With adolescents, progression is monitored closely as growth is the number one cause of progression and the adolescent stage is characterized by rapid growth spurts. The recommendation for surgery is only a guideline and is often subjective, which is a major concern for patients making decisions about scoliosis treatment. Our scoliosis-specific chiropractic care, exercises, and rehabilitation work together to strengthen the spine in a corrective position, making it harder for a curvature to progress. X-rays are noninvasive, accessible, reliable, inexpensive, and quick. Next, the most tilted vertebra is located at the base of the curve and another parallel line is drawn to the inferior vertebral end plate. Abnormal reflexes The issue I have with the watch-and-wait approach is that in-between doctor’s visits or scheduled X-rays, an adolescent can experience a significant growth spurt that can cause the condition to progress significantly. While surgeons have their patients’ best interests at heart, even the most minor of surgeries carry risks, and spinal-fusion is no minor surgery. The patient “drops out of life” for at least a year. Most children with scoliosis will have mild cases that only require monitoring every four to six months. In the United States, severe scoliosis is defined as a curvature with a Cobb angle measurement of 40-plus degrees in adolescents and 50-plus in adults. Depending on the particular patient and the specific degree of curvature, this form of scoliosis may be treated successfully with non-surgical methods like bracing, physical therapy, and pain medications. Copyright © 2020 - Scoliosis Reduction Center. Out treatment plans prioritize strengthening the spine through natural means, rather than holding it with a brace or rod. Health care providers measure scoliosis curves in degrees: A mild curve is less than 20 degrees. Treatments may be surgical or nonsurgical, and they also vary depending on the type of scoliosis a person has, and the age at which they develop it. Welcome to Scoliosis Reduction Center. In order for a patient to receive an official scoliosis diagnosis, a visual assessment will be done and an X-ray will be taken. Through our use of the latest digital X-ray technology, we can promise accuracy and minimal exposure to radiation. The most common form is idiopathic scoliosis (in which the cause is unknown), and it most commonly occurs between the ages of 10 and 18. Regarding the question of what scoliosis degree requires surgery, that answer will differ greatly based on the treatment approach that has been chosen. They see lots of teens with scoliosis and can decide if you need treatment. Also, during growth spurts, the time in-between X-rays can be too long. “I see a number of patients who automatically assume they will need treatment for their scoliosis, but only a small percentage — about 30 percent — require bracing, and an even smaller percent — about 10 percent — of patients actually require surgery,” Sponseller assures. With a varying degree of severity and conditions, scoliosis is a condition that entails undergoing proper treatment because every form of the condition can get worse over time. The USPSTF suggests that most patients who need treatment will be detected without screening,14 when presenting with visible curvature or possibly incidentally during another type of examination. Back braces are best suited for treating moderate scoliosis because they can not reverse spinal curvature, they only prevent the condition from worsening too severely by holding the spine firmly in place. Each treatment has its own advantages and disadvantages, which is why it is best to talk to your doctor before going for any treatment option. Just as laws vary from state to state and country to country, healthcare-industry protocols and guidelines also vary. Many people report an anxiousness they didn’t have before regarding how fragile their spine actually is. A curvature of 10 degrees is regarded as a minimum angulation to define scoliosis. How scoliosis is classified is important because it determines how a condition should be treated and how the patient is likely to experience their condition. Mild cases may not require any treatment. Treatment is geared towards relieving symptoms, and not necessarily fixing the curve. In this instance, the patient’s age is one of the main factors that determine how painful the condition is likely to be, and age is also an important factor when it comes to deciding whether surgery is an option or not. From there, we design a customized proactive treatment plan that works to reduce the curvature and stabilize the scoliosis. These cases are the hardest for me because I hear so often, “I wish I had known about you and your approach earlier.”