Treatment Options

Observation & Monitoring

Periodic observation and monitoring is usually the first method of treatment for Scoliosis Curves less than 20-25º .

• You will visit your Scoliosis Specialist every four to six months.
• X-rays or EOS scans will be taken regularly and reviewed against previous films.
• The specialist will document changes and make recommendations for treatments as necessary.
• You may be referred to other specialists to make sure there are no other problems in other parts of the body.

Physical Therapy

Physical therapies may be useful to help strengthen core muscles and manage pain.

Physical therapy (specifically designed – Schroth Method) or some chiropractic therapies have some scientifically proven benefits seen to slow curve progression. They can help strengthen your core muscles, improve general posture and even help manage any discomfort associated in some scoliosis.

Bracing

Bracing is a non-operative treatment suitable for curves between 25 and 45º in growing children. The goal is to prevent further progression of the curve while the spine continues to grow. Bracing will not correct the curve, the ultimate goal is to avoid surgery.

• Suitable for mild to moderate curves.
• Requires a cooperative patient, supportive family and regular ongoing examinations by the specialist.
• The brace will require changing as the child grows.
• The brace allows the child to participate in general childhood activities such as exercise, sports and dance when the physician allows an elective “time out” for the brace.
• Physiotherapy exercises are increasingly used in conjunction with scoliosis bracing to offer advantages over more simplified treatments.

Casting

Casting is a form of bracing that cannot be removed until a scheduled change of cast. In most cases this will require anaesthesia to make the child more comfortable and to increase flexibility of the curve. The cast will need to be changed every few months as the child grows, again requiring an anaesthetic. It is usually for very young children as is quite uncommon.

Casting has been shown to delay the progression of curvatures and the need for more invasive surgery by correcting the deformity sufficiently to allow bracing to be used.

Your Orthopaedic Surgeon will discuss the advantages and disadvantages of this treatment option with both the patient and carers.

Spine and Rib-Based Growing-Rods

This surgical technique uses a spine-based or a rib-based system where one or two rods are inserted under the skin, spanning the curve and avoiding the growth tissues of the spine.

The goal of this surgical technique is to correct the curvature by approximately 50% at the time of the first operation. Following the surgery, patients will use bracing for several months. Children will return about every six months to have the rods lengthened until spinal maturity. Multiple surgeries will be involved in this treatment. Once the spine has grown, the Orthopaedic Surgeon will remove the instrumentation and perform a formal spinal fusion.

Vertebral Body Tethering (VBT) – “Fusionless” surgery

The goal of this technique is to allow the spinal curvature to correct itself through more growth on the concave side of the curve. This technique is commonly performed in patients who are still growing and whose curves are less than 35º.

The placement of special vertebral body tethers produces relative growth inhibition on the convex side of the curve, allowing the patient’s natural growth to straighten out the spine.

Hemi-Epiphysiodesis

The goal of this surgical technique is to address abnormal growth on one side of the spine, allowing continued growth on the other side to correct the curve over time. This technique is most commonly used for patients with Congenital Scoliosis where the bones have improperly formed. Your Orthopaedic Surgeon will discuss the risks of this operation with you.

Hemivertebra Resection

This surgical treatment is an option for young children where their scoliosis presents with abnormally shaped vertebrae (triangular vs rectangular) and who present with a “trunk lean” or a much worse deformity.

The procedure removes hemivertebra(e) from the spine, allowing the vertebrae above and below the resection to be fused together, often with instrumentation. Bracing or casting also commonly accompanies this procedure while the spine heals. Your Orthopaedic Surgeon will discuss the risks of this operation with you.

In Situ Spinal Fusion

This surgical technique will address the scoliosis curve early before it worsens and becomes a severe deformity. This procedure stops the progression of scoliosis by fusing together vertebrae. In situ translates to “where it is” meaning little correction of the spine will occur. Occasionally instruments such as rods and screws may be placed to help straighten the spine and brace the bone graft.

Where instrumentation is not utilised, usually in young children, bracing or casting may accompany the surgery to provide for best outcomes for the patient as part of their patient journey. This procedure is considered safer than those that offer more correction to the spine’s curvature. Your Orthopaedic Surgeon will discuss the risks of this operation with you.

Anterior Open Rods:

Thoracoscopic Anterior Spinal Rod: