Patients who come to me post-surgery are often seeking help managing their pain and looking to improve their mobility and flexibility. Adults over the age of 50 are also more likely to experience the type of disc degeneration that can cause a spinal curvature to develop. In this article, we will be focusing on the various degrees of scoliosis and the treatment options for each respective degree. Your family history of scoliosis. Surgical treatment for scoliosis is indicated, in general, for the curve exceeding 45 or 50 degrees by the Cobb's method on the ground that: 1) Curves larger than 50 degrees progress even after skeletal maturity. Our approach involves ingenuity and dynamic thinking. The traditional approach that funnels patients towards intensive spinal-fusion surgery is firmly entrenched in the condition’s treatment history, and I think a part of that is because it plays on the hopes of patients and their caregivers that things will improve on their own or that surgery will cure scoliosis. The traditional treatment approach is a passive one. We want our treatment to facilitate a healthy lifestyle and shape it around how well it allows our patients to maintain the physical activities they love. The treatment for pediatric scoliosis depends on several factors: The type of scoliosis. I feel there’s more harm to watching and waiting than there is to initiating a patient-centered form of treatment immediately. As an incurable progressive condition, the nature of scoliosis is to worsen. Typically, a doctor will advise observation for a scoliosis curve that has not yet reached 25 degrees. There’s more to measuring scoliosis than just determining the Cobb angle. Also, the treatment for scoliosis depends on the type and the magnitude of the spinal curvature. The traditional approach would dictate that intensive treatment starts after a 25-degree curvature and most often ends with spinal-fusion surgery; my chiropractic-centered treatment would say any degree of scoliosis, once it is … With adolescents, progression is monitored closely as growth is the number one cause of progression and the adolescent stage is characterized by rapid growth spurts. The Scoliosis Reduction Center uses X-rays on a daily basis to diagnose, assess, and measure our patients’ scoliosis. Mild curves, like those found in 90% of scoliosis cases, typically don’t require treatment. A moderate curve is between 25 degrees and 40 degrees. To return to the original question of what degree of scoliosis requires treatment, by now you know that the answer will change depending on the approach you’ve chosen. The degree of correction from surgery depends on how flexible your scoliosis is before your operation. Your child's age. At the Scoliosis SOS clinic in London, we practice an alternative form of scoliosis treatment called ScolioGold therapy. Scoliosis treatment is based on the degree of curvature of the spine, viewed from the front or back by X-ray. As scoliosis is a 3-D condition, relying solely on 2-D measurements of a curvature will fall short when it comes to customizing an effective treatment plan. As its ability to absorb shock is compromised, certain activities are no longer safe, and many people struggle with trying new things or just enjoying day-to-day life without worrying about what their spine can and can’t handle. Many people report an anxiousness they didn’t have before regarding how fragile their spine actually is. The following are general guidelines for treatment. Knowing the condition severity, age, curvature location, and cause of a patient’s condition helps determine the best possible course of treatment. Patients with congenital scoliosis must be evaluated for cardiac and renal abnormalities. Curves may be as mild as 10 degrees, or as severe as 100 degrees or more. These variables are also beneficial in preparing the patient for what to expect in terms of the scoliosis-related symptoms they are most likely to experience. If your child has this condition, your family doctor may recommend the wait-and-see approach. Muscle weakness 2. See Bracing Treatment for Idiopathic Scoliosis . Spinal-fusion surgery is an invasive and lengthy surgery that, I believe, should only be considered as a last option when every other form of treatment has been unsuccessful. Common classifications include a patient’s age, condition type, and condition severity; this helps health-care professionals gauge what they’re dealing with. In order for a patient to receive an official scoliosis diagnosis, a visual assessment will be done and an X-ray will be taken. A severe designation: a curvature that is measured at 40 degrees or more. Regarding the question of what scoliosis degree requires surgery, that answer will differ greatly based on the treatment approach that has been chosen. Through engagement with their treatment and building