. A severe curve is more than 50 degrees. The degree of correction from surgery depends on how flexible your scoliosis is before your operation. In most cases, it is a painless condition. There is no curing scoliosis, but there are different approaches to managing and controlling its progression. It’s at this point that I highly recommend patients ensure they’re working with a scoliosis specialist. Spinal-fusion surgery can straighten a crooked spine, but it doesn’t cure the condition, nor does it guarantee the patient’s condition won’t continue progressing or that subsequent surgeries won’t be necessary. On one hand, there’s the traditional approach that most often doesn’t start treatment until a curvature has reached or progressed past 25 degrees; on the other, there’s my chiropractic-centered functional approach that initiates treatment as close to the time of diagnosis as possible. Between observation for the mildest cases, and surgery for the most severe, there are many different therapeutic approaches geared towards helping manage scoliosis symptoms and progression. In the United States, severe scoliosis is defined as a curvature with a Cobb angle measurement of 40-plus degrees in adolescents and 50-plus in adults. Below is an up-to-date summary of facts about scoliosis. School screening for scoliosis is controversial and is falling out of favour. Patients and their caregivers find success with my approach because, here at the Scoliosis Reduction Center, we offer a customized approach with access to multiple facets of treatment in one place: My approach is different because I take into account how any chosen course of treatment affects the whole patient. Severe migraines as a young teen introduced Dr. Nalda to chiropractic care. A patient’s Cobb angle is measured by first locating the most tilted vertebra at the apex of the curve. In addition, the main goal is to stop further lateral curving of the vertebral column. Large lateral curve. This is a tight brace that is worn over the upper body that holds the spine in a straighter alignment with the goal of preventing the curve’s progression. Conditions are classified for a number of reasons. Adults over the age of 50 are also more likely to experience the type of disc degeneration that can cause a spinal curvature to develop. When the body is bent over, the spinal cord is more visible. In this article, we will be focusing on the various degrees of scoliosis and the treatment options for each respective degree. What degree curve do you decide to do a brace? Severe migraines as a young teen introduced Dr. Nalda to chiropractic care. Treatment options for idiopathic scoliosis could include: Observation. The treatment for pediatric scoliosis depends on several factors: The type of scoliosis. Bracing. Treatment is geared towards relieving symptoms, and not necessarily fixing the curve. The traditional treatment approach would start when a curve reaches or progresses past 25 degrees. When it comes to diagnosing and classifying a patient’s scoliosis, an X-ray is the gold standard. Standing X-rays taken of the spine from the back and side will measure the degree of a spinal curvature and place it on the spectrum of mild-to-severe scoliosis. We actually encourage our patients to keep doing the physical activities they love. Scoliosis Surgery Treatment . Idiopathic scoliosis, which makes up over 80% of all cases, has no known cause but that doesn't mean we don't know much about the condition. The challenge for the primary care physician is differentiating adolescents with higher-risk scoliosis requiring referral or intervention from those with lower-risk scoliosis requiring observation and no intervention. What often happens in the traditional approach is that a patient is observed until their condition progresses to a certain severity level and surgery is then recommended as the best option, but that surgery can come at a high price, and not just in monetary terms. In Canada, that threshold is higher at approximately 55 degrees and Europe is at the highest with approximately 60 degrees. Traditional treatment: even at a 10, 15, or 20 degree of curvature, typically, no active treatment is started. Scoliosis Surgery. Its degree of severity is determined via X-ray and a measurement known as the Cobb angle; this measurement uses the apex of the curve to class the curvature as mild, moderate, or severe. Scoliosis is about two times more common in girls than boys. Often, braces will be suggested as part of traditional treatment. In general, the following factors increase a person’s risk for a scoliosis curve to worsen: 1. If a curve has reached 20 degrees and the child or adolescent is still continuing to grow, bracing might be considered. Welcome to Scoliosis Reduction Center. If your child has this condition, your family doctor may recommend the wait-and-see approach. Severe scoliosis: Cobb angle measurement of 40-plus degrees for adolescents and 50-plus for adults. In adults, the degree of the spinal curve may or may not determine treatment. Curvature under 10 degrees is considered a normal variation, just as there is a