Treatment for scoliosis can be divided into two main categories: non-surgical treatment and surgical treatment. Common non-surgical treatments include physical therapy, gymnastics, casts, and braces, but the most important and reliable method is brace therapy.
Treatment
Treatment for scoliosis can be divided into two main categories: non-surgical treatment and surgical treatment.
Common non-surgical treatments include physical therapy, gymnastics, casts, and braces, but the most important and reliable method is brace therapy.
Generally, idiopathic scoliosis of less than 20 degrees can be left untreated initially and closely observed. If the scoliosis worsens by more than 5 degrees per year, brace therapy should be initiated. Adolescent idiopathic scoliosis of 30–40 degrees at initial diagnosis should be treated with brace therapy immediately, as more than 60% of these patients will experience further progression. Surgical treatment should be considered for adolescent idiopathic scoliosis in the following situations:
(1) Thoracic curvature greater than 40 degrees, thoracolumbar/lumbar curvature greater than 35 degrees;
(2) Scoliosis that cannot be controlled by bracing and is progressing rapidly;
(3) Significant lower back pain or symptoms of nerve compression.
For patients with congenital scoliosis, if the scoliosis is of a progressive type or shows significant progression during the observation period, surgical treatment should be performed as early as possible. Generally, 3-5 years of age is a good time for surgery.
Because the etiology of scoliosis is complex and there are many types, whether surgery is needed is not simply based on the patient’s age or the degree of curvature. Factors such as the type, characteristics, segment, rate of progression, the patient’s bone age development, and the degree of impact of the deformity on the patient’s posture should also be considered. It is generally agreed that progressive congenital scoliosis should be surgically corrected early, as the deformity worsens with age and becomes rigid, making it difficult to correct. However, premature posterior fusion correction in childhood for idiopathic scoliosis may impair spinal growth and development, potentially leading to further deformity in the long term. Furthermore, factors such as spinal balance and the impact of surgery on spinal growth and mobility must be considered. Therefore, each scoliosis patient should be analyzed individually, and treatment measures should be tailored accordingly.
The goals of scoliosis surgery are: to prevent deformity progression; to restore spinal balance; to correct the deformity as much as possible; to preserve as many spinal segments as possible; and to prevent nerve damage. Using current three-dimensional correction techniques and pedicle screw fixation techniques, scoliosis can achieve good surgical correction, but 100% correction is not possible. Surgery must also consider the patient’s spinal and spinal cord tolerance; excessive correction can easily lead to internal fixation failure, increase the incidence of surgical complications, and even cause nerve damage and paralysis. The degree of scoliosis correction varies with age, degree of curvature, and etiology; generally, the correction rate for idiopathic scoliosis is typically 60%–80%.
Prevention
Scoliosis is a common disease affecting adolescents and children. If not detected and treated promptly, it can develop into a very serious deformity and affect cardiopulmonary function, even leading to paralysis in severe cases.
School-aged children should pay attention to maintaining good sitting and standing postures and strengthening their muscles. The most crucial aspect of preventing and treating scoliosis is early detection, early diagnosis, and early treatment. Scoliosis prevention knowledge should be promoted in schools, and regular scoliosis screenings should be conducted.
