As the human body grows, the spine undergoes changes as well. We recommend close observation for all spinal conditions, which allows us to detect any potential changes quickly and initiate appropriate treatment as soon as possible, giving you the best long-term results.

Children ages 8 and up should be screened annually by their physician. If your family has a known history of scoliosis, keep a close eye on your children as they approach and enter their growth spurts, particularly at puberty. The quicker curves are caught, the more treatment options may be available to address your curve and halt progression. You can learn more about how to screen your child at home for scoliosis in this video.

For children and adolescents with scoliosis measuring less than 15 degrees, we typically recommend close observation with scoliometer checks and/or repeat low-dose x-rays every 6 months. Conservative therapies may be initiated for curves above 15 degrees, with repeat x-rays every 3-6 months. Once they reach skeletal maturity, follow-up visits are recommended every year until age 25. Children and adolescents with structural or postural kyphosis also benefit from routine follow-up and imaging every 6 months during adolescent growth.

For our adult patients with stable or progressing curves, routine follow-up can also be beneficial to catch any changes in your curve or posture before they become problematic. Scoliosis has been shown to progress during periods of hormonal change, including pregnancy. As a result, we recommend our female patients return for additional follow-up imaging with our team in the year following each pregnancy. In older adults, degeneration and decreased bone quality can cause progression of scoliosis and kyphosis.Having more data over time enables us to monitor and track the progression of scoliosis and kyphosis and helps guide your choices in treatment options.

BRACING IN ADOLESCENTS

A brace is a conservative treatment that can maintain and sometimes even reduce a scoliosis curve in adolescents. It can be a great option in lieu of surgery.

As part of our new clinic, we have added a brace fabrication lab! Our orthotist uses 3D body scanning technology to create custom, light-weight Rigo-Cheneau style braces in-house.

Brace Fabrication lab onsite using 3D body scanning technology to create custom, light-weight Rigo-Cheneau style braces!

What is a 3D CAD CAM Style Brace?

The 3D CAD CAM 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 types of braces. Studies have shown that this particular brace can halt curve progression, help with pain and sometimes even improve curve measurements in flexible curves.

How does it work?

The brace applies pressure to certain areas of the spine, while also having expansion areas to allow for de-rotating and straightening of the spine. It is customized to fit a person’s body shape and size based on a 3D scan. The orthotist then makes additional modifications to improve fit and comfort, as well as to maximize effectiveness.

What are the benefits of a 3D CAD CAM Style Brace over a Boston Brace?

The Rigo-Cheneau brace is customized to fit a person’s curve presentation and body shape based on a 3D scan and design. It is made with a light-weight thin plastic, which allows for a lower profile design that can be more comfortable than the Boston Brace. The slim design is sleeker and easier to conceal under clothing. The Boston Brace targets only the Cobb angle of a curve, whereas the Cheneau addresses the Cobb angle and rotation of the spine, thereby providing better curve control. Another benefit is that the straps are located in the front of the brace, rather than in the back. This improves ease of use and allows patients to take the brace on and off independently, which is especially important for gym class, sports, and other times a parent may not be available to assist.

Check out our Video Blog about brace break-in by our Orthotist! Click here

BRACING IN ADULTS

A brace is a conservative treatment option that can allow adult patients to prevent curve progression, with full time wear, while also reducing pain. The goals are different than with adolescents, as curves cannot be readily reduced in skeletally mature spines. However, adult bracing can be a great option when surgery is not.

What is PSSE – Physiotherapeutic Scoliosis Specific Exercises (Schroth Physical Therapy)?

Schroth is a type of scoliosis-specific physical therapy designed to strengthen and retrain the muscles of the back and core to hold the spine in improved 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 designed to address each individual curve type.

What makes Schroth a good option?

Schroth is a conservative, non-surgical approach to treating scoliosis. This form of treatment can be combined with bracing and has been shown to reduce progression of scoliosis during adolescent growth and, in some cases, decrease the angle of the spinal curvature.