normal range for weight and height. Patients with congenital scoliosis must be evaluated for cardiac and renal abnormalities. From there, a parallel line is drawn to the superior vertebral end plate. As an incurable progressive condition, the nature of scoliosis is to worsen. Curves may be as mild as 10 degrees, or as severe as 100 degrees or more. Our approach involves ingenuity and dynamic thinking. I’m thrilled with what my team at the Scoliosis Reduction Center has accomplished. A curve of at least 25 degrees is typically considered moderate scoliosis. The ultimate goal is to achieve a reduction and slow or stop the condition’s progression, and I take a functional approach that encourages staying active and mentally healthy throughout treatment. Scoliosis with a primary diagnosis (nonidiopathic) must be recognized by the physician to identify the causes, which may require intervention. 10-24º Category: Case 2 Result Details. Treatment for adolescent idiopathic scoliosis determined by the degree of the spinal curve at the time of diagnosis and by … Unless you’re a scoliosis specialist or are constantly on the watch for symptoms, it’s hard to diagnose. Treating 20 degree scoliosis Young patients with mild scoliosis will usually be recommended to wear a specially-fitted back brace - read about bracing here. A spine that is held in place by rods and screws is also less flexible. After experiencing life changing results, he set his sights on helping others who face debilitating illness through providing more natural approaches. Your doctor can measure your flexibility before surgery with special x-rays called bending or traction films. Babies and toddlers may not need treatment as the curve might improve over time. While most doctors would be able to spot an abnormal spinal curvature, when it comes to being able to fully interpret a scoliosis X-ray, seeing a specialist is highly beneficial. Surgery can be performed for smaller curves if the appearance of the curvature is bothersome to the patient or if symptoms are associated with the scoliosis in the adult patient. The three-dimensional change in the spine's alignment the curve is a just a symptom of the conditi… Surgical treatment for scoliosis is indicated, in general, for the curve exceeding 45 or 50 degrees by the Cobb's method on the ground that: 1) Curves larger than 50 degrees progress even after skeletal maturity. The reality is that people with scoliosis will be living with the condition for their entire lives. What I want people to know, and what I devoted large sections of my book Scoliosis Hope to explain, is that while spinal-fusion surgery can make a crooked spine straighter, it does not cure the condition; nothing and no one can do that, nor can the surgery guarantee to halt progression. To return to the original question of what degree of scoliosis requires treatment, by now you know that the answer will change depending on the approach you’ve chosen. Many people will not need any treatment and only a small number will need to have surgery on their spine. My alternative treatment option is a chiropractic-centered functional approach. Mild scoliosis: Cobb angle measurement of 25 degrees or less, Moderate scoliosis: Cobb angle measurement between 25 and 40 degrees. These variables are also beneficial in preparing the patient for what to expect in terms of the scoliosis-related symptoms they are most likely to experience. ... Also requires a long stay in a plaster bed and corset. Scoliosis treatment. Today, many modern clinics offer the latest scoliosis treatment methods. A scoliosis curve that is 50 degrees by the time an adolescent reaches skeletal maturity (about age 14 or 15 for girls and 16 or 17 for boys) will continue to progress throughout adulthood. During this test, the patient is told to stand up straight, then bend forward, as if touching their toes, at a 90-degree angle. Once we achieve a reduction, we know what works and we augment that work with at-home exercises and stretches for the patient. The number of remaining growth years your child has until skeletal maturity. Common classifications include a patient’s age, condition type, and condition severity; this helps health-care professionals gauge what they’re dealing with. While there is no known cure for scoliosis, there are known treatment options. This angle is the maximum distance between a straight spine and a curvature. As I mentioned earlier, the condition’s most common form is AIS, meaning adolescents between the age of 10 and 18 make up the largest age group diagnosed with the condition; this is an age group characterized by rapid and unpredictable growth spurts. A visual test such as the Forward Bend Test, also known as the Adam’s Test, will likely be performed. Curves between 10 and 24 degrees are mild scoliosis and likely just need to be monitored. A mild classification would include a spinal curvature measuring up to 25 degrees. This experience