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How to Treat Scoliosis: From Braces to Surgery

Scoliosis is a spinal condition characterized by an abnormal curvature of the spine. It’s typically diagnosed during the growth spurts in adolescence. However, it may also be diagnosed later in life. Treatment approaches vary depending on the severity and progression of the curve. They can range from observation and bracing to more invasive options like surgery. Let’s explore these treatment options and look at the diagnostic process of scoliosis.

Understanding Scoliosis

Scoliosis is a medical condition in which the spine curves sideways, forming a C- or S-shape. This curve can occur on either side of the spine and may cause symptoms such as uneven shoulders, an asymmetrical waist, a bulging rib cage, or a limited range of motion. In approximately eight out of 10 cases, the cause of the curvature is unknown. However, it’s believed that a combination of factors plays a role in the development of the condition. 

Diagnostic Process of Scoliosis

How is it diagnosed?

Scoliosis is typically first noticed by a change in the appearance of the back or visible asymmetries in the body. While it’s often self-diagnosed, pediatricians can also detect it during routine check-ups. The common signs may include a difference in shoulder height when viewed from the back, a head that’s not centered with the rest of the body, and/or a difference in hip height or position. 

Scoliosis may progress quickly during the growth spurts in adolescence. This is why early detection is crucial to take necessary precautions and minimize the progression of mild cases. Once scoliosis is detected, a medical examination may include a visit to an orthopedist. During the medical diagnosis, you may be asked to bend forward. This position makes it easier to examine the spinal curvature and rib deformities, allowing the orthopedic expert to better observe any unevenness in the skeletal system. 

X-rays — which can provide detailed images of the spine — play a crucial role in helping to measure the severity of the scoliosis. Regular X-rays are used to monitor changes in the curvature over time and evaluate the effectiveness of treatments, such as bracing. They also help determine the necessity of surgical interventions. 

Who can treat scoliosis?

While pediatricians may diagnose scoliosis in children, they typically refer patients to specialists for further evaluation and treatment. Orthopedists are responsible for prescribing braces and may suggest surgery if needed. For adults, physical therapy may be recommended to improve posture and reduce discomfort. However, physical therapy does not correct the scoliosis itself.

Non-Surgical Treatments

Observation and monitoring

Observation is often recommended for mild cases of scoliosis (when the curvature is less than 20 degrees). In these cases, regular check-ups are sufficient to ensure the condition does not progress.

Doctors track the progression of scoliosis by scheduling periodic appointments and using tools (like scoliometers and X-rays) to measure any changes in spinal curvature. This ongoing assessment helps determine if an intensive treatment is necessary.

Bracing

Braces are effective for children and teens who are still growing. By applying pressure to the spine, braces help stabilize the curvature and prevent it from worsening during periods of growth.

• The Boston brace is a low-profile option worn under clothing. It works by applying pressure to the spine’s curve pattern by pushing in the abdomen and flattening the lumbar curve.

• The Milwaukee brace extends from the pelvis to the neck and is typically used for more severe curves. It’s often worn part-time and has shown better results when combined with physical therapy.

Success rates of the braces can vary, but studies show that bracing can significantly slow or stop the progression of scoliosis when worn as directed. However, it does not correct existing curvature and is less effective once growth is complete.

Physical therapy

Physical therapy is often recommended to adults who have recently or previously been diagnosed with scoliosis. While physical therapy does not correct the curve, it may be effective in maintaining a better quality of life. Exercises in physical therapy are designed to:

• Stabilize the curve

• Mobilize the ribcage

• Improve postural alignment

• Promote postural correction

• Enhance neuromuscular control

• Increase muscle strength and endurance

• Reduce pain

• Improve respiratory function

Chiropractic care

Chiropractic care is an alternative medical practice focused on diagnosing, treating, and preventing mechanical issues in the musculoskeletal system. In scoliosis treatment, chiropractors use manual techniques such as stretching, sustained pressure, and specific joint manipulations. These are typically delivered by hand with a quick, gentle thrust. Similar to braces and physical therapy, chiropractic care is not a cure, but it may help manage the symptoms and support spinal health.

Surgical Treatments

Surgery is typically recommended when the spinal curvature exceeds 40-50 degrees, particularly if it continues to progress despite non-surgical treatments. 

