out more than one orthopedic doctor who specializes in Idiopathic Scoliosis.

If surgery is a must check out the new options available that are either less evasive or less risky such as Tethering, VEPTR and vertebral body spinal stapling. Organizations such as the Harm Study Group which is associated with the Clear Institute are knowledgeable on the latest possible advances on bracing and surgery for Idiopathic Scoliosis. Even if your child’s back is seriously curved, he/she can still beat the odds as Meaghan Duggan did.