In many cases, 

no treatment is necessary. Some children will need to wear

a brace to stop the curve from worsening. Others may need surgery to
straighten severe curves.

Scoliosis is not treated by medications other than analgesics to treat back pain in severe
scoliosis or degenerative scoliosis. Back pain associated with scoliosis is usually managed with
over-the-counter pain relievers such as acetaminophen or aspirin or prescription NSAIDs

Treatment
Your doctor will consider several things when planning your child's treatment:
 The location of the curve
 The severity of the curve
 Your child's age
 The number of remaining growing years — once an adolescent is fully
grown, it is not common for a curve to rapidly worsen.
By evaluating these factors, your doctor will determine how likely it is that your
child's curve will worsen and be able to suggest the best treatment option.

Nonsurgical Treatment

Observation. If your child's spinal curve is less than 25 degrees or if he or she is

almost full-grown, your doctor may recommend simply monitoring the curve to
make sure it does not get worse. Your doctor will recheck your child about every 6 to
12 months and schedule follow-up X-rays until your child is fully grown.

Bracing. If the spinal curve is between 25 and 45 degrees and your child is still
growing, your doctor may recommend bracing. Although bracing will not straighten
an existing curve, it often prevents it from getting worse to the point of requiring
surgery.

In a recent research study of scoliosis patients with curves at a high risk for
worsening, bracing significantly decreased the incidence of curves that progressed to
the point of needing surgery.

There are several types of braces for scoliosis. Most of them are underarm braces
that are custom-made to fit your child's body comfortably. Your doctor will
recommend the type that best meets your child's needs and will determine how long
the brace should be worn each day.

Note: This underarm brace is intended to prevent a spinal curve from worsening to the point
where surgery is needed.

Clothes in loose-fitting styles easily cover the brace. Your child can take off the brace for
sports activities.
Surgical Treatment
Spinal Fusion
Your doctor may recommend surgery if your child's curve is greater than 45 to 50
degrees or if bracing did not stop the curve from reaching this point. Severe curves that
are not treated could eventually worsen to the point where they affect lung function.

A surgical procedure called spinal fusion will significantly straighten the curve and then
fuse the vertebrae together so that they heal into a single, solid bone. This will stop
growth completely in the part of the spine affected by scoliosis.

During the procedure, the spinal bones that make up the curve are realigned. Small
pieces of bone — called bone graft — are placed into the spaces between the vertebrae to
be fused. Over time, the bones grow together — similar to when a broken bone heals.

Metal rods are typically used to hold the bones in place until the fusion happens. The
rods are attached to the spine by hooks, screws, and/or wires.

Exactly how much of the spine is fused depends upon your child's curve(s). Only the
curved vertebrae are fused together. The other bones of the spine remain able to move
and assist in motion.

Other Procedures
Several institutions are investigating fusion-less spine surgery in younger patients with
moderate curves (45 to 50 degrees) who are still growing. However, more patient follow-
up is needed to determine the usefulness of this tethering growth modulation surgery
and its lasting effect. For this reason, spinal fusion surgery is still considered the gold
standard for surgical treatment of scoliosis.

Recovery
By the first day after spinal fusion surgery, most patients are able to walk without
wearing a brace. Discharge from the hospital is usually from 3 to 4 days following
surgery. Most children can return to school and resume their daily activities within 4
weeks.

Long-Term Outcome
Spinal fusion is very successful in stopping the curve from growing. Surgery is also able
to straighten the curve significantly, which improves the patient's appearance.

Most children can return to sporting activities within 6 to 9 months after surgery.
Because surgery causes permanent limitation of some spine movements, however,
participation in contact sports such as football may be discouraged.
Spinal fusion does not increase the risk of complications during girls' future pregnancies
or deliveries.

Surgery

Severe scoliosis typically progresses with time, so your doctor might suggest scoliosis
surgery to help straighten the curve and prevent it from getting worse.

