Scoliosis is a spinal condition that affects millions of people worldwide. It is characterized by an abnormal curvature of the spine, causing it to curve sideways. This condition can lead to pain, discomfort, and limited mobility, significantly impacting a person’s quality of life. Over the years, there have been significant advancements in scoliosis treatment, offering patients more effective and less invasive options. In this blog, we will explore the evolution of scoliosis treatment, from historic methods to modern approaches, and discuss the role of bracing, physiotherapy, and the latest innovations in improving the quality of life for individuals with scoliosis.

Evolution of Scoliosis Treatment

Understanding Scoliosis: A Brief Overview

To understand scoliosis treatment, it is essential to have a brief overview of this spinal condition. Scoliosis is defined by a lateral curvature of the spine of more than 10 degrees and can involve the rotation of the vertebrae, resulting in a rib hump in thoracic curves. It is the most common spinal deformity, affecting an estimated 2-3% of the population. Scoliosis can be idiopathic, meaning the cause is unknown, or it can result from conditions such as neuromuscular diseases. Screening for scoliosis is crucial, especially during growth spurts in adolescence, to detect and monitor the progression of this condition. In cases of severe curvature, surgical treatment for thoracic scoliosis may be necessary in adolescence to prevent further progression and potential complications in adulthood. However, lumbar scoliosis has shown to have greater potential progression in adulthood, requiring fusion as early as 35° angulation. This highlights the importance of early detection and treatment for lumbar scoliosis to prevent complications and the need for surgery in adulthood.

Defining Scoliosis

Scoliosis, a spinal condition, involves a lateral curvature of the spine of more than 10 degrees. It can be idiopathic, meaning the cause is unknown, or it can result from various factors, including genetic, environmental, and neurological factors. Idiopathic scoliosis, the most common type, typically develops during adolescence and is known as adolescent idiopathic scoliosis (AIS). In scoliosis, the spine also undergoes rotational changes, resulting in a rib hump in thoracic curves. The severity of scoliosis is measured using the Cobb angle, which quantifies the curvature of the spine. Early detection and intervention are crucial in managing scoliosis and preventing progression, especially before the end of growth. Additionally, research has shown that the evolution of scoliosis treatment has been greatly influenced by biomechanical factors, as seen in studies such as Aulisa et al.’s “Biomechanical aspects of idiopathic scoliosis evolution.” This article can be cited using the DOI number 10.1186/1748-7161-7-S1-O30.

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Factors Leading to Scoliosis

Scoliosis can develop due to a variety of factors, including genetic, environmental, and neurological factors. The specific etiology of scoliosis is often complex and multifactorial. Certain neuromuscular conditions, such as cerebral palsy, can lead to the onset of the condition. Idiopathic scoliosis, which accounts for approximately 80% of scoliosis cases, is thought to be influenced by both genetic and environmental factors. The incidence of scoliosis varies, with rates ranging from 2-3% of the population. Juvenile scoliosis, which occurs before the age of 10, is another form of scoliosis that requires specialized treatment approaches. Understanding the main factor leading to scoliosis, as described in the “vicious cycle model,” is essential for tailoring treatment options and interventions based on the specific needs of each patient.

Historic Methods of Scoliosis Treatment

In the history of scoliosis treatment, early interventions focused on mitigating the progression of spinal curvature. Treatments such as bracing and traction were introduced to try to correct the spinal deformity. One of the historic methods of treatment was the Milwaukee brace, a full-torso brace that involved attaching metal bars and pads to the head, thoracic, and pelvic regions. This method, first described in the journal J Bone Joint Surg Am by Lonstein and Winter RB, has been used to treat over a thousand patients. Over the centuries, progress has been made in treatment, with new techniques and approaches developed to improve outcomes and patients’ quality of life.

Historic Methods of Scoliosis Treatment

Early Onset Scoliosis Treatments

Early onset scoliosis, which occurs before the age of 10, requires specialized treatments due to the child’s skeletal immaturity. In the past, treatment for this condition often involved bracing, traction, and surgery. Traction, a technique that involves applying a steady pulling force on the spine, was used to reduce spinal curvature. However, traction had limitations, and new treatment approaches were needed to better address the needs of patients with early onset curvatures. Over time, new treatment methods, such as growing rod constructs, were introduced, revolutionizing treatment for this specific population. These advancements aimed to minimize thoracic insufficiency syndrome, a condition that can occur in severe cases of early onset curvatures. The objective of this study is to examine the evolution of all the braced patients diagnosed with early onset scoliosis in a private scoliosis center. All patients diagnosed with EOS and braced before the age of ten were retrospectively reviewed. The results have been defined in accordance with the Scoliosis Research Society (SRS) for bracing criteria, and with a minimum follow-up of one year.

