If your child has scoliosis, the treatment they receive will depend on their age, the extent of the curvature of their spine and how well their lungs work.
There are four treatment options:
- observation
- casting
- bracing
- surgery
The different treatment options are described below.
Observation
Treatment for scoliosis is often unnecessary because most cases are not severe and the condition often corrects itself as the child grows.
However, X-rays are needed every six months so that the progress of the curvature can be carefully monitored.
Casting
In early cases of scoliosis, your young child’s spine may need to be guided back into its normal position as they continue to grow. This can be achieved by using a brace, made out of of plaster of Paris, which is attached to your child’s body.
Your child will have to wear the cast constantly, without removing it. However, it will need to be changed regularly to allow for your child’s growth and development. Due to the specific way that a cast is made, your child should be referred to a scoliosis specialist if a cast is required.
If your child is under the age of two, the cast will be changed under an anaesthetic every two to three months to straighten the spine. However, it is likely that your child may need to use a removable brace after the casting treatment.
Bracing
If the curve of your child's spine is more severe (with an angle of more than 20 degrees), a brace will be required. A brace cannot cure scoliosis or correct the curve, but it can stop the curve from getting worse.
The brace will need to be carefully fitted to your child's spine. To do this, a cast of your child's spine will need to be taken. This can be done on an outpatient basis, which means that your child will not have to stay overnight in hospital. Instead, they will have one or more appointments at a hospital or clinic.
It is usually recommended that the brace is worn for 23 hours a day, and that it is only removed for baths and showers. The brace should not interfere with normal everyday activity and can be worn during most non-contact sports. However, it is recommended that the brace is removed during contact sports.
It is important for children who wear braces to take regular exercise. This will help improve muscle tone and body strength, and will help make wearing the brace more comfortable.
The brace will have to be worn for as long as your child's body is still growing. Boys typically stop growing at around the age of 17 and girls typically stop growing at around the age of 15.
Surgery
If your child's scoliosis is severe (if their spine has a curve of more than 50 degrees), they may require surgery and will be referred to a specialist unit.
Surgery can help prevent damage to the heart and lungs, and can also help to alleviate back pain and the abnormal development of your child's body.
Spinal fusion surgery is a complicated technique where the spine is straightened using metal hooks and rods, before being fused into place using bone grafts. It should only be carried out by experts in this type of surgery.
The surgery will take four to eight hours. After surgery, your child will be transferred to an intensive care unit (ICU), where they will be given intravenous fluid (administered through a vein) and pain relief. Most children are well enough to leave intensive care after 24 hours, although they will often need to spend another 7 to 10 days in hospital.
After the operation, most children can return to school after four to six weeks and can play sports about a year after having surgery. Some children may need a back brace to support their spine, which is usually removed after six months.
After having spinal fusion surgery, your child will need to return to hospital every six months to have the rods lengthened by approximately 1cm to keep up with their growth. This is usually an outpatient procedure that is performed through a small incision (cut). A brace will need to be worn to protect the rods. The rods will be removed during surgery when your child is older and their spine has grown.
Risks of spinal fusion surgery
There are several risks associated with spinal fusion surgery. It will not be recommended for your child unless the surgeon feels the benefits outweigh the risks. It is important that parents and children understand the risks of spinal fusion surgery so that they can make an informed decision about treatment.
The known risks of spinal fusion surgery are described below:
- Rod displacement. In around 5% of people who have surgery, one of the rods used to straighten the spine will move from its correct position. This should not cause any discomfort, but additional surgery may be required to return the rod to its correct position.
- Pseudarthrosis occurs when one or more of the bones used to fuse the spine into place fails to graft properly. Pseudarthrosis happens in around 1-5% of cases. It can cause mild discomfort and, in some people, can also cause some loss of the correction of the curvature of the spine. Further surgery will be needed to re-graft the relevant bones.
- Infection. Around 1%-2% of people develop an infection after surgery. However, this can usually be easily treated with antibiotics.
- Nerve damage. In very rare cases (in about one or two cases in every 1,000), spinal fusion surgery will cause damage to the nerves in the spine. The results of this nerve damage can be relatively mild (a feeling of numbness in one or both legs), or it can be more severe and cause a loss of all lower bodily functions (paraplegia). To minimise this risk, a neurologist (a specialist in conditions of the nervous system) will be present during spinal fusion surgery to monitor the nerves and prevent any damage to them.
Additional therapies
Several additional therapies may be helpful in correcting scoliosis. These include:
- osteopathy - manipulation of the muscles, nerves and joints
- physiotherapy - massage and manipulation to help improve general health and wellbeing
- reflexology - a therapy where certain areas of the body, such as the soles of the feet, are massaged to help improve general health
- acupuncture - a traditional Chinese treatment that involves sticking needles into certain points of the body to improve health
- electronic stimulation of the nerves in the back
It is important to note that there is little evidence to show that these additional therapies are effective in treating scoliosis. Physiotherapy can be beneficial, but only when it is used in combination with a back brace.