Surgical options include:

 Spinal fusion. In this procedure, surgeons connect two or more of the

bones in the spine (vertebrae) together so they can't move independently.
Pieces of bone or a bone-like material are placed between the vertebrae.
Metal rods, hooks, screws or wires typically hold that part of the spine
straight and still while the old and new bone material fuses together.

 Expanding rod. If the scoliosis is progressing rapidly at a young age,

surgeons can attach one or two expandable rods along the spine that can
adjust in length as the child grows. The rods are lengthened every 3 to 6
months either with surgery or in the clinic using a remote control.

 Vertebral body tethering. This procedure can be performed through small

incisions. Screws are placed along the outside edge of the abnormal spinal
curve and a strong, flexible cord is threaded through the screws. When the
cord is tightened, the spine straightens. As the child grows, the spine may
straighten even more.

Nonsurgical treatments for scoliosis include observation, physical therapy, the Schroth
method, bracing and Mehta casting.

Scoliosis treatment methods

Observation for scoliosis

If your child has only a slight curvature of the spine – less than 20 degrees – no
immediate treatment is usually necessary. Depending on the curve size, your physician
may check the child's spine regularly until the child has stopped growing (around late
puberty) to make sure the curve is not progressing and that other health problems don't
arise. If your child's curve does progress beyond 20 degrees, your doctor might
recommend additional treatments to prevent worsening of the curvature as they grow.

Physical therapy for scoliosis

If your child is experiencing pain because of the spine's curvature, traditional physical
therapy can help. Physical therapists work to strengthen your child's back and leg
muscles, increase flexibility and prevent injury. The therapist may use general flexibility
techniques, focus on your child's core or try manual therapy, in which the therapist's
hands guide and retrain the patient's movements. Although physical therapy doesn't
correct the curvature, it can alleviate your child's discomfort.

Schroth Method for scoliosis

For children with certain types of spinal curves, you might consider a specialized type of
physical therapy called the Schroth method. While research is limited, Schroth method
is the only form of therapy shown to improve curvature. With the Schroth method, a
specially trained therapist demonstrates how to perform a series of breathing, stretching
and strengthening exercises in five different positions:
 Lying on the back

 Lying on each side

 On hands and knees
 Sitting
 Standing
Schroth exercises are customized to meet the treatment needs of each child. For
example, a child might have rib prominences and flatter areas throughout the back
because scoliosis has caused the spine and ribs to rotate. Schroth exercises can treat
these issues by strengthening the muscles that support the child's posture and improve
alignment.

The benefits of the Schroth method for scoliosis include:

 Improved mobility
 Reduced pain
 Stronger core and back
 Realignment of the spine – improved posture
 Prevention of the curve from getting worse
 Improved heart and lung function
The Schroth method is particularly effective while your child is still growing. It can also
be used in conjunction with bracing or surgery. Schroth therapy requires a large time
commitment and involvement from the patient and may not be suitable for all patients.
Your physician will assist in determining if this is a possible treatment option.

Bracing for scoliosis

If your child's spinal curve is greater than 20 degrees, your physician might suggest a
custom-made brace. This is most typically prescribed for patients with curvatures
greater than 25-30 degrees with significant skeletal growth remaining. A health care
professional called an orthotist makes the brace, working closely with your physician to
ensure correct fit and comfort. The goal of bracing is not to correct the curvature but is
used to prevent a spinal curvature from worsening as the patient grows.

To be effective, the child must typically wear the brace for a minimum of 18 hours a day.
Not everyone is a good candidate for a brace – it depends on the type of scoliosis and
extent of your child's spinal curve. Your physician will explain the best option for your
child.

Mehta casting for scoliosis

For babies and toddlers who are diagnosed with severe curvature (called infantile
or early onset scoliosis), your doctor might suggest a treatment called Mehta casting.
Mehta casting involves the physician applying a cast around the child's back and chest
using a special technique designed to correct the deformity of the spine over time. This
is typically performed under general anesthesia and the cast is changed every 2-3
months while the child grows. This procedure may require several cast changes during
treatment but potentially allows the physician to fully treat the curvature without any
incisions. For some children, a brace or surgical treatment may also be needed in the
future