Scoliosis, or the side-to-side curvature of the spine, can progress at any age, and therefore requires close follow-up throughout the lifespan. The Scoliosis Research Society has an excellent article regarding early onset Scoliosis. You can review it here.

When identified early, there are several conservative treatments that can be utilized to help prevent progression of a curve, or in some cases, even help correct it!

OBSERVATION

For curves that are less than 15 degrees, we typically recommend close observation with scoliometer checks and/or repeat low-dose x-rays every 3-6 months. This allows us to detect any potential changes quickly and initiate appropriate treatment as soon as possible, giving you the best long-term results!

PHYSICAL THERAPY

Schroth therapy is a method of physical therapy specific for scoliosis that can be started once a curve reaches ~15 degrees. It is a technique designed to strengthen and retrain the muscles of the back and core to hold the spine in better alignment. The goal is to elongate, de-rotate and stabilize the spine. The Schroth method consists of stretches, strengthening exercises, breathing techniques and postural training exercises using yoga blocks and balls, Schroth bars, poles and other equipment. The exercises are individualized for each person’s unique curve.

BRACING

Children with curves above 25 degrees may be eligible for a Rigo-Cheneau scoliosis brace. The Rigo-Cheneau brace is a light-weight brace that addresses not only the Cobb angle of a curve, but also the rotation of the spine, providing for better corrections than other styles of braces. We have an orthotist on staff who can fabricate a custom 3D-molded brace right here at Hey Clinic. Schroth therapy and the Rigo-Cheneau brace can be used separately, or together, as a conservative method for treating scoliosis in children, in order to hopefully avoid the need for surgery in the future.

SURGERY

The Hey Clinic team does not take the notion of surgery lightly. We will exhaust all conservative treatment methods; however, there are times when surgical intervention is needed. The decision for scoliosis surgery hinges on patient and family preference, understanding scoliosis natural history truths combined with individual clinical factors that are discussed in a “Shared Decision-Making” dialogue with Dr. Hey.

During your visit at Hey Clinic, we will thoroughly discuss all appropriate treatment options based on your diagnosis, and help you choose the one that is best suited for you and your family. Every patient is precious and every spine is unique. Therefore, we provide care tailored to each individual, putting YOU at the center of the decision-making process to ensure that you are comfortable and confident with the chosen treatment plan.

Scoliosis, or the side-to-side curvature of the spine, can progress at any age, though it is at highest risk of progression during the adolescent growth spurt. Many medical providers will screen for scoliosis using a scoliometer measurement on a forward-bend test. If the scoliometer reading is greater than 5 degrees, an x-ray is recommended to confirm the diagnosis. Any curvature of the spine measuring greater than 10 degrees on an x-ray is considered scoliosis.

It is important to closely monitor for progression of a curve with repeat low-dose x-rays every 3-6 months during growth. When identified early, there are several conservative treatments that can be utilized to help prevent progression of a curve, or in some cases, even help correct it.

Schroth therapy is a method of physical therapy specific for scoliosis that can be started once a curve reaches ~15 degrees. Teenagers with curves above 25 degrees who still have growth remaining may be eligible for a Rigo-Cheneau scoliosis brace. Schroth and the Rigo-Cheneau brace can be used separately, or together, as a conservative method of treating scoliosis.

SCOLIOSIS

Scoliosis can be detected by seeing abnormal humps on the upper and/or lower back, asymmetric shoulders or a trunk shift. It can also be diagnosed with a forward bend test, measuring the Angle of Trunk Rotation (ATR) in the upper and lower back with a scoliometer or level on a smartphone. An ATR greater than 5 degrees is often associated with a scoliosis on X-Ray, and is a good reason to refer to a scoliosis center for a high quality “long” X-Ray and clinical evaluation and treatment. This is especially important in the growing child or adolescent, since conservative interventions can actually stop and/or reverse the curvature which can have a life-long impact on quality of life and the need for future surgery. Any curvature of the spine measuring greater than 10 degrees on an x-ray is considered scoliosis. 68% of adolescent scoliosis curves will progress during adulthood, with curves under 30 degrees much less likely to progress, and curves 30-50 degrees 70-80% likely to progress and curves over 50 with nearly 100% chance of life-long progression ( Weinstein SL, Ponseti IV. Curve progression in idiopathic scoliosis. J Bone Joint Surg Am. 1983;65(4):447-455.). As a result of this known natural history, early detection of scoliosis in the growing child to try to keep the curve under 30 degrees is critical, using methods such as Schroth exercises and bracing. Schroth exercises and bracing can be helpful for adult patients as well as for children and adolescents. Lifelong follow-up especially for curves over 30 degrees is therefore also indicated to identify ongoing curve progression and allow for earlier conservative and/or possible surgical intervention when appropriate. The decision for scoliosis surgery hinges on patient and family preference, understanding scoliosis natural history truths combined with individual clinical factors that are discussed in a Shared Decision-Making dialogue with Dr. Hey.