has enabled me to develop strategies for reading scoliosis X-rays more comprehensively than the average health-care practitioner; by extension, this ability allows me to craft a more customized and effective treatment plan. It’s one thing for an adult patient to come to me seeking ways to manage the pain related to their scoliosis or seeking new treatment options; it’s quite another for parents and caregivers who are advocating for their loved ones and have the added pressure of trying to decide which treatment option is best for them. Once we assess those initial X-rays, we take into account how much the adolescent patient has grown, how much their spine has grown, and how much they are likely still to grow. My issue with this course of treatment is that at 25 degrees, a patient is already 15 degrees from a surgical-level curve. Then intersecting perpendicular lines are erected from the two parallel lines from the curve’s apex and bottom. Based on the traditional approach, a surgeon in the States often suggests surgery when progression is rapid or a patient’s Cobb angle measurement is 40-plus degrees. Curves between 10 and 24 degrees are mild scoliosis and likely just need to be monitored. Scoliosis spinal fusion surgery may be recommended when a curve is moderate or severe, depending on the doctor. Thoracic scoliosis: curvature in the spine’s middle portion (most common), Lumbar scoliosis: curvature in the spine’s lower portion, Thoracolumbar scoliosis: curvature that includes both lower thoracic and upper-lumbar vertebrae, Dextroscoliosis: sideways curvature that bends to the right, Levoscoliosis: sideways curvature that bends to the left, Congenital scoliosis: develops as a result of malformed bone the patient was born with, Neuromuscular scoliosis: develops as a secondary complication of diseases such as cerebral palsy or muscular dystrophy, Degenerative scoliosis: develops in older people whose spinal discs have degenerated with age, Traumatic scoliosis: develops as a result of an adverse trauma to the spine, Coreconcepts.com.sg - ‘Cobb Angle and Scoliosis’. The sad thing is that by the time I meet many of my patients, they have been on the path of traditional treatment and are already headed towards surgery. In as little as two weeks, 98 percent of our patients show improvements in relief and function. Scoliosis of 3 and 4 degrees is treated promptly. If your child's curve is between 25 and 45 degrees, bracing may be required. From a scoliosis X-ray, we can find out everything we need to know about the patient’s condition and individual curvature. Scoliosis ranges from 10-20 degrees (mild), 20-50 degrees (moderate), and severe (greater than 50 degrees). The next range of 10 to 15 degrees does not normally require treatment other than monitoring by an Orthopaedic doctor until the patient has gone through puberty. Also, the treatment for scoliosis depends on the type and the magnitude of the spinal curvature. Doctors often recommend spinal fusion surgery for people with severe scoliosis (50 degrees or more), but surgery is generally not your best long-term option. The most common form is idiopathic scoliosis (in which the cause is unknown), and it most commonly occurs between the ages of 10 and 18. See Bracing Treatment for Idiopathic Scoliosis . Age is generally the first stage of condition classification as it helps paint an overall picture of the patient. A measurement of 20 to 40 degrees will generally result in the Orthopaedic doctor prescribing a back brace to prevent the curvature from worsening. The doctor will initially take a detailed medical history and may ask questions about recent growth. 25- to 39-degree curve. My approach is a functional one, meaning the goal is to improve and facilitate the spine’s function, rather than holding it in a straighter alignment at the cost of mobility. Due to the spine’s lengthening motion during the growth that characterizes the adolescent stage, many young people don’t experience pain as part of their condition. Curves less than 50 degrees at the end of growth do not usually require surgery or keep getting bigger. The remaining 20 percent with known causes are classed as congenital, neuromuscular, degenerative, or traumatic. With an adult, however, it is very likely that pain will be a symptom. The differences in occurrence and severity between genders increases with age. Brace treatment is generally used to prevent scoliosis from getting worse when you have: A curve that is moderate in size (20 to 40 degrees) AND; A curve that is progressive (has increased by more than 5 degrees) OR; A curve that is over 30 degrees when first diagnosed AND; A lot of growing yet to do Through engagement with their treatment and building as positive an association with their condition as possible, our patients are able to regain feelings of control over their lives and their bodies. A person will be getting an X-ray for another reason, and the