After receiving a diagnosis of scoliosis, the most important decision to make is how to respond with treatment. There are two main scoliosis treatment approaches, known as traditional and conservative, and it’s crucial that patients understand how each can affect the spine so they can make an informed treatment choice.
There is more than one approach to treating scoliosis. Traditional treatment offers a surgical response, while modern conservative treatment provides a non-surgical treatment option. Spinal fusion can be risky and affect the spine adversely, so should be considered carefully.
As the first stop on the road to treatment is a diagnosis, let’s start with how a diagnosis of scoliosis is reached.
Diagnosing Scoliosis
When it comes to diagnosing scoliosis, there are certain parameters that have to be met.
Scoliosis involves the development of an unnatural lateral (sideways) curvature of the spine, but a scoliotic spine doesn’t just bend unnaturally to the side, it also twists, and the rotational component is what makes scoliosis a complex 3-dimensional condition.
Diagnosing scoliosis also involves an X-ray to confirm a patient’s Cobb angle measurement; a Cobb angle measurement of at least 10 degrees is needed to reach a diagnosis of scoliosis.
A patient’s Cobb angle is determined by drawing lines from the tops and bottoms of the curve’s most-tilted vertebrae, and the resulting angle is expressed in degrees.
When the spine’s natural and healthy curves are in place, its vertebrae are aligned: stacked on top of one another in a straight and neutral alignment.
If one or more of the spine’s healthy curves are lost, it can disrupt the biomechanics of the entire spine.
The higher a patient’s Cobb angle, the more out of alignment the spine is, and the more severe the condition:
- Mild scoliosis: Cobb angle measurement of between 10 and 25 degrees
- Moderate scoliosis: Cobb angle measurement of between 25 and 40 degrees
- Severe scoliosis: Cobb angle measurement of 40+ degrees
- Very-severe scoliosis: Cobb angle measurement of 80+ degrees
A key condition-characteristic to understand is its progressive nature because it shapes how different treatment approaches respond to a diagnosis, and with progressive conditions, sometimes, when a condition is responded to is almost as important as the type of treatment applied.
Scoliosis is a Progressive Condition
As scoliosis is a progressive condition, it has it in its nature to worsen over time, and this means that where a scoliosis is at the time of diagnosis doesn’t mean that’s where it will stay.
Scoliosis can easily progress from mild to moderate and severe to very severe; only proactive treatment can work towards counteracting the condition’s progressive nature.
Scoliosis progressing means the size of the unnatural spinal curve is increasing, and while we don’t always know what triggers scoliosis to develop initially, we do know what triggers it to get worse: growth.
So when treating scoliosis in children, a focus is on monitoring for progression throughout growth; when I see as little growth as an inch, I want to see how the spine is responding.
As scoliosis progresses, the condition’s uneven forces are increasing, as are their effects; the main effect of scoliosis in children is postural deviation, and the main symptom of scoliosis in adults is pain.
Scoliosis becomes a compressive condition once skeletal maturity has been reached; prior to that, the lengthening motion of a growing spine counteracts the compressive force of the scoliotic curve.
In addition, scoliosis progression makes the condition more complex to treat. Progression causes increasing spinal rigidity, making it less responsive to treatment, and it can also make it difficult for some patients to perform key therapeutic exercises as part of treatment.
In some cases of adult scoliosis, where significant progression has already occurred by the time they receive a diagnosis, I have to do some preparatory work to first establish a baseline level of spinal flexibility before the regular course of treatment can start.
So when it comes to treatment, as an incurable progressive condition, how a diagnosis is responded to is crucial and can have far-reaching effects.
There are two main scoliosis treatment approaches to choose between, and I want to ensure that all patients are aware of the differences between them because they affect spinal health, function, and overall quality of life differently.
Scoliosis Surgery Guidelines
Traditional treatment offers a surgical response, and spinal fusion surgery is an invasive and costly procedure, but more importantly, it can also affect the spine in a number of ways, and this is what I want patients to fully understand.
Scoliosis surgery involves fusing the curve’s most-tilted vertebrae into one solid bone, and this is done to prevent movement (progression) in the affected vertebrae.
Commonly, rods are attached to the spine with pedicle screws to hold it in place, and while spinal fusion can straighten a scoliotic spine, the way it does so is contrary to the spine’s movement-based design.
What many patients are disappointed with post-surgery is that their spines are far less flexible, and a reduced range of motion can lead to activity restrictions, and not being able to participate in once-loved activities can impact a patient’s overall quality of life.
In addition, a spine that’s fused is not going to be as strong, and the knowledge that living with a fused spine means an increased risk of injury can also have a psychological effect that shouldn’t be discounted.
The surgical procedure itself is associated with the following risks: infection, excessive blood loss, adverse reaction to hardware used, and nerve damage.
For those who choose to forgo a surgical recommendation, or who simply prefer trying a less-invasive and costly option first, there is a conservative non-surgical treatment response.
Conservative Scoliosis Treatment Guidelines
Here at the Scoliosis Reduction Center®, I apply a proactive conservative scoliosis treatment approach to work towards preventing progression, escalating symptoms, and the need for surgical treatment in the future.
Conservative treatment is also known as chiropractic-centered and/or functional because its approach preserves as much natural spinal strength and function as possible, so in terms of overall spinal health, conservative treatment complements the spine’s natural movement-based design.
Conservative treatment integrates multiple scoliosis-specific treatment disciplines so conditions are impacted on every level, but first and foremost, as a structural spinal condition, it has to be impacted on a structural level, and this is worked towards through chiropractic care.
Through a series of chiropractic techniques and manual adjustments, the curve’s most-tilted vertebrae can be manipulated so their position is more aligned with the rest of the spine, and this is known as a curvature reduction.
When treating scoliosis in children, the goal is to achieve a significant curvature reduction and hold it there despite the constant trigger of growth, and in adults, the focus is reducing a curve back to where it was prior to becoming painful.
In addition to chiropractic care, physical therapy, corrective bracing, and rehabilitation are additional facets of conservative treatment that all work together and can be apportioned accordingly based on how the spine is responding to growth and treatment.
Conclusion
When it comes to scoliosis treatment guidelines, the most important thing to understand is that the way a diagnosis of scoliosis is responded to can permanently affect the spine’s overall health and function.
When a spine is fused, it’s held in place through artificial means, and this can mean a spine that’s more rigid, less moveable, and more back pain, particularly at the fusion site.
While all surgical procedures come with risks, spinal surgery carries some particularly heavy potential risks, side effects, and complications, so should be considered carefully.
When it comes to non-surgical conservative treatment, this approach is aligned with the spine’s natural movement-based design, so when successful, it can maintain a natural range of motion and flexibility.
Conservative treatment works towards treating scoliosis on every level; chiropractic care works towards reducing the size of the scoliotic curve, physical therapy can increase core strength so the spine’s optimally supported by its surrounding muscles, corrective bracing can help push the spine into a corrective position, and rehabilitation can involve custom-prescribed home exercises to further stabilize and heal the spine.
When it comes to how to decide which treatment option is best for you, knowledge is power, and ensuring you are aware of all treatment options available, plus how they affect long-term spinal health and function, is key.
Here at the Center, I spend a lot of time speaking with patients and informing them of the different paths their scoliosis-treatment can take; the reality is that many cases of scoliosis don’t require surgery, and conservative scoliosis treatment results speak for themselves.
