Medical Treatments
BRACING
In cases where a curve is continuing to progress, bracing may be recommended, particularly for young patients whose skeletons haven’t fully matured (generally girls ages 11-13 and boys ages 12-14). It’s important to understand that a back brace will not straighten an existing curve, only hold the spine straight to prevent the curve from progressing while a child is growing.
Curves of 50 degrees or more can continue to progress into adulthood, so the aim of a back brace is to prevent the curvature from reaching that point. Braces can extend to varying lengths from the hips to the neck and are custom-fit to the body of each individual. There are many types of braces, though they’re usually made of plastic and worn under the clothes for up to 23 hours a day.
WHAT YOU NEED TO KNOW
You will not need to wear a brace for your entire life.
Braces are only really effective while a person is still growing, though in rare instances they may be used by adults. Most patients who wear a brace will discontinue its use sometime between the ages of 18-22.
Wearing the brace for less time than is suggested daily can affect the results.
The length of time suggested for wearing a brace depends on the severity of the curve. If it’s recommended that the brace be worn for 23 hours a day, and you only wear it for 10, it will be difficult for the body to adjust to the new pattern created by the brace to counteract the degree of the curve.
Complementing the use of a brace with daily muscular exercise can reduce the length of time the brace needs to be worn.
In some cases, the wearing of the brace can cause some muscle atrophy. A dedicated daily practice of targeted core, back, and leg strengthening can aid your muscles in developing the strength and alignment needed to support your spine. This doesn’t mean you can stop wearing the brace entirely, but (depending on the severity of your curve) it may make it safe for you to take the brace off for a period of time per day.
A brace may be needed for a short time following surgical treatment.
If you decide to undergo surgery to correct your curve, you may be asked to wear a corset brace for some time after the surgery. The corset helps to limit back movement so that the spine can heal.
SURGERY
In cases where bracing is either not possible or ineffective, surgery may be recommended to stop the progression of the curve. Surgery can help to significantly reduce, though not eliminate, both the amount of curve in the spine and the resulting imbalances of the torso. Surgery follows the fusion, fusionless and/or growing systems method, with fusion surgery being the most commonly employed.
Fusion involves the permanent fusing of two or more vertebrae combined and the use of rods, screws, hooks and/or wires to straighten and de-rotate the spine as much as possible.The goal is to maintain a more natural curve. This results in some mobility loss, particularly in back bending and twisting.
The growing systems approach, usually recommended for children, delays the need for fusion surgery and involves anchoring rods to the spine to correct the spine’s curvature as a child grows. Rods need to be replaced every 6-12 months until skeletal maturity is reached.
Fusionless surgeries, based on growth modulation, are relatively new so long-term data is limited. The aim here is to slow growth and encourage greater bone density by putting constant pressure on a bone, in this case the outer side of a spinal curve.
WHAT YOU NEED TO KNOW
Surgery can be the best option for patients with severe curvature of the spine.
Bracing and strengthening exercises can be helpful, but they aren’t usually sufficient to correct severe curves, particularly those above 45-50 degrees. This degree of curvature is more likely to continue progressing during adulthood and surgery is often the most viable treatment in these cases.
In cases of mild or moderate curves, a diligent back care and strengthening practice can often achieve similar results to surgery.
There are many success stories of people choosing exercise over surgery. In fact, one of our TOPS' mentors and guest teachers, Elise Browning Miller, chose yoga over surgery and through years of dedicated practise, she has managed to decrease her curve significantly. You can read her story http://yogaforscoliosis.com/about/
Post surgery, it it important to learn how to exercise carefully to ensure your back stability.
Sometimes, scar tissue and decreased mobility in the spinal joints following surgery cause people to feel they are blocked or frozen in the torso. Gentle exercises like walking, swimming and bike riding are helpful to gain strength after surgery. After the patient is fully healed, gentle massage and yoga can help to realign and strengthen the 'straightened' body while also developing maximum range and mobility. Over time, each person can explore whichever activities they are comfortable with.
You will not die if you choose not to have surgery, even if your curve is severe.
Without treatment, thoracic curves seldom progress past 70 degrees and lumbar curves seldom past 80 degrees. Though this may cause difficulty and discomfort, your heart and lungs will not be crushed and surgical intervention is not “medically necessary, although most professionals will highly recommend it for extreme curves.
Surgery will not fully correct your curve.
Depending on the flexibility of your spine, the curve and twist may be corrected to a significant degree, but not completely.Lateral curves can usually be reduced by 50-70%. Most patients grow a few inches during surgery, but this will likely settle over the years.
You may still have pain.
Everyone reacts differently, but in most cases, people eventually feel some 'side effects' from the surgery. Sometimes it is just a bit aching or pinching where the spine is fused. In other cases, the whole body can feel different. Familiar movements like walking or sitting can feel strange while the body adjusts. Over the years, there may be some chronic joint or chronic muscle pain.
In addition, the unfused vertebrae above and below the fusion often overcompensate for the lack of spinal movement. This can sometimes result in degeneration and slipped or ruptured discs.
Supportive care can help with all of these symptoms.
Daily back care and a proper strengthening regime will still be necessary.
Surgery changes the structural alignment of your entire body, which can impact all of the major joints — neck, shoulders, hips, sacrum, knees, ankles and feet. If the body defaults to its pre-surgery muscular habits, this can put a great deal of strain on your joints. You need to retrain your muscles to function within your new alignment, which involves both strength and mobility training.
Fusions and Surgical hardware may fail.
In general, surgeries go smoothly and there are no major problems. Occasionally, the rods, screws and wires used in spinal fusion surgery become dislodged from their attachments, and occasionally bone fusions don't hold. In these situations, it is highly recommended to have revision surgery to correct these problems.
Fusion rods can be removed.
The surgery to remove the rods is fairly elaborate but it is possible. Once the fusion has occurred and the bones have grown together, the rod used to hold the bones in place becomes superficial. Many people are unaware and untroubled by the rods; however, a small number of people can “feel” the hardware inside of them. They can cause physical pain, or can can also trigger a negative emotional response. There have also been cases where the patient develops a chronic infection or physical resistance to the foreign objects in their bodies. In these cases, removing the rods may be the best option, physically and mentally, for the patient.