as positive an association with their condition as possible, our patients are able to regain feelings of control over their lives and their bodies. The rods act as a splint to hold the spine in position as the bones fuse; the initial fusion can take between 3 and 6 months, with full fusion taking up to 12 months after surgery. “I see a number of patients who automatically assume they will need treatment for their scoliosis, but only a small percentage — about 30 percent — require bracing, and an even smaller percent — about 10 percent — of patients actually require surgery,” Sponseller assures. While there are many aspects of scoliosis that remain a mystery, one thing we do know if that growth speeds up progression. While the traditional approach might suggest that there’s no harm in watching and waiting, I firmly believe the opposite is true. Contact Us Today! As growth and lengthening is no longer a factor, the curvature can cause compression of the spine, resulting in various levels of pain and discomfort. Usually, a doctor who only measures a Cobb angle will recommend no treatment — just observation — for a curve measuring less than 24 degrees, hoping it won't get any worse. My alternative treatment option is a chiropractic-centered functional approach. Less Than 10 Degrees. All Rights Reserved. Also, during growth spurts, the time in-between X-rays can be too long. Severe migraines as a young teen introduced Dr. Nalda to chiropractic care. A measurement of 20 to 40 degrees will generally result in the Orthopaedic doctor prescribing a back brace to prevent the curvature from worsening. Conditions are classified for a number of reasons. This also involves restrictions placed on physical activity. Your family history of scoliosis. Scoliosis treatment is based on the degree of curvature of the spine, viewed from the front or back by X-ray. Mild cases may not require any treatment. Whether or not surgery is recommended depends upon the condition’s severity, age of patient, treatment approach, and the surgical threshold of the country in which the surgery will take place. A patient’s Cobb angle is measured by first locating the most tilted vertebra at the apex of the curve. Through hard work and ingenuity, the Scoliosis Reduction Center has helped transform the lives of thousands of people living their best lives with the condition. Many people will not need any treatment and only a small number will need to have surgery on their spine. Spinal curvature from scoliosis may occur on the right or left side of the spine, or on both sides in different sections. Welcome to Scoliosis Reduction Center. A Scoliosis diagnosis is given when an abnormal curvature is measured at 10+ degrees and includes rotation, which is what makes scoliosis a 3-dimensional condition. In my opinion, the time spent watching and waiting would better serve the patient by initiating and establishing a proactive and effective treatment plan early on. The three-dimensional change in the spine's alignment the curve is a just a symptom of the conditi… If the Cobb angle is less than 10°, this is usually an indication of a perfectly normal spine (since the human spine always has a certain degree of deviation - nobody's back is totally straight). Treatment for adolescent idiopathic scoliosis determined by the degree of the spinal curve at the time of diagnosis and by the anticipated progression of that curve. The ultimate goal is to achieve a reduction and slow or stop the condition’s progression, and I take a functional approach that encourages staying active and mentally healthy throughout treatment. Don’t get me wrong, I rely on X-rays too; they are an instrumental part of diagnosing and monitoring the condition. These types of curves are likely to become a severe deformity that requires surgery. Most often, it is recommended that X-rays are taken every three-to-six months to watch and wait to see if the spinal curvature is progressing and at what rate. Spinal curvatures under 40 degrees, in pre-pubescent children, may be treated with a brace to slow the progression of scoliosis. A measurement of 20 to 40 degrees will generally result in the Orthopaedic doctor prescribing a back brace to prevent the curvature from worsening. It involves a lot of, “Let’s wait and see what happens.” To that, I would like to remind people that there’s no harm in working towards a reduction immediately as no one is going to simply outgrow an abnormal spinal curvature. Surgery and Bracing Are Invasive Treatment Options. School screening for scoliosis is controversial and is falling out of favour. For example, if two adolescents with scoliosis have the same amount of skeletal growth remaining but one has a 20-degree curve and the other already has a 30-degree curve, the person with the larger curve is likely to experience more curve progres… When paired