Get Ahead of the Curve
The ‘next step’ for every patient is different because each person’s body, growth and curvature is different. Knowing what to do and when are in constant evolution. As a result of these changes and many variables, you may sometimes hear your treatment team refer to a ‘continuum of care’. The following is designed to be a guide that aids you in identifying where you or your loved one is within that continuum.
First Step: Know your curve
The Cobb angle and Continuum of Care
Your Cobb angle is a measure of the curvature of your spine in degrees. This measurement helps your doctor determine what type of treatment is necessary.
In order to be diagnosed with scoliosis, your Cobb angle must be at least 10 degrees.
The Cobb angle helps your doctor and orthotist track your scoliosis to see if your curve is progressing, or getting larger.
Below are general guidelines on what treatment might be recommended by your physician based on you Cobb angel.
10° – 25°
Watch and Wait
This period refers to a stage where the scoliosis has been identified and diagnosed but is deemed by the physician to be not severe enough to intervene with any sort of treatment – bracing or otherwise. “The treatment for mild (<25°) adolescent idiopathic scoliosis (AIS) has traditionally been the ‘watch and wait’ approach1,2,3). “
25° – 45°
Brace for Treatment
After a curve has shown progression over time, or if, upon diagnosis, the curve is larger than 25 degrees, a physician may recommend the patient as a candidate for bracing. According to Boston Children’s Hospital and many other pediatric organizations, orthopedic doctors typically recommend scoliosis bracing for children who are still growing and have a curvature of 25 degrees or more. The primary goal of a scoliosis brace is to keep the curve from progressing to the level that surgery is required. Some patients achieve curve reduction with bracing.
There are some recent advancements in bracing that may be able to offer correction of a curve, rather than just stopping progression, but the technology is new and still being studied. Depending on when a patient embarks upon their bracing journey a brace or several different braces may be worn over a series of months and years. Brace treatment for scoliosis typically concludes for 2 reasons – 1. The patient has stopped growing (reached skeletal maturity) or 2. The patient’s curve has progressed beyond ~45 degrees.
45° or More
Surgical intervention occurs when scoliosis is at an advanced state. According to The American Academy of Orthopedic Surgeons, most scoliosis surgeons agree that children who have very severe curves (45-50° and higher) will need surgery to lessen the curve and prevent it from getting worse… If your curve is greater than 45-50°, it will very likely get worse, even after you are fully grown. This may increase the cosmetic deformity in your back, as well as affect your lung function. This is the point where surgery would be presented as a good option.
The traditional procedure for scoliosis surgical correction is called spine fusion, however, there have been several new advancements in this area recently. Some of the newer surgical options are often referred to as Growth Rod Surgery (MAGEC, Api-Fix, etc.) and/or Vertebral Body Tethering (known as VBT for short). These new surgical technologies each have different pros and cons as well as different indications.
Facts About Scoliosis Every Parent Should Know
When they hear their child has scoliosis, many parents are understandably frantic for answers about how this diagnosis will affect their loved one’s health and future. They wonder, will this curve get worse? Will my child need bracing or surgery in the future? Will my child be paralyzed from the procedure?
While scoliosis is a non-life threatening condition associated with positive outcomes, this type of response is normal. Learning more about the science behind scoliosis and its treatments can help families feel less worried about their child’s diagnosis.
Searching for more information? Here are 5 facts about scoliosis that every parent should know:
Scoliosis Is Not an Emergency Diagnosis
First off, don’t panic! Contrary to popular belief, there is no danger in having scoliosis. Upon diagnosis, most children don’t need to be hospitalized, removed from sports teams or have their daily schedules changed. In fact, the biggest risk is significant curve progression over years of time. While parents should always discuss their child’s prognosis with their doctor in detail, it’s important to remember that the vast majority of scoliosis patients can continue living their normal lives.
The Younger the Child, the Likelier It Will Progress
Most children with scoliosis are diagnosed between the ages of 10 and 15. It’s far less common to show signs of scoliosis at infanthood or early age. Referred to as early-onset scoliosis, these patients usually face a different set of risk factors. For one, early-onset scoliosis is sometimes accompanied by other conditions, such as chest wall deformities, spina bifida or cerebral palsy. The curvature of the spine also may continue to progress as young children grow older, making the use of braces and surgery more likely.
However, kids diagnosed with scoliosis at a young age may develop normally, without medical interference. By working with a specialist, parents will gain a better understanding of what treatments their child may need and the potential complications they face.
Scoliosis Is Usually Hereditary
Scoliosis tends to be passed down to children through genetics. Although parents might feel perplexed by this if they didn’t have scoliosis as a child, it may have occurred in other family members, such as a great-grandparent. Whether a documented family history of scoliosis is present or not, a child having scoliosis is no one’s fault. Yes, getting lots of exercise and eating a healthy diet is vital for a child’s overall health. But scoliosis itself is not preventable, meaning there’s no way that parents could have changed the outcome of their child’s diagnosis.
Most Scoliosis Patients Do Not Need Surgery
Upon hearing the word “scoliosis,” some parents may envision their children having to immediately endure surgery, followed by endless days of inactivity. Fortunately, this preconceived idea of treatment is inaccurate. In fact, only about 10 percent of children with scoliosis will need to have spinal surgery in the future. Only about 30 percent of scoliosis patients will have to wear a torso brace, which is used to support and straighten out a child’s spine as they grow.
While surgery is a serious decision for any parent to make, the outcomes for scoliosis surgery are positive, especially if the child receives surgery at a young age. Through discussions with their doctor, parents will develop a better understanding of what risks surgeries carry, as well as what the recovery process will be like for their child.
The Curve Shouldn’t Interfere with Normal Activities
Scoliosis normally doesn’t cause significant pain or other health problems. Therefore, not only do most scoliosis patients never undergo surgery for their condition, they continue living fulfilling, active lives.
For parents worried about their children’s futures, it’s important to remember this: Famous actors, dancers, models and even Olympic athletes have revealed that they have scoliosis. The takeaway? While scoliosis requires monitoring and — depending on its severity — possible life adjustments, it’s a manageable condition with positive outcomes. Even with a torso brace, kids are known to compete in sports, play with their friends and enjoy a fun, carefree childhood.
Author: Jose A Herrera, MD – Pediatric Orthopedic Surgery