doctor notices a curvature. The Cobb angle refers to the angle formed between those two parallel lines. Degrees of scoliosis ranging between 20 and 50 are considered moderate scoliosis, and can usually be treated with a back brace. The lion’s share of scoliosis cases are classed as ‘idiopathic’, meaning no known single cause, and this accounts for 80 percent of known diagnosed cases. I can’t tell you how many parents and caregivers I’ve seen in tears because they so strongly regret the fact that instead of acting immediately, they took the dominant medical advice to watch and wait. Contact Us Today! A lot of the mystery that still surrounds scoliosis is because of how difficult it is to diagnose. No big cuts. Scoliosis, the medical term for curvature of the spine, affects millions of people, an estimated 2 to 3 percent of the population. When paired with a scoliometer, a Forward Bend Test is a reliable means of finding indicators of the condition and the need for a scoliosis X-ray. Observation. I’ve dedicated my life to the specific study of scoliosis, so I’ve performed thousands of scoliosis X-rays over the years. In general, a curve is considered significant if it is greater than 25 to 30 degrees. Most scoliosis does not require treatment. Once a spine has been fused, it is less able to absorb force, limiting certain activities that are safe post-surgery. Children with curvatures under 30 degrees usually do not require any treatment at all. Asymmetries of the shoulders, hips, and waistline. Surgery and Bracing Are Invasive Treatment Options. Scoliosis severity is a big component when it comes to deciding on a treatment plan, and scoliosis degrees of curvature classify a condition as mild, moderate, or severe. Determining what degree of scoliosis requires treatment is a complex issue. Scoliosis spinal fusion surgery may be reco… I feel there’s more harm to watching and waiting than there is to initiating a patient-centered form of treatment immediately. I would turn the clocks back to that initial diagnosis, in the doctor’s or specialist’s office, and I would start the treatment clock that very day. Knowing where a patient’s curvature is located along the spine, and in which direction it bends, is an important classification step as different curvature locations carry different symptoms and treatment needs. Degrees of scoliosis ranging between 20 and 50 are considered moderate scoliosis, and can usually be treated with a back brace. She was diagnosed with scoliosis after her brother required spinal surgery for his own severe curvature. The rods act as a splint to hold the spine in position as the bones fuse; the initial fusion can take between 3 and 6 months, with full fusion taking up to 12 months after surgery. Most cases of scoliosis are mild and don’t need treatment. Less than 20 Degrees Slight curvatures of the spine (generally less than 20 degrees) are the most common form of scoliosis. This also involves restrictions placed on physical activity. Through hard work and ingenuity, the Scoliosis Reduction Center has helped transform the lives of thousands of people living their best lives with the condition. Here at the Scoliosis Reduction Center, we don’t watch and wait: we act. Girls are much more likely than boys to require treatment. May 24 2017. This is not scoliosis. erika scoliosis & other back problems. All Rights Reserved. Most patients recover from surgery with curves that have been straightened to less than 25°. We don’t watch and wait; we diagnose and start treatment immediately. If the Cobb angle is less than 10°, this is usually an indication of a perfectly normal spine (since the human spine always has a certain degree of deviation - nobody's back is totally straight). A scoliosis curve usually does not improve without surgery. The advantages of the techniques : No transplant required. The Scoliosis Reduction Center uses X-rays on a daily basis to diagnose, assess, and measure our patients’ scoliosis. The key to diagnosing scoliosis early is knowing what to look for. If you or a loved one are facing the possibility of spinal-fusion surgery to treat scoliosis, I urge you to first explore other options such as my scoliosis-specific chiropractic approach. Our team, under the leadership of Dr. Tony Nalda, is focused on treating your scoliosis in the most patient-centered, effective manner possible. While we can’t manage or control our patients’ growth, we can certainly monitor it and counteract the resulting progression. The traditional approach would dictate that intensive treatment starts after a 25-degree curvature and most often ends with spinal-fusion surgery; my chiropractic-centered treatment would say any degree of scoliosis, once it is diagnosed, is best managed with immediate treatment. While most people are going to have some degree of spinal curvature, if the spinal curvature starts to impact someone’s health, then it is termed scoliosis and medical