Whenever possible, nonsurgical treatments are chosen first. Spinal surgery will generally be a last resort due to the risks involved. Conservative treatments commonly include medication, bracing, and physical therapy and exercise.
If osteoporosis is present, treatment of the osteoporosis may also slow the progression of the scoliosis. This can be accomplished in several ways. The current recommendations include increasing calcium and vitamin D intake, hormone replacement therapy, and weight-bearing exercises. Learn more about preventative measures for osteoporosis>.
Mild pain medications may be prescribed to use as needed. Usually strong pain medications, such as narcotics, are not recommended due to the risk of addiction.
A spinal brace may provide some pain relief. In adults, it will not cause the spine to straighten. Once you have reached skeletal maturity, bracing is used for pain relief rather than prevention. If there is a difference in the length of your legs (or if the scoliosis causes you to walk somewhat crooked), special shoe inserts, called orthotics, or a simple shoe lift may reduce your back pain. Learn more about braces used to treat back problems.
Physical Therapy and Exercise
Adults with scoliosis may work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving mobility and strength, and helping them do daily activities with greater ease and ability.
Exercise has not proven helpful for changing the curves of scoliosis. However, it can be helpful by addressing pain, posture, and spinal stabilization. Therapy sessions may be scheduled each week for four to six weeks.
The goals of physical therapy are to help
- learn ways to manage the symptoms of scoliosis
- improve spine posture
- maximize spinal stabilization
Surgery for adult scoliosis has some significant risks. That is why it is only recommended when the expected benefits far outweigh the risks. Surgery is generally only considered in patients who have continual pain, difficulty breathing, significant disfigurement, or a steadily worsening curve. Surgery will not be recommended for most cases-particularly in patients with curves of less than 40 degrees. Curves above 100 degrees are rare, but they can be life-threatening if the spine twists the body to the point where pressure is put on the heart and lungs.
Surgery may be needed in the following situations:
- Pain The most common reason for scoliosis surgery is pain relief for chronic discomfort that keeps getting worse. About 85 percent of adult scoliosis surgeries are done to relieve severe pain. Surgery will probably not be recommended if the pain is manageable through conservative treatments.
- Progression of Curve Surgery may be suggested if the curvature continues to worsen and the curve gets beyond 40 to 45 degrees to prevent problems that come with severe scoliosis. Surgery will usually be recommended for curves above 60 degrees, as the twisting of the torso can lead to serious lung and heart conditions.
- Cosmetics Surgery is generally not recommended merely for the sake of appearance. But sometimes the scoliosis causes physical deformity that is unbearable to the patient. Surgery may be the only option for correcting the condition. Most cases of cosmetic scoliosis surgery are in young adults that have very noticeable curves.