Scoliosis: How to avoid spine surgery

Mark Locke, MD

Pediatric Orthopedic Surgery

Scoliosis – an abnormal curve of the spine – typically occurs during puberty when a child is going through a growth spurt. Although many may think scoliosis requires surgery, Mark Locke, MD, explained that spine surgery is not always the answer for correcting scoliosis.

“When most individuals hear that they have scoliosis, a major fear is the potential need for spine surgery. However, the majority of scoliosis patients can successfully manage without surgery,” Dr. Locke said. “In some cases, surgery is needed to help with the correction, but that is not always the case and other treatment options are available.”

How can you avoid surgery if you have scoliosis?

The best way to avoid surgery for scoliosis is through early detection, diagnosis and treatment, which typically involves:

• An examination by a primary care physician. During a regular well visit, a doctor can visually inspect the spine for a curve by having a child bend forward and touch their toes.
• X-ray. A simple X-ray will detect scoliosis and provide the specific details about the condition.
• Early bracing. Once a curve hits 20 degrees, it is crucial to start a brace. Early bracing is only possible with early detection.

“All families need to be diligent about having children checked once they start their adolescent growth phase,” Dr. Locke said. “Some kids start puberty in 5^th grade, but most begin in middle school and some as late as high school. Any evidence of anything out of symmetry with the ribs, shoulders, hips or legs should be evaluated by a doctor with an X-ray.”

If scoliosis is confirmed, what are the next steps?

If scoliosis is found early, the majority of children respond well to nonsurgical treatment options. Once confirmed by X-ray, the next step is physical therapy.

“There is evidence-based research showing that specific methods of physical therapy are successful in stopping some cases of scoliosis,” said Dr. Locke.

Therapy starts with once-a-week visits for a few months, then transitions over to a home exercise therapy. The scoliosis is then monitored with X-rays at 6-month intervals. Keeping a curve under 20 degrees is the best way to avoid surgery.

When might a brace be needed?

If the curve reaches 20 degrees, early brace treatment has been shown to prevent surgery. There are many types of braces. “The key is to evaluate the success of the brace by monitoring with X-rays,” Dr. Locke said. “If a certain brace is not working, a different one needs to be tried.”

Treatment usually begins with a nighttime brace, but if a nighttime brace is not working, a daytime brace may be the next step. Wearing the right brace properly is the key to having it properly stop scoliosis.

Most braces can be stopped when a patient is done with their major growth spurt, but certain criteria need to be met to avoid surgery and keep the curve under 30 degrees.

When does surgery become the answer?

When a spinal curve goes over 30 degrees and the child is still growing, the chances of surgery begin to increase. When a curve goes over 40 degrees and a child is still growing, the chances of surgery become the most likely outcome. When a curve goes over 50 degrees, surgery is certain.

“To avoid surgery to correct scoliosis, X-ray early, begin physical therapy early and brace early,” said Dr. Locke.