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Treatment Options

Can scoliosis curves get better on their own?

Idiopathic scoliosis curves do not straighten out on their own. Many children have slight curves that do not need treatment. In these cases, the children grow up to lead normal lives—but their small curves never go away. If the patient has a larger curve and/or the patient is still growing, it is very important that curves be monitored for change by periodic examination and standing x-rays as needed. Increases in spinal abnormalities require evaluation by an orthopaedic surgeon to determine if active treatment is required.

What factors determine treatment for idiopathic scoliosis in children and adolescents?

Patient age
Bone age (the maturation of bone is not always the same as the chronological age)
Degree of curvature
Location of curve in the spine
Status of menses/puberty
Patient gender
Curve worsening
Associated symptoms such as back pain or shortness of breath

In summary, when planning a child's treatment, a doctor will take into account how severe the child's curve is and where it occurs in the spine. The child's age is also an important factor — if the child's spine is still growing, it will affect treatment choices. The doctor will determine how likely it is that the curve will get worse, and then suggest treatment options to meet the child's specific needs. Most scoliosis surgeons agree that children who have very severe curves (50 degrees and higher) will need surgery to lessen the curve and prevent it from getting worse.

What are treatment options for spinal abnormalities?

The treatment options for scoliosis fall into three main categories:

Observation of scoliosis

Observation is for curves that have a small degree measurement when patients are growing (adolescent scoliosis), or for moderate size curves (< 40-45 degrees) when patients are done growing. For adults, observation and physical therapy are for those patients who have mild symptoms and have curves that are not large.

Nonoperative treatment

Nonoperative treatment, such as bracing, is for curves between 25 and 45 degrees in growing children to prevent further progression of the curve while growth of the spine remains. The goal of bracing is to prevent further progression since the brace cannot correct curves. Please visit the Bracing for Idiopathic Scoliosis FAQ's page for further information on bracing.

Surgical treatment

Surgical treatment is reserved for curves which are generally greater than 50 degrees for adolescent patients and adults. Surgery can be performed for smaller curves if the appearance of the curvature is bothersome to the patient or if symptoms are associated with the scoliosis in the adult patient. The goals of surgical treatment are to obtain curve correction and to prevent curve progression by fusing the spine at the optimum degree of safe correction of the deformity. This is generally achieved by placing metal implants onto the spine that are then attached to rods, which correct the spine curvature and hold it in the corrected position until fusion, or knitting of the spine elements together. Please visit the Surgery for Adolescent Idiopathic Scoliosis FAQ's page for further information on what to expect before, during and after surgery.

What happens if no treatment is done? Will the curve get worse?

Two factors can strongly predict whether a scoliosis curve will get worse: young age and a larger curve at the time of diagnosis. Children younger than 10 years with curves greater than about 35 degrees tend to get worse without treatment. Once someone is done growing, it is very rare for a curve to progress rapidly. We know from studies that once someone is fully grown, scoliosis less than 30 degrees tends not to get worse, while those curves greater than 50 degrees can get worse over time, by about 1 to 1 1/2 degrees per year.

Are there other complementary and alternative treatments that may help with my scoliosis or my symptoms?

Many patients and their parents ask about the effectiveness of treatment options other than bracing and surgery.

Alternative treatments to prevent further curve progression like chiropractic medicine and yoga have not demonstrated any scientific value in treating scoliosis. However, these and other methods may provide some physical benefit to the patient (e.g., core strengthening and symptom relief). Physiotherapy scoliosis-specific exercises are increasingly used in conjunction with bracing in the treatment of progressive idiopathic scoliosis. The combination of the two may offer advantages over more simplified treatment plans. Scoliosis Research Society (SRS) supports pilot research studies for the role of exercises in scoliosis treatment.

Will physical therapy help my scoliosis?

It has not been proven that physical therapy can help people with scoliosis. Different physical therapy methods have been designed to offset the effects of scoliosis, and improve the shape and look of your body. There is some scientific evidence to show that physical therapy may help you to look straighter and improve your breathing. However, there is little evidence to show that physical therapy is more effective than doing nothing in stopping the curve from getting worse during growth. If you have spinal problems in addition to your scoliosis (such as back pain), your doctor may prescribe physical therapy to address your specific needs.

Will chiropractic treatment help my scoliosis?

Chiropractic is a controversial method of treatment that seems most effective in treating acute, short-term pain. Chronic conditions do not seem effectively managed by long-term chiropractic care. Patients who have scoliosis and choose chiropractic treatment should be referred to a spinal orthopaedist or neurosurgeon if their curves keep increasing. Insurance may or may not cover chiropractic treatment.

Will acupuncture help treat and manage my back problems?

Acupuncture uses fine needles that are intended to stimulate points in the body and supposedly create an energy flow to treat many illnesses. There is no scientific evidence that proves this theory or that its use helps in treating back problems or back pain. Insurance usually does not cover such treatment.

Will yoga help treat and manage my back problems?

Most yoga systems are intended to improve muscles through stretching, holding positions, and breathing exercises. Some yoga systems also include meditation. How much it will help with back problems is not proven, but those with back pain may be helped. Insurance may or may not cover treatment.

How can a massage help my back problems?

Massage may help those with back pain. Your spinal orthopaedist or neurosurgeon may refer you to one. There are many techniques of massage. Be sure to find out if your massage therapist is licensed by the state in which you live, and where he or she has been trained. Insurance generally does not pay for massage treatments.

Will Pilates make my scoliosis or back problems better?

Pilates are vigorous exercises that focus on strengthening abdominal and back muscles. There also is emphasis on posture and breathing. Exercises should gradually increase in level of difficulty, and should not increase back pain. Pilates are not intended for those with severe back pain. Patients should ask about the training of any instructor.

Treatment Options

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