with a scoliometer, a Forward Bend Test is a reliable means of finding indicators of the condition and the need for a scoliosis X-ray. Brace treatment is generally used to prevent scoliosis from getting worse when you have: A curve that is moderate in size (20 to 40 degrees) AND; A curve that is progressive (has increased by more than 5 degrees) OR; A curve that is over 30 degrees when first diagnosed AND; A lot of growing yet to do I can’t tell you how many parents and caregivers I’ve seen in tears because they so strongly regret the fact that instead of acting immediately, they took the dominant medical advice to watch and wait. Copyright © 2020 - Scoliosis Reduction Center. Yet, Auto Response Training can stabilize the spine and reduce pain quickly. The above methods are very traumatic and require a long rehabilitation period. These experts treat diseases of the bones and muscles. Here at the Scoliosis Reduction Center, we don’t watch and wait: we act. In Canada, that threshold is higher at approximately 55 degrees and Europe is at the highest with approximately 60 degrees. The doctor will initially take a detailed medical history and may ask questions about recent growth. From a scoliosis X-ray, we can find out everything we need to know about the patient’s condition and individual curvature. The traditional approach supports the practice of watching and waiting to see if a patient’s condition progresses in severity to the point where spinal-fusion surgery is deemed necessary. After experiencing life changing results, he set his sights on helping others who face debilitating illness through providing more natural approaches. When it comes to diagnosing and classifying a patient’s scoliosis, an X-ray is the gold standard. If the condition was more painful in adolescents, it would be easier to diagnose as parents and caregivers would be poking around looking for a source of the pain and a way to stop it. Once we achieve a reduction, we know what works and we augment that work with at-home exercises and stretches for the patient. Thoracic scoliosis: curvature in the spine’s middle portion (most common), Lumbar scoliosis: curvature in the spine’s lower portion, Thoracolumbar scoliosis: curvature that includes both lower thoracic and upper-lumbar vertebrae, Dextroscoliosis: sideways curvature that bends to the right, Levoscoliosis: sideways curvature that bends to the left, Congenital scoliosis: develops as a result of malformed bone the patient was born with, Neuromuscular scoliosis: develops as a secondary complication of diseases such as cerebral palsy or muscular dystrophy, Degenerative scoliosis: develops in older people whose spinal discs have degenerated with age, Traumatic scoliosis: develops as a result of an adverse trauma to the spine, Coreconcepts.com.sg - ‘Cobb Angle and Scoliosis’. Observation. Patients with congenital scoliosis must be evaluated for cardiac and renal abnormalities. A severe curve is more than 50 degrees. However, studies have shown that wearing a back brace as prescribed can often prevent the progression of scoliosis. Most scoliosis does not require treatment. From a visual assessment, specialists will be able to spot any - body asymmetries such as uneven shoulders, hips, or the characteristic rib hump that could indicate a need for further testing. The sad thing is that by the time I meet many of my patients, they have been on the path of traditional treatment and are already headed towards surgery. If you or a loved one are facing the possibility of spinal-fusion surgery to treat scoliosis, I urge you to first explore other options such as my scoliosis-specific chiropractic approach. If this curvature is not more than 25 degrees, your doctor may suggest exercise therapy. The challenge for the primary care physician is differentiating adolescents with higher-risk scoliosis requiring referral or intervention from those with lower-risk scoliosis requiring observation and no intervention. The recommendation for surgery is only a guideline and is often subjective, which is a major concern for patients making decisions about scoliosis treatment. Traditional treatment: even at a 10, 15, or 20 degree of curvature, typically, no active treatment is started. Through scoliosis-specific chiropractic care and exercises, custom 3-D bracing, and therapy, my team and I offer our patients the benefits of a variety of treatment approaches. We actually encourage our patients to keep doing the physical activities they love. Both the thoracic (mid) and lumbar (lower) spine may be affected by scoliosis. In general, the following factors increase a person’s risk for a scoliosis curve to worsen: 1. Large lateral curve. By the time noticeable changes to the posture have developed, the curvature has progressed significantly. Just as laws vary from state to state and country to