KYPHOSIS

Kyphosis is another disorder that is first noted at a young age. This is more common in males than females and is usually monitored with regular x-rays to check for progression. In some cases, the kyphosis can actually improve as the
teenager grows. Treatment options for kyphosis include conservative therapies including PT, and/or surgery depending on the severity of the curve and symptoms.

SPONDYLOLISTHESIS

Some young athletes will develop a pars fracture as a result of injury or overuse. This can lead to a condition known as “spondylolisthesis,” or slippage of one vertebra over another. Treatment options for this vary from conservative to
injections or surgery as a last resort, depending on the teenager’s symptoms and whether or not the slippage is progressive.

During your visit at Hey Clinic, we will thoroughly discuss all appropriate treatment options based on your diagnosis, and help you choose the one that is best suited for you and your family. Every patient is precious and every spine
is unique. Therefore, we provide care tailored to each individual, putting YOU at the center of the decision-making process to ensure that you are comfortable and confident with the chosen treatment plan.

Though scoliosis is at highest risk of progression during the adolescent years, the curve can continue to progress at any time in adulthood. Having accurate follow-up measurements throughout your life is critical for helping you guide
future treatment decisions and maximize your quality of life in the long run. Our EOS X-Ray machine allows us to get excellent quality images, while also dramatically decreasing radiation exposure down to 4% of regular digital x-rays,
which decreases cancer risk. For those who have finished growing, we recommend follow-ups once a year through age 25 and after each pregnancy. After age 25, follow-up is usually every 1-3 years depending on risk of progression, or earlier
if the deformity becomes symptomatic.

While scoliosis is generally diagnosed in childhood, existing curves can progress as an adult, or new curves can develop. For females, this is especially true after menopause. Hormonal changes, decreased bone quality and/or loss of disc
space can lead to changes in the curvature of the spine. Therefore, it is important to continue monitoring scoliosis and kyphosis throughout the lifespan.

As we age, there are many degenerative changes that occur in the spine. The facet joints become arthritic and intervertebral discs begin to wear out, causing the bones to rub against each other which can be very painful. For people with
scoliosis, the curve can start to “buckle” over time due to uneven loads put on the discs as a result of the curve. In response to degeneration, the spine will grow bone spurs in an effort to strengthen the spine and prevent movement. The
human body is amazing in that it has these methods of healing itself, however this process can be slow and sometimes frustrating. There are many conservative therapies to help manage back pain while the body finishes this process.

As we get older, it is frustrating to feel that our bodies are slowing us down. Our bodies begin to “settle” and may start to degenerate and lose bone quality. Oftentimes, the spine becomes the focus of our weariness and discomfort. Have
you ever gotten back pain relief by leaning over the shopping cart? If so, the shopping cart is acting as a support, taking some of the load off of your spine. Leaning forward also relieves pressure on the nerves in the spine, thereby
reducing symptoms of stenosis. Frequently, strengthening the core abdominal muscles or adding a supportive low back brace can provide ongoing relief.

Scoliosis and kyphosis can continue to progress in older adults as a result of degeneration and decreased bone quality. It is particularly important for older women to get a enough calcium and vitamin D in their diet (or through
supplements) and to get regular DEXA scans to monitor for osteopenia and osteoporosis. While it is not common for men over the age of 40 to lose bone density as rapidly as women, there may be a slight risk for some men.