Schroth at the Hey Clinic

As part of our commitment to the conservative and lifelong care of our patients, we have two full-time Schroth-certified physical therapists. The physical therapists will develop an individualized home exercise program after multiple one-on-one sessions in our office, so that the exercises can be continued on a daily basis, which is critical to the success of conservative treatment options. Our physical therapists work with each patient to train them to eventually be independent in management of their spine throughout their life. If you are in the Charlotte area, we recommend contacting Brittany Hunt, PT, BSPTS C1/C2 Schroth Certified Therapist at the Charlotte Scoliosis Clinic.

Some spinal conditions can be treated with an injection. There are two main types of injections that we routinely prescribe.

Epidural Steroid Injections (ESI)

A steroid, which is a strong anti-inflammatory agent, is injected into the epidural space. This reduces inflammation caused by conditions such as a disc herniation or stenosis, thereby reducing pain.

Radiofrequency Ablation (RFA)

A small electrical current is used to heat the nerves in the facet joint. This limits the nerves’ ability to transmit pain signals.

If you and the clinician decide that a spinal injection is the best route for treatment, we will order the injection and arrange for you to have this done at another medical office. Spinal injections are not performed at the Hey Clinic.

Surgery for scoliosis, kyphosis, or other spinal conditions (such as spondylolisthesis, stenosis, and disc herniations) may be considered as a treatment option. Dr. Hey will walk you and your loved ones through a “Shared Decision-Making” dialogue. This discussion will thoroughly explain the short- and long-term benefits versus the risks of various treatment options including physical therapy, bracing, injections, and surgery. Dr. Hey and his team perform a variety of surgeries from minimally invasive procedures to highly complex fusions.

• Microdiscectomy
• Laminectomy
• SI joint fusion
• One level lumbar fusion
• Multi-level lumbar fusions
• ACDF (anterior cervical discectomy and fusion) neck surgery
• Growth modulation (VBT) more detail below
• Spinal deformity correction with instrumentation and fusion
• Robotic-assisted surgery

Once you understand the surgical options, you and your family can make your own decision on what is best for you. Dr. Hey has been perfecting his surgical techniques for scoliosis and other spine surgeries for over 25 years with his clinical and surgical teams.

Vertebral Body Tethering (VBT)

This surgical treatment is different from other scoliosis treatments because the spine is still able to bend and flex rather than become stiff and held in place by metal rods. VBT is a new, minimally invasive procedure that allows surgeons to access the spine through several small incisions with less muscle and soft tissue disruption. Screws are placed along the outside edge of the abnormal spine curve and a special cord is then attached to several vertebrae. When the cord is tightened, the tension from the tether straightens the spine and guides the spine for future growth. This approach may prevent the need for spinal fusion surgery while a person is actively growing and uses their own growth to repair the curve. VBT is not appropriate for all types of scoliosis.

Spine Surgery Safety and Best Outcomes

With a focus on continued quality and safety improvements, Dr. Hey has developed special software which is used by his teams to error-proof every step of the surgical process, similar to techniques employed in aviation.

• Dr. Hey created a custom Electronic Medical Records (EMR) software so that his team can better serve you. Before surgery, they use the patient records to review medical history, medications, and symptoms to create a custom pre-surgery checklist. There are hundreds and hundreds of details on these checklists that ensure the patient’s comfort and care during each and every important step. These steps ensure optimal results before, during, and after the surgical experience. In addition, every week Dr. Hey and his team have a “quality huddle” to review the checklist and make final preparations, helping the surgery go as smoothly as possible.
• Dr. Hey has also developed an intra-operative checklist software named 3Greens™ that he uses to make aviation-style safety checklists to ensure process standardization and encourage OR team coordination. He also utilizes a post-op checklist to monitor every patients’ recovery both during and after their inpatient stay.

While massage, chiropractic care, Pilates, yoga, stretching and other therapies may provide symptomatic relief, these have been proven inefficient in correcting a scoliosis curve. The Scoliosis Research Society (www.srs.org) has published a paper on alternative treatments. Find more information about treatment options on their website.