Scoliosis: treatment
Scoliosis is treated conservatively with physiotherapy or a corset and, in severe cases, surgically. Scoliosis therapy should begin as soon as possible after the diagnosis. The choice of treatment depends on the extent, cause and location of the spinal curvature, as well as the age and physical condition of the patient. In the case of mild scoliosis, physiotherapy is often sufficient; doctors with a scoliosis corset treat more severe forms . If the curvature is very strong, surgery can help.
Goals of scoliosis therapy
With the treatment of a curvature of the spine, doctors, together with other specialists such as physiotherapists, try to ensure that scoliosis regresses or at least does not worsen. If scoliosis therapy was able to reduce the curvature, further treatment steps ensure that this success is maintained. The guidelines set a clear goal for children and adolescents: the Cobb angle should be below 40 degrees when growth is complete. If this succeeds, surgical scoliosis therapy is no longer necessary, according to experts.
Scoliosis corset
A scoliosis corset is used for severe spinal curvatures in the child (Cobb angle 20-50 degrees). This often results in very good results for scoliosis that are not based on serious underlying diseases (malformations, muscle or nerve diseases, etc.).
The corset is made of plastic and has both integrated pressure pads (pads) and free spaces (expansion zones).
It is made to measure, attached to the body by means of straps and Velcro fasteners and is intended to bring the spine back to its natural shape. The orthosis should be worn for 22 to 23 hours a day. Depending on the height of the main curvatures, different scoliosis corsets are available.
Girls can gradually reduce the daily wearing time, depending on the course, about two to three years after the first menstrual period. In boys, a certain skeletal maturity should only be reached (Risser stage four or five), so that a large growth of the spine is no longer to be expected.
Adults benefit little from this scoliosis therapy because their bone growth has already been completed. Nevertheless, the orthoses are also used in old age, for example to stabilize and thus alleviate the course of the disease.
Regular gymnastics exercises also support successful scoliosis therapy with orthoses.
Plaster treatment
In some cases of early curvature of the spine (under five years of age, early-onset scoliosis), scoliosis therapy using a plaster corset is an option. Here, the spine can continue to grow normally. The plaster treatment is usually followed by therapy with a scoliosis corset.
Operative scoliosis therapy
In some cases, conservative scoliosis therapy (physiotherapy, corset) is not sufficient. If scoliosis worsens and the curvature is pronounced, doctors usually recommend surgical scoliosis therapy. They take several factors into account:
- the degree of curvature (from a Cobb angle of approximately 40 lumbar and 50 degrees thoracic)
- rapid progression and impending wear
- the age (if possible, not before the tenth to twelfth year)
- general physical condition (psychological stress, constant pain)
Surgical scoliosis therapy is intended, among other things, to prevent stiffening due to spondylosis . In spondylosis, the body builds bone substance on the vertebral body edges in order to compensate for increased stress. These bone spikes of neighboring vertebrae can, however, grow together with each other through the resulting bone bridge stiffens the spine. An operation is also attempted to prevent possible effects on the cardiovascular system and lung function.
During the actual surgical procedure, the surgeon exposes the affected spine section. The operation takes place either from the front, over the chest or abdominal cavity, or from behind. The goal of all operative scoliosis therapies is that the crooked spine should be stretched and its rotation should be eliminated. The doctor also stabilizes the spine, for example by means of screws and rods.
Scoliosis surgery: stiffening therapy
With the so-called spondylodesis (spinal stiffening) you intentionally cause the vertebrae to grow together at the affected area. So you want to stiffen the spine in its previously corrected form.
Newer operative scoliosis therapies for children and adolescents
Stiffening the spine prevents it from growing naturally. Therefore, it is not an option for children and adolescents. Instead, doctors use special titanium rods in these cases, for example.
The so-called VEPTRs (vertical expandable prosthetic titanium rib) are used in such a way – for example from the rib to the vertebra – that they do not prevent the spine from growing.
With this scoliosis therapy, doctors have to adjust the rods regularly through further minor interventions, approximately every four to six months.
Modern variants of such rods, the ” growing rods ” (= growing rods) contain a small remote-controlled motor. In this way, they can be adjusted to the respective spinal growth from the outside and without renewed intervention.
A complex system of screws, rods and a special plate called the Shilla process also promises scoliosis therapy without hindering growth. The rods used “grow with” because they can slide in their fastening screws. When bone growth is complete, the system can be removed.
Correction system
Another method is the ApiFix correction system. It is attached vertically in the arch of scoliosis. Physiotherapy treatments follow in the months after the implantation.
The correction system can react to this with a ratchet mechanism: If the spine stretches through an exercise, the system is pulled along and engages in a new position. As a result, the spine can no longer fall back into its crooked starting position. This scoliosis therapy is carried out gradually so that the surrounding tissue can adapt better.
Clip technology
This form of surgical scoliosis therapy is suitable for curvature angles below 35 degrees. Doctors attach special, claw-shaped clips (shape memory alloy, SMA) to the side of the spine. Before the procedure they are cooled, after the procedure they are pushed back to their original shape by the body heat of the patient and thus correct the scoliosis.
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