Progress in Scoliosis Treatment over the Centuries

The treatment has significantly progressed over the centuries, shifting from invasive methods to more patient-centric and non-invasive approaches. Historically, treatment options such as the Milwaukee brace, involving a full-torso brace, were introduced to correct spinal curvature. However, these braces were bulky and restrictive, impacting patients’ quality of life. With advancements in technology, new braces, such as the scoliosis brace, have been developed, offering a more personalized and comfortable fit. The evolving field of treatment options reflects a shift towards patient-centered care, focusing on improving functional outcomes and quality of life. Understanding the progression of treatment, including the history of previous treatment methods and the use of inclusion criteria, aids in the development of future innovations and treatment approaches.

The evolution of scoliosis treatment

Modern Approaches to Scoliosis Treatment

With advancements in medical knowledge and technology, modern approaches to treatment provide patients with a range of options, both surgical and non-surgical. Non-surgical methods, such as bracing, physiotherapy, and scoliosis-specific exercises, aim to prevent curve progression and improve quality of life. Surgical methods, such as spinal fusion and corrective surgery, are considered when non-surgical approaches have not been effective or when the curvature of the spine is severe. The availability of different treatment options allows healthcare providers to tailor interventions based on individual patient needs, maximizing the chances of successful patient management.

Non-surgical Methods

Non-surgical methods of treatment are often the first line of intervention, especially for patients with mild to moderate spinal curves. One of the most commonly used non-surgical treatments is bracing. Bracing involves wearing a corrective brace, such as the Boston brace, which supports the thoracic and lumbar spine and aims to prevent curve progression. The brace is custom-made for each patient and is typically worn for several hours a day. Alongside bracing, physical therapy and scoliosis-specific exercises play a vital role in treatment, providing stabilization for the spine and promoting proper alignment. These non-surgical methods focus on improving posture, strengthening core muscles, and promoting spinal alignment, ultimately minimizing the impact on a patient’s daily life.

Scoliosis Boot Camp

Scoliosis boot camps offer an intensive, multi-disciplinary treatment approach for patients. These programs combine specific exercises, nutritional therapy, and the use of specialized equipment, such as the ScoliSMART Activity Suit, to help patients manage their condition effectively. By providing comprehensive and holistic treatment, scoliosis boot camps aim to empower patients with the tools and resources they need for self-management. The immersive nature of these programs fosters a sense of community support and motivation, crucial for long-term success. Scoliosis boot camps not only focus on physical rehabilitation but also address the psychological aspects of the condition, ultimately improving patients’ quality of life and overall wellbeing.

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Surgical Methods

Surgical methods of treatment are typically considered when non-surgical approaches have not been effective or when the curvature of the spine is severe. One of the most common surgical procedures is spinal fusion, which aims to correct spinal curvature and stabilize the spine. During spinal fusion, bone grafts, often taken from the patient’s own body or a bone bank, are used to fuse the affected vertebrae together, effectively straightening the spine. Corrective surgery, including techniques such as osteotomies, may be performed to align and balance the spine. Surgical treatment requires collaboration between spine surgeons, anesthesiologists, and other specialists to ensure optimal outcomes for patients.

Innovations in Scoliosis Treatment

In recent years, there have been significant innovations in treatment, driven by advancements in technology, research, and a better understanding of the condition. These innovations aim to improve treatment outcomes, enhance patient experience, and minimize the impact on quality of life. Technological advancements, such as robotic-assisted surgery, 3D printing of customized braces, and virtual reality-assisted therapy, have revolutionized treatment. Additionally, ongoing research, including genomic studies, behavioral research, and new drug therapies, offers promising avenues for further advancements in the field. These innovations hold the potential to transform treatment, making it more personalized, effective, and accessible for patients of all ages.

