Scoliosis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The traditional medical management of scoliosis is complex and is determined by the severity of the curvature, skeletal maturity, which together help predict the likelihood of progression.
Medical Therapy
The conventional options are, in order:
- Observation
- Bracing - for example the Milwaukee brace
- Surgery
Bracing
- Bracing is commonly prescribed to prevent progression of the spinal curvature in adolescents. There are several types of braces depending on the individual's condition and type of curve. These include the Boston Brace, also known as the Thoraco-Lumbo-Sacral-Orthosis, that fits around the patient's body like a jacket, pressing against the rib cage to prevent the spine curving inwards. Another type of brace is the Milwaukee brace, or the Cervico-Lumbo-Sacral-Orthosis. The features that separate it from a Boston Brace are large metal bars that extend around the shoulders to help against spine curvature. The third type of brace, the Charleston Bending Brace, is molded to work when the patient is lying on their side. It is used only at night.
- There is also a new type of brace called Spincor which attempts to improve quality of wearer's life by allowing freedom of movement and improved cosmesis. Large scale clinical trial has been completed and results are very promising. Spinecorcan be worn by adults as a postural support as well as a treatment for Adolescent Idiopathic Scoliosis.
- The amount of time an adolescent has to wear a brace each day can range from sixteen hours a day to twenty-three hours a day, depending on the patient. A recent study shows that there is no significant difference between these two time ranges.
- Adolescent patients can be required to wear the brace for as long as five years, and generally lasts until his or her growth spurt has completed. Braces are not always effective, however, and patients may require surgery even after being braced.
- Bracing is only done when the patient has bone growth remaining, and is generally implemented in order to hold the curve and prevent it from progressing to the point where surgery is necessary. Bracing involves fitting the patient with a device that covers the torso and in some cases it extends to the neck. The most commonly used brace is a TLSO, a corset-like appliance that fits from armpits to hips and is custom-made from plastic. It is usually worn 23 hours a day and applies pressure on the curves in the spine. Bracing is only mildly effective as compliance is typically low, although some of the newer braces (such as the Charleston back brace) are touting better compliance rates and outcomes. Typically braces are only used for idiopathic curves that are not grave enough to warrant surgery, but they may also be used to prevent the progression of more severe curves in young children, in order to buy the child time to grow before performing surgery which would prevent further growth in the part of the spine affected.
- In infantile, and sometimes juvenile scoliosis, a body cast or plaster jacket may be used instead of a brace. It has been proven possible to permanently correct some cases of infantile idiopathic scoliosis by using a series of plaster body casts applied under corrective traction, which help to "mould" the infant's soft bones and work with their infantile growth spurts. This method was pioneered by UK scoliosis specialist Min Mehta.
Physical Therapy
- Chiropractic and physical therapy have some degree of anecdotal success in treating scoliosis that is primarily neuromuscular in nature, however non-surgical approaches will not address severe bone deformities associated with many cases of scoliosis. Chiropractors utilize joint mobilization techniques and therapeutic exercise to increase a scoliosis patient's flexibility and strength, theorizing that this better enables the brace to influence the curvature of the spine. Electronic Muscle Stimulation (EMS) is another therapeutic modality commonly utilized by chiropractors and physical therapists to reduce muscle spasms and strengthen atrophied muscles.
- There is limited published scientific research to evaluate the efficiency of treatment programs that include a combination of bracing along with physical therapy. While much debate remains in the scientific community about whether or not chiropractic and physical therapy can influence scoliotic curvature, there may well be palliative benefit from them in scoliosis patients who experience back pain either directly as a result of their deformity or indirectly from wearing an uncomfortable brace for the vast majority of the day.
- A non-invasive treatment for idiopathic scoliosis used successfully in Europe since the 1920s was established in the English-speaking world in the first years of the 21st century. Originally developed in Germany by scoliosis sufferer Katharina Schroth, this method is now taught to scoliosis patients in clinics specifically devoted to Schroth therapy in Germany, Spain, England, and, most recently, the United States. Physical therapists who do not specialize exclusively in Schroth therapy but who have received Schroth certification through the clinics in Spain and Germany offer Schroth therapy throughout Europe, parts of the Middle East, and the United States.
- The Schroth method of physical therapy, combined with the Rigo-Cheneau bracing system (developed by Dr. Manuel Rigo of Spain and Dr. Jacques Cheneau of France), addresses scoliosis from a three-dimensional approach both to prevent progression of scoliotic curvature (in children) and reduce resulting pain as well as promote anatomical symmetry (in children and adults). Because each individual's curve is unique, and because scoliosis involves the rotation (twisting) of vertebrae--in different directions in different areas of the spine--as well as the side-to-side, S-shaped or C-shaped curvature, this three-dimensional approach seeks both to "untwist" (or de-rotate) and to straighten the spine by employing specialized equipment and exercises that elongate shortened muscles and strengthen overstretched, overtaxed muscles. The exercises are augmented by a technique called "rotational breathing," which expands collapsed portions of the rib cage, thus also helping to pull the spine out of its twisting and curving.
- In children with immature skeletons and remaining growth potential, Schroth-method physical therapy is used in combination with the Rigo System-Cheneau brace not only to prevent progression of (and sometimes reduce) the condition but also to train and strengthen patients in holding their bodies in as corrected a position as possible after completion of the bracing treatment (i.e., when the skeleton has reached maturity). A patient's consistent practicing of an individualized Schroth program for one-half hour per day, after an initial intensive training period of two to six weeks, has been clinically shown to inhibit the mechanical forces, exacerbated by poor postural habits and gravity, that otherwise perpetuate the progression of the curvature over time (the so-called "vicious cycle"), even after the cessation of physical growth.