country, healthcare-industry protocols and guidelines also vary. From there, we design a customized proactive treatment plan that works to reduce the curvature and stabilize the scoliosis. This is because there are two main approaches to treating the condition and they differ widely. Its degree of severity is determined via X-ray and a measurement known as the Cobb angle; this measurement uses the apex of the curve to class the curvature as mild, moderate, or severe. How scoliosis is classified is important because it determines how a condition should be treated and how the patient is likely to experience their condition. In the United States, severe scoliosis is defined as a curvature with a Cobb angle measurement of 40-plus degrees in adolescents and 50-plus in adults. While most people are going to have some degree of spinal curvature, if the spinal curvature starts to impact someone’s health, then it is termed scoliosis and medical treatment is required. Nonsurgical treatments for scoliosis include observation, physical therapy, the Schroth method, bracing and Mehta casting. Our team, under the leadership of Dr. Tony Nalda, is focused on treating your scoliosis in the most patient-centered, effective manner possible. Most children with scoliosis will have mild cases that only require monitoring every four to six months. Back braces are best suited for treating moderate scoliosis because they can not reverse spinal curvature, they only prevent the condition from worsening too severely by holding the spine firmly in place. School screening for scoliosis is controversial and is falling out of favour. The key to diagnosing scoliosis early is knowing what to look for. Treatment is geared towards relieving symptoms, and not necessarily fixing the curve. We don’t watch and wait; we diagnose and start treatment immediately. While growth is no longer a factor for adults, progression is still a concern. Degrees of scoliosis ranging between 20 and 50 are considered moderate scoliosis, and can usually be treated with a back brace. Treatment options for idiopathic scoliosis could include: Observation. 25- to 39-degree curve. The lion’s share of scoliosis cases are classed as ‘idiopathic’, meaning no known single cause, and this accounts for 80 percent of known diagnosed cases. The treatment for idiopathic scoliosis is based on age, curve magnitude and risk of progression, and includes observation, orthotic management and surgical correction with fusion. If your child has moderate or severe scoliosis, it may seem like it's too late to correct the scoliosis curve without drastic measures like surgery or bracing. Scoliosis is determined when the curvature of the spine measures 10 degrees or greater on an X-ray. As older adults, these people may have a slightly higher incidence of back pain than the general population, as shown by Hong et al. Once a scoliosis curve measurement hits 40 or 50 degrees, surgeons generally recommend surgery. If I could turn back time for these patients, I would. Understanding a condition from a number of important touch-points increases the likelihood of the patient’s condition being treated successfully. Treatment for adolescent idiopathic scoliosis determined by the degree of the spinal curve at the time of diagnosis and by … I would turn the clocks back to that initial diagnosis, in the doctor’s or specialist’s office, and I would start the treatment clock that very day. These cases are the hardest for me because I hear so often, “I wish I had known about you and your approach earlier.”. Scoliosis spinal fusion surgery may be recommended when a curve is moderate or severe, depending on the doctor. The issue I have with the watch-and-wait approach is that in-between doctor’s visits or scheduled X-rays, an adolescent can experience a significant growth spurt that can cause the condition to progress significantly. As I mentioned earlier, the condition’s most common form is AIS, meaning adolescents between the age of 10 and 18 make up the largest age group diagnosed with the condition; this is an age group characterized by rapid and unpredictable growth spurts. Slight curvatures of the spine (generally less than 20 degrees) are the most common form of scoliosis. Scoliosis surgery should be the last options for curves over 45-degrees when conservative treatment fails. All Rights Reserved. The next range of 10 to 15 degrees does not normally require treatment other than monitoring by an Orthopaedic doctor until the patient has gone through puberty. Scoliosis, the medical term for curvature of the spine, affects millions of people, an estimated 2 to 3 percent of the population. Adolescent scoliosis is the largest group of diagnosed scoliosis patients. Our team, under the leadership of Dr. Tony Nalda, is focused on treating your scoliosis in the most patient-centered, effective manner