There is no clear evidence that untreated scoliosis, or scoliosis treated with bracing or spinal fusion, will increase the risk of back pain or arthritis in the long term. The younger a child, or the more she or he has to grow, the greater the risk of scoliosis progressing.
After puberty and growth, curves under 50 degrees are not likely to get worse. For this reason, the ultimate goal of scoliosis management is to keep curves under 50 degrees until the child has matured. Children with curves under 50 degrees typically grow up into adults with no significant problems related to scoliosis.
Scoliosis treatment is based on the degree of curvature of the spine, viewed from the front or back by X-ray. The following are general guidelines for treatment.
Less Than 10 Degrees
This is not scoliosis. Scoliosis is defined as spinal curvature greater than 10 degrees. Curvature under 10 degrees is considered a normal variation, just as there is a normal range for weight and for height.
10 Degrees to 30 Degrees
In this range, scoliosis is observed for progression. The measurement error in reading X-rays is up to 4 degrees. This means that a difference of 4 degrees between office visits may not be real, but rather a reflection of the inherent inaccuracies of measuring X-rays. Partly because of this, significant progression is defined as an increase in curvature of at least 5 degrees. The typical rate of progression is 1 degree per month, so it would take at least five months to see significant progression. As a result, the child is seen every six months for follow-up, which includes both physical and X-ray examinations.
30 Degrees to 50 Degrees
In this range, bracing is the standard of care in the United States. The scoliosis brace is known as a TLSO, which stands for thoraco-lumbar spinal orthotic. The idea behind bracing is to stop or slow progression of the curve so that it stays under 50 degrees. An X-ray of a brace shows that the brace can straighten the spine, but the spine will return to its original curvature when the brace is removed. The two principal types used are the Milwaukee brace, developed by Dr. Walter Blount of Milwaukee, and the Boston brace, developed by Dr. John Hall of Boston.
The brace is worn more than 20 hours per day. Time is allowed out of the brace for hygiene and for sports. Part-time bracing doesn’t work as well and may not work at all. The child is weaned into the custom-made brace gradually over a two-week period. This allows the child to adjust and prevents significant skin irritation from the brace. After two weeks of full time wear, or approximately four weeks after initial fitting of the brace, the child is seen in the office for X-rays in the brace.
Successful bracing reduces the curve by half or better as determined by X-rays. At later visits, X-rays are taken out of the brace, which is removed the night before to allow full relaxation of the spine and a more realistic measure of the degree of curvature. Brace treatment successfully stops curve progression in about 80 percent of children.
More Than 50 Degrees
Beyond 50 degrees, the spine loses its ability to compensate and progression becomes inevitable even after the child is mature. The only way to stop progression at this stage is a surgery called spinal fusion. Think of the vertebrae as beads on a string. The spine bends between the vertebrae as a string bends between the beads, causing the beads to move. The way to stop the beads from moving is to stick them together. Spinal fusion surgery joins the vertebrae.