Surgery for scoliosis is typically considered when:

• The spinal curvature is severe (usually over 40-50 degrees) and worsening

• The curvature causes significant pain or functional impairment

• Non-surgical treatments — such as bracing or physical therapy — have been ineffective

• The deformity affects breathing, organ function, and daily activities

Spinal fusion surgery

Spinal fusion surgery involves permanently connecting two or more vertebrae (backbones) to prevent further curvature of the spine. During this procedure, the surgeon fuses the vertebrae using bone grafts. This helps the bones grow together over time, eliminating motion between them and stabilizing the spine. Post-surgery, patients may stay in the hospital for a few days to monitor pain. Over the next few months, physical therapy is usually recommended to improve mobility and strengthen the muscles around the spine. Full recovery can take anywhere from six months to a year, depending on the patient's health, age, and commitment to following post-surgery recommendations.

Vertebral body tethering (VBT)

Vertebral body tethering (VBT) is a newer option for treating scoliosis. It works by attaching a flexible cord (called a tether) to the outside of the curved part of the spine. Approved by the FDA in August 2019, the tether used in VBT is suitable for children and adolescents whose scoliosis continues to progress despite bracing. 

VBT is less commonly used in adults because it relies on growth to correct spinal deformities. The cord is tightened over time, helping to straighten the spine as the child grows. Unlike spinal fusion — which makes a part of the spine stiff and unable to bend — VBT keeps the spine flexible and allows it to keep growing. While VBT has shown promising results, there is limited long-term data on its effectiveness and safety.

Spinal osteotomy

Spinal osteotomy is a more complex surgical procedure typically performed in severe cases of scoliosis. It involves the removal or resection of a portion of the vertebrae to correct spinal deformities. This procedure is typically performed for adults with rigid scoliotic curves greater than 90 degrees. Due to its invasive nature, spinal osteotomy may involve a longer recovery period compared to other treatments.

Alternative and Complementary Treatments to Manage Discomfort

There are alternative ways to manage the discomfort that is caused by scoliosis. Keep in mind that these alternatives are not ways to correct scoliosis, but they may be supplementary in managing scoliosis-related discomfort. They should not be considered solutions.

Acupuncture

Acupuncture may aid in pain management and relaxation by stimulating specific points on the body with thin needles. This practice may potentially relieve muscle tension, improve circulation, and enhance overall well-being. 

Yoga and pilates

Yoga and Pilates can improve flexibility and strengthen core muscles. These practices help maintain spinal alignment and reduce discomfort, complementing other treatments such as physical therapy. Always remember to modify yoga and pilates practices to prevent strain on the spine. Not all movements are suitable for individuals with scoliosis. 

A diet rich in calcium and vitamin D

A strong skeletal structure can help support and stabilize the spine and potentially prevent the condition from progressing. This is why maintaining strong bones is highly important if you have scoliosis. A diet rich in calcium and vitamin D can strengthen bone and spinal health, and foods that provide these nutrients may include:

• Nuts and seeds (such as almonds and chia seeds)

• Fortified plant-based milks (like almond or soy milk)

• Mushrooms (especially those exposed to UV light)

• Oranges (for fortified vitamin D)

• Canned fish with bones (like sardines and salmon)

Living with Scoliosis

Managing scoliosis effectively involves not only medical care but also attention to overall well-being. Making lifestyle adjustments and staying informed about new treatment options can greatly improve the quality of your life.

Ongoing care

If you have scoliosis, having regular check-ups with your healthcare provider is important. Follow your healthcare provider’s advice and stick to low-impact exercises. 

Psychological support

Scoliosis can affect your mood and self-esteem due to physical changes and limitations. Seeking counseling or joining support groups can be beneficial in coping with these issues.

What Else Can I Do to Improve My Quality of Life?

While living with scoliosis may affect both physical comfort and emotional well-being, it does not mean that those with scoliosis can’t live emotionally and physically fulfilling lives. You can help alleviate the symptoms of scoliosis by making the right lifestyle adjustments. 

LifeMD doesn’t provide direct treatment for scoliosis. However,  board-certified healthcare professionals are here to offer guidance on lifestyle adjustments to improve your quality of life — from a diet that supports bone health to pain management strategies.

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