Scoliosis Overview

patient-handbook-1

introduction-1

Phase I: Diagnosis

Phase III: Operative

Phase IV: Life After Surgery

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What is Scoliosis Brace?

What does observation entail?

Observation means that the patient will continue to be monitored via returning to the specialist every four to twelve months for x-rays and an exam. The frequency of visits will be based on what stage of growth the child is in. Because of small variability (up to five degrees) in day to day measurements of x-rays, it is not recommended that comparative x-rays be done more frequently than every four to six months. Progressive curves generally increase at a rate of one to two degrees per month, so x-rays more frequent than every four months cannot reliably determine true progression. Observation alone is usually recommended for curves less than twenty to twenty-five degrees if growth remains and for all curves less than forty to fifty degrees in those patients who are done growing.

Will my curve progress?

In general, the younger, less skeletally mature the patient and the bigger the curve(s) at the time scoliosis is identified, the greater the potential for progression.


Remember, most small curves stay small.


The graph below shows the rapid rate with which adolescents grow during the approximately 18 months before the first Risser Sign appears (called the stage of peak height velocity). They will continue to grow taller, but as shown below, at a slower rate. Females go through this growth spurt earlier than males, usually before their first period.

 

We’ve been observing the curve and it has gotten worse...what’s next?

There are a few different scenarios for curves in the 25 - 40 degree range:

    1. If the curve has gotten worse but is less than 40 degrees and growth is complete, there is little risk of the curves continuing to progress in adulthood.

    2. If the curve has gotten worse, but not enough that surgery is recommended, and you’re still growing, observation is required and a brace may be considered.

 

What is Bracing?

At some point in your treatment for scoliosis, your doctor may need to discuss with you whether or not a brace may be beneficial. This discussion is held when curves are progressive and there is enough skeletal growth remaining that bracing might be effective in preventing further progression.

Bracing is typically considered when curves reach more than 20 – 25 degrees and there is enough growth remaining that the brace may limit progression and avoid surgery. The goal of bracing is to halt progression and rarely leads to any significant correction of a curve.

 

What is a scoliosis brace?

It is a rigid plastic brace (also called an orthosis) that fits around the trunk and hips, applying counter-pressure to a curve. The theory behind bracing is that pressure against a curve from the outside may allow more normal growth of the spine. Braces typically do not permanently correct an existing curve and are only considered for preventing progression of scoliosis when there is significant skeletal growth remaining.

 

What does a brace look like?

There are a variety of brace styles, some designed to be worn full-time (ex: Boston, Wilmington, custom), and others just at nighttime, during sleep (ex: Charleston, Providence).

Which brace should be used?

The curve pattern, location of the primary curve and physician preference will determine which of these is recommended. As discussed earlier, there are three main regions of the spine that can develop curves – the upper thoracic, main thoracic and lumbar and these can occur in combination. Upper thoracic curves are not typically amenable to under-arm bracing because that section of the spine is blocked by other bony structures.

A TLSO (thoraco-lumbar-sacral orthosis) worn full-time (18-23 hours per day) is typically the most commonly recommended brace type and can be used for single curves in the thoracic region and double curves. For a single lumbar curve some physicians suggest a night time only brace. X-ray and physical exam will help to determine which brace has the most potential to be effective. The use of a brace and which specific brace design suggested vary widely amongst experienced scoliosis experts.

 

To brace or not to brace - Is bracing effective?

Sometimes yes, sometimes no. Bracing continues to be controversial as it may help some patients, but it is not uniformly or consistently effective. Some experts suggest that bracing in some children seems to prevent progression of scoliosis to some degree, thus avoiding surgery. It is also known that some curves progress and require surgery even when a brace is worn. Likewise some curves never progress even when a brace is never worn.

Though doctors and scientists continue to work to answer this question, what is not known at this time is whether scoliosis progression can be prevented in an individual case (patient). This leads to braces worn both by teens that never needed them as well as in teens whose curves will progress despite wearing a brace.

At this time it is not possible to determine the natural history of scoliosis, though there is work being done to develop such a test for progression.

Although the debate on effectiveness continues, bracing only makes sense when significant skeletal growth remains (Risser 0 – 2) and there is a strong commitment from the teen to wear the brace.

 

We’ve decided not to go ahead with a brace ...what’s next?

Choosing not to brace is choosing observation, and your doctor will recommend how frequently you should follow up for x-rays and exam. Given the evidence (and unfortunately we need better evidence), choosing observation is certainly a reasonable choice.

 

Are there other treatments that will stop scoliosis from getting worse?

There are a variety of other treatments and techniques that proponents claim can stop scoliosis progression. These include acupuncture and acupressure, electrical stimulation, biofeedback, physical therapy, nutritional and vitamin supplements, chiropractic manipulation, shoe orthotics, and other types of less traditional treatments. None of these to date has been proven scientifically to have any effect on scoliosis.

Sports and other activities will not make your scoliosis worse, so please continue to play and be active.


We chose a brace...what’s next?

Your doctor will write a prescription for an orthotist to make a brace. Though insurance coverage can affect the choices, generally your doctor will refer you to an orthotist that they have confidence in and have worked with before.

It will generally take 2 – 4 weeks for you to receive the brace. Your doctor will want to have an x-ray done with you wearing the brace and will help you to schedule an appointment soon after you receive it. You’ll then return periodically to follow the curve with an exam and x-rays.

 

How long will the brace need to be worn?

A brace is worn until a child is done growing or the curve progresses to a degree where surgery is recommended. Most girls are done growing 18 – 24 months after the start of their menstrual periods. Boys tend to grow into their late teens so often need to wear a brace for a longer period of time than girls.

 

Psychosocial effects of bracing

The teen years are ones of rapid change, sensitivity to differences between themselves and their peers, sometimes fragile self-confidence, and increased peer pressure. Having to wear a brace can affect how teens adjust to an already challenging time of life.

 

Helpful hints from brace-wearers and their parents

 

Teens: Parents:

• Enjoy shopping for new clothes that will fit over the brace

• Keep doing everything you did before you got it

• Don’t be embarrassed by it— it’s just like braces on your teeth. Temporary!

• Don’t expect it to get you out of P.E.

• Decorate the brace

• Name the brace

• It’s hard, but you can do it.

• Keep your children in sports and activities.

• Give them a break sometimes—for a sleepover, vacation, or special event.

• Recognize that it is difficult, both for your teen and you

• Talk to other parents whose teens are wearing braces

• Support your teen in their efforts

 

If the curve keeps getting bigger, ...what’s next?

If scoliosis progresses to the point where it will continue to get worse in adulthood and lead to significant health issues later in life, surgical intervention may be recommended.

 

When might surgery be recommended?

This depends partially on the stage of growth, the location of the curve and the curve pattern.
In general:

• At skeletal maturity, curves less than 45-50 degrees tend not to progress any further though lumbar curves may have a lower threshold, possibly 40 degrees.

• At skeletal maturity, curves greater than 50 degrees are at high risk for continued progression throughout adulthood, though at a slower rate (approximately 1 degree a year). Surgery will likely be recommended.

• At skeletal maturity, some curves between 40 and 50 degrees progress and some do not. Treatment recommendations vary.

• When a curve reaches 40 degrees and growth is not complete, surgical intervention may be recommended.

end faq

 

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