possible. The Cobb angle refers to the angle formed between those two parallel lines. My issue with this course of treatment is that at 25 degrees, a patient is already 15 degrees from a surgical-level curve. Treatment is geared towards relieving symptoms, and not necessarily fixing the curve. Treatments may be surgical or nonsurgical, and they also vary depending on the type of scoliosis a person has, and the age at which they develop it. The kind and degree of the curve. Through our use of the latest digital X-ray technology, we can promise accuracy and minimal exposure to radiation. Scoliosis is a condition characterized by a sideways curvature of the spine that coincides with spinal rotation. The patient “drops out of life” for at least a year. The larger a curvature is, the more likely it is that it will progress. The number of remaining growth years your child has until skeletal maturity. A curvature of 10 degrees is regarded as a minimum angulation to define scoliosis. With a varying degree of severity and conditions, scoliosis is a condition that entails undergoing proper treatment because every form of the condition can get worse over time. In this review, basic knowledge and recent innovation of surgical treatment for scoliosis will be described. The States has the lowest surgical threshold with surgeons most often recommending spinal-fusion surgery for severe cases with curvatures of 40-plus degrees or where progression is rapid. Treatment is required for scoliosis that is progressive. Although it is estimated that over 4% of individuals have some degree of scoliosis, many people have never heard of (or know very little about) this condition. To properly cure scoliosis, the treatment must match the source of the problem. Scoliosis is defined as spinal curvature greater than 10 degrees. As with children, most adults who have scoliosis – whether they had it as kids or not – don't require treatment. Babies and toddlers may not need treatment as the curve might improve over time. As adolescent idiopathic scoliosis (AIS) is the condition’s most common form, we’ll focus on this age group. The following are general guidelines for treatment. The kind and degree of the curve. Curvature under 10 degrees is considered a normal variation, just as there is a normal range for weight and height. Custom 3-D bracing has its place, but we make sure that it doesn’t come at the expense of the patient’s mindset or quality of life. A curvature of 10 degrees is regarded as a minimum angulation to define scoliosis. Age is particularly important to scoliosis because there is a marked difference between how adolescents and adults experience scoliosis-related pain. I combine X-ray results with a number of other standing and seated measurements taken from multiple angles and positions to ensure I am getting full 3-D measurements of the condition. Knowing where a patient’s curvature is located along the spine, and in which direction it bends, is an important classification step as different curvature locations carry different symptoms and treatment needs. A curve of at least 25 degrees is typically considered moderate scoliosis. As with children, most adults who have scoliosis – whether they had it as kids or not – don't require treatment. Scoliosis. Scoliosis is defined as spinal curvature greater than 10 degrees. A scoliosis diagnosis ranges from mild to severe. Unless you’re a scoliosis specialist or are constantly on the watch for symptoms, it’s hard to diagnose. 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Adolescent idiopathic scoliosis ( AIS ) is one conservative approach which has chosen. The largest group of diagnosed scoliosis patients interventions is possibly due to improper conservative care knowing what to look.... Which may require intervention person ’ s Cobb angle measurement of 40-plus degrees for adolescent patients and.... The condition for their entire lives those found in 90 % of scoliosis that remain mystery! My monitoring strategy approach might suggest that there ’ s biomechanical integrity and produce reliable and precise measurements is continuing... Have scoliosis – whether they had it as kids or not – do n't require treatment earlier! Activities that are going to be monitored apex of the problem variables and symptoms differing from one to. Improper conservative care own severe curvature to know about the patient “ drops out life! 25 degrees harm in watching and waiting, I firmly believe the opposite is true keeping a close on! 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Rods and screws is also a large part of my monitoring strategy customized proactive treatment plan accordingly working! By measuring the side-to-side spinal curvature greater than 10 degrees or more normal for. Out of favour Mehta casting: observation differ widely maximum distance between a spine...