Natural History of Scoliosis (Part Two)

If not treated, curves exceeding 50° can lead to long-term problems. Progressive worsening of the scoliotic curve that may occur in some patients can lead to reduced lung capacity and the development of restrictive lung diseases. Cosmetic concerns are significant for many patients. The incidence of back or lower back pain in patients with scoliosis is similar to that of the general population.

Treatment- Indications

• The type of treatment required depends on the type and degree of the curve, the age of the child, and the number of growth years remaining until the child reaches skeletal maturity.
• Considering the slow progression of the disease, it is advised to have, around the age of 5-6 years, a preventive type check-up visit. Then it will be the orthopedist who will decide whether further examinations are needed. This disease needs to be diagnosed quickly (maximum by the age of 13 years). After this age, it becomes difficult to achieve good results, because the growth plates gradually begin to close, making the bone structure we want to correct less "moldable". Therefore, this is a pathology that needs to be treated during adolescence, with physiotherapeutic (postural gymnastics), corrective (spine stabilizers - braces) or surgical (stabilizations), depending on the case.

Non-Surgical Treatment

Observation- Follow-up

This option is suitable when the curve is mild (less than 20°) or if the child is near skeletal maturity. However, the doctor may ask you for frequent rechecks to see if the curve is progressive or worsening. You may be asked to visit every 3-6 months for reexamination. Most cases of scoliosis identified by screening at school, fall into this category.

Bracing

The purpose of bracing is to prevent the worsening of scoliosis. Braces can be effective if the child is still growing and has a spinal curvature between 25° and 45°. There are various types of braces, most are worn under the arms.

Your orthopedist will recommend a brace and will tell you how long it should be worn each day. Wearing a brace does not affect participation in sports activities.

Surgical Treatment

If the curve is more than 45° and the child is still growing, the doctor may recommend surgery. If the patient has reached skeletal maturity, surgery may still be recommended for scoliosis curves exceeding 50° by 5°.

Procedure

Before the surgery, you may be asked to donate blood (which will be used during the operation, if necessary).

The implants used consist of rods, hooks, screws, and/or wires that serve to straighten the back. Bone graft is taken from the bone bank from the child's own pelvic bones that are used to enhance consolidation and healing of the spine.

After surgery, patients usually walk from the second day, without needing a brace, leave the hospital within 1 week, and can quickly resume their daily activities.

Long-term outcomes after surgery

Patients usually do not experience much pain during the rehabilitation phase after surgery. A return to sports activities is possible 6-9 months after surgery. However, due to the permanent limitation of some back movements after surgery, participation in contact sports, such as football or rugby, are not recommended.

Scoliosis surgery does not affect future pregnancies or childbirth in female patients.