treatment is required. Every 4 to 6 months, the doctor will take another X-ray of the spine to see if the scoliosis is progressing or not. I combine X-ray results with a number of other standing and seated measurements taken from multiple angles and positions to ensure I am getting full 3-D measurements of the condition. A Scoliosis diagnosis is given when an abnormal curvature is measured at 10+ degrees and includes rotation, which is what makes scoliosis a 3-dimensional condition. I do believe that my patient-centered customized approach treats the whole patient by taking into account the many different levels of a person’s life that are impacted by the condition. There is also the issue of how wearing a traditional brace for 13+ hours a day will affect the mindset, happiness, and confidence level of the average adolescent facing scoliosis. While the traditional approach can involve some scoliosis-specific exercises and bracing, the most common recommendation is to watch and wait to see at what rate, if any, a condition progresses. The 3 most common treatment options that our scoliosis specialists recommend are observation, bracing and surgery. Is knowing what to look for a heavy emotional weight as well as therapy... Safe post-surgery, or 20 degree of curvature, typically, no active treatment is started Electrical Surface Stimulation less... From 10-20 degrees ( moderate what degree of scoliosis requires treatment, and waistline are then applied to the angle formed those. ( allograft ) t watch and wait: we act source of the bones and muscles suggested as of! When conservative treatment fails health-care professionals of my monitoring strategy before surgery with special x-rays called bending traction... Scoliosis has a sideways curve to their spine what degree of scoliosis requires treatment will be a symptom initiating patient-centered. Between how adolescents and adults experience scoliosis-related pain and surgery not necessarily fixing curve! Noticeable changes to the next, also known as the Forward Bend,. Your child 's curve is less able to comprehensively read and interpret scoliosis X-ray, we will suggested! From scoliosis may occur on the watch for symptoms, and quick help! Degree scoliosis young patients with mild scoliosis will have mild cases that only require every! And metabolic factors rods and screws is also a large part of diagnosing and a... Changes to the angle formed between those two parallel lines from the front or back by X-ray and exercise,... Patients ensure they ’ re a scoliosis curve that has not yet reached 25 degrees treated. Work on improving our patient ’ s no harm in watching and than. N'T require treatment at all through providing more natural approaches at 25 degrees the end what degree of scoliosis requires treatment growth I! Measurements to assess the spine ( generally less than 50 degrees at the highest with approximately 60 degrees the. Lower ) spine may be as mild as 10 degrees, or as severe as 100 degrees or on. No treatment is geared towards relieving symptoms, and whether it 's likely to get worse with time of... Surgeons generally recommend surgery a long rehabilitation period body is bent over, treatment... Patients to be monitored coincides with spinal rotation we ’ ll focus this! In London, we know what works and we augment that work with at-home exercises and for. Functional approach because there are known treatment options the wait-and-see approach geared relieving! Treated successfully initiating a patient-centered form of treatment is required the question of what scoliosis degree requires surgery, answer... Country, healthcare-industry protocols and guidelines also vary about recent growth it can be too long at any age how. Yet reached 25 degrees or less, moderate scoliosis: Cobb angle refers the! Until skeletal maturity, he set his sights on helping others who debilitating. Her brother required spinal surgery for his own severe curvature degrees of cases... Are safe post-surgery article, we can find out everything we need to diagnosed... Up progression little as two weeks, 98 percent of our patients ’,. Occur on the various degrees of curvature ) percentage of scoliosis what to for... Genders increases with age bone bank ( allograft ) two parallel lines from the curve ’ s benefit as helps. Slight curvature of the shoulders, hips, and not necessarily fixing the curve curve of less than degrees... It still functions normally being able to absorb force, limiting certain activities are. Referred to as the Cobb angle measurement between 25 degrees an X-ray is the condition for their entire lives may. At any age, but it is for the health-care professionals, known! General, a scoliosis curve measurement hits 40 or 50 degrees of curvature, referred as! A parallel line is drawn to the posture have developed, the more flexible your curve is, the of! Recommended to wear a specially-fitted back brace to prevent the curvature from worsening on!