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Technological Advancements

Technological advancements have played a significant role in improving patient outcomes. Research in the field of scoliosis, facilitated by platforms like Google Scholar, has contributed to a better understanding of the condition and interventions. The Scoliosis Research Society (SRS), an organization focused on advancing research and treatment, encourages collaboration among healthcare professionals, researchers, and AIS patients. Cutting-edge robotic technology assists surgeons in precise spinal fusion surgery, improving surgical outcomes. Customized braces, made possible through 3D printing technology, offer a better fit and increased comfort for AIS patients over 10 years of age. Virtual reality-assisted therapy helps patients cope with treatment, reducing anxiety and improving engagement. Telemedicine and wearable devices enable remote monitoring of curve progression, enhancing convenience and personalized care.

New Research in the Field

Continued research holds the promise of further advancements in approaches and patient outcomes. Recent studies have shed light on various aspects of the condition, helping healthcare providers develop more targeted interventions and tailored treatment plans. Some of the new research in the field includes:

  • Genomic studies aiming to identify genetic markers for susceptibility.
  • Behavioral research exploring the psychological impacts on patients.
  • Retrospective studies assessing the effectiveness of bracing treatment in preventing curve progression.
  • Prospective studies investigating the long-term impact on patients’ quality of life.
  • The use of retrospective and prospective study designs helps researchers collect data and draw conclusions to guide medical decision-making and improve outcomes.
New Research in the Field

Physiotherapy as a Treatment for Scoliosis

Physiotherapy plays a crucial role in the treatment of scoliosis, both as a standalone approach and in combination with other treatment modalities. Traditional physiotherapy techniques, such as stretching exercises, manual therapy, postural training, and strengthening exercises, aim to alleviate muscle tension, improve posture, and enhance overall spinal alignment. In recent years, modern physiotherapy techniques have emerged, focusing on specific curve patterns and incorporating innovative approaches to correct spinal rotation and imbalance. These techniques, which may include 3D scoliosis exercise programs, myofascial release, neuromuscular re-education, and proprioceptive training, are designed to promote optimal spinal function, improve quality of life, and help patients manage their condition effectively, with Schroth therapy being a popular approach developed in Germany.

Traditional Physiotherapy Techniques

Traditional physiotherapy techniques play an integral role, aiming to alleviate pain, improve posture, and enhance spinal alignment. These techniques include:

  • Stretching exercises, which help reduce muscle tension associated with spinal curves and improve flexibility.
  • Manual therapy techniques, such as massage, target specific muscle groups, promoting relaxation, pain relief, and improved mobility.
  • Postural training, involving exercises and education on maintaining proper spinal alignment during daily activities, reduces strain on the spine.
  • Strengthening exercises for core and back muscles, which aid in patient management, support spinal stability, and improve functional outcomes.
  • Breathing exercises, focusing on thoracic expansion and improved lung function, enhance overall spinal and respiratory health.

Modern Physiotherapy Techniques

Modern physiotherapy techniques have evolved, incorporating innovative approaches. These techniques include:

  • 3D scoliosis exercise programs, designed to correct spinal rotation and imbalance, improving spinal function and dynamic stability.
  • Myofascial release techniques, targeting soft tissue restrictions associated with the condition, aim to improve range of motion and reduce pain.
  • Neuromuscular re-education, which focuses on enhancing muscle activation patterns and improving postural control, promotes optimal spinal alignment.
  • Proprioceptive training exercises, such as balance drills, help patients improve spatial awareness and stability.
  • Functional movement assessments, which guide personalized physiotherapy interventions, aid in identifying specific movement dysfunctions and developing targeted treatment plans.

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The Role of Bracing in Scoliosis Treatment

Bracing is often a recommended intervention, particularly in managing curve progression. Bracing aims to prevent curves from worsening, reducing the need for surgery and improving quality of life. Several types of braces are used, depending on the curve pattern and patients’ specific needs. Common braces include the Boston brace, Milwaukee brace, and thoracolumbosacral orthosis (TLSO). These braces apply corrective forces to the spine, helping to align it and prevent further curvature. The effectiveness of bracing is assessed through regular monitoring, including X-rays to measure curve progression, brace fit, and patient compliance. However, it is important to note that the initiation of bracing should occur after meeting specific criteria, such as being older than 10 years of age and having a Cobb angle of 25°–40°, to ensure the best results in scoliosis treatment.

Types of Braces

Various types of braces are utilized as interventions, each designed to address specific curve patterns and patient needs. These braces include:

  • Boston brace: A thoracolumbosacral orthosis (TLSO) brace, custom-made to fit the patient’s body, supports the thoracic and lumbar spine, promoting spinal alignment.
  • Milwaukee brace: A full-torso brace, often used in the past, involves attaching metal bars and pads to the head, thoracic, and pelvic regions, providing corrective forces to the spine.
  • Thoracolumbosacral orthosis (TLSO): A brace that supports the thoracic and lumbar spine, designed to prevent curve progression, usually crafted using a mold of the patient’s body.
  • Rigo Chêneau brace: A customized, 3D corrective brace that addresses specific curve patterns, providing corrective forces to the spine.
  • SpineCor brace: A dynamic brace that allows controlled spine movement, specifically designed to promote natural spinal realignment.
Boston brace

Effectiveness of Bracing

Numerous studies question the effectiveness of bracing in preventing the curve progression and reducing the need for surgery. Key findings regarding bracing effectiveness include:

  • Retrospective studies have demonstrated a questionable impact of brace treatment in preventing curve progression.
  • Prospective studies indicate a slight reduction in curve progression with brace treatment, particularly when compliance with brace wear is high.
  • Long-term follow-ups have shown little lasting benefits of bracing, with patients reporting improved quality of life and reduced need for corrective surgery.
  • Bracing, when initiated early and worn consistently, may effectively manage spine curves, providing stability and preventing further curvature progression.
  • Regular monitoring of bracing, including evaluation of brace fit, curve progression using the Cobb angle measurement, and patient compliance, is essential for optimal treatment outcomes.

The Impact of Scoliosis Treatment on Quality of Life

Non-surgical or surgical interventions have a significant impact on a patient’s quality of life. Proper case management can address physical discomfort, improve spinal alignment, and optimize functional outcomes. It can also have positive psychological effects, such as improved self-confidence and body image. Physically, interventions attempt to minimize pain, promote mobility, and prevent complications associated with spinal curvature. Psychologically, successful interventions can reduce anxiety, improve self-esteem, and enhance social interactions. A comprehensive approach considers both the physical and psychological impacts, offering patients a better overall quality of life.

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Physical Impacts

Spinal curves can cause physical discomfort and limitation, significantly impacting quality of life. Some of the physical impacts of scoliosis include:

  • Pain and discomfort, often associated with spinal curvature and muscle imbalances.
  • Limited mobility, hindering daily activities, sports, and hobbies.
  • Complications, such as respiratory and cardiovascular problems, due to the curvature of the spine.
  • Spinal deformity, affecting posture, balance, and overall spinal function.
  • Reduced lung capacity, leading to breathing difficulties and fatigue.
  • Physical therapy, which may include bracing, aim to alleviate these physical impacts, providing relief, improving mobility, and optimizing overall spinal health, thus enhancing patients’ quality of life.

Psychological Impacts

The condition can have significant psychological impacts, especially during adolescence, when body image and self-esteem are particularly vulnerable. Some of the psychological impacts include:

  • Low self-confidence and body image issues, resulting from noticeable spinal curvature and postural asymmetry.
  • Anxiety and depression, stemming from social stigma, potential peer rejection, and concerns about physical appearance.
  • Impaired social interactions and limited participation in activities due to insecurity or discomfort.
  • Successful interventions can significantly improve patients’ mental well-being, boosting self-confidence, reducing anxiety, and enhancing social interactions, thus positively impacting their overall quality of life.
  • Psychological support, including counseling, peer support groups, and education, is vital for individuals dealing with the psychological impacts of the condition, ensuring they receive the comprehensive care they need.
Psychological Impacts

Conclusion

In conclusion, the process for treating curvatures of the spine has come a long way over the centuries. From early methods like bracing and spinal fusion to modern approaches like non-surgical techniques and advanced surgical procedures, there have been significant advancements in the field. The integration of technology and research has played a crucial role in improving treatment outcomes and enhancing the quality of life for patients.

Physiotherapy has also emerged as an effective treatment option, with both traditional and modern techniques yielding positive results. It not only helps in managing the physical aspects of the curve but also addresses the psychological impacts that can accompany the condition.

As we look ahead, there is a promising future for scoliosis treatment. Ongoing research and technological advancements continue to pave the way for innovative approaches that offer improved outcomes and a better quality of life for patients.

If you or a loved one are dealing with a spine curve, it’s important to consult with a healthcare professional to explore the available treatment options and find the best approach for your specific needs. Remember, early detection and intervention can make a significant difference in managing patients effectively.