Scoliosis Management
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What is scoliosis?
Scoliosis (abnormal curvature of the spine) can be a frightening diagnosis for parents and their children. We can help parents and children, along with other healthcare team members, understand scoliosis and ways orthotic treatment can help. Treatment is typically directed by a specialized orthopedist or physiatrist. The healthcare team treating patients with scoliosis may include a physical therapist, orthotic clinician, and other relevant physicians and healthcare providers. The curvature of the spine may be monitored, treated with a scoliosis TLSO (back brace), and in, some cases, surgically corrected. The Scoliosis Research Society (SRS) is an international organization made up of over 1,000 healthcare professionals dedicated to understanding and treating scoliosis. Del Bianco P&O encourages you to visit the SRS website to learn as much as you can about scoliosis. Follow this link to learn more about scoliosis from SRS: https://www.srs.org/ How can Del Bianco P&O help with my scoliosis? Del Bianco P&O is dedicated to helping patients with any type of scoliosis. We can help patients with infantile, juvenile, adolescent, adult and neuromuscular/syndromic scoliosis. Our team of experts is trained and has experience in the Boston Style TLSO, Charleston nighttime bending brace, Providence TLSO, and the Wood-Rigo-Cheneau (WCR) TLSO. We work, directed by your physician and therapist, to ensure that you have the best possible outcome. We are the ONLY provider in the Triangle area partnered with Grant Wood and the Align Clinic, the nation's leading expert in the Rigo Cheneau style scoliosis treatment. Click here for more infomation. Do Scoliosis TLSOs really work? Numerous studies have authoritatively shown that TLSOs used to treat scoliosis are effective at preventing the abnormal spinal curvature from progressing to the point of surgery compared to no treatment. The Boston Brace TLSO has the most research and is currently the “gold standard” at treating scoliosis in terms of evidenced based practice. The Charleston and Providence are designs that use hyper corrective forces in a night-time only TLSO. These newer designs have case studies and limited researching showing their effectiveness. Objectively, they seem best for smaller curves or patients who are unwilling to follow a full-time wear schedule. Rigo-Cheneau type TLSOs are full time devices like the Boston TLSO but differ significantly in the way in which it treats and addresses scoliosis. The Boston TLSO focuses on correcting the spine in one dimension in a symmetric shaped device, while the Rigo-Cheneau type TLSOs focus on a 3 dimensional correction of the spine and associated deformities in a asymmetric shaped design. While the Rigo-Cheneau type designs don’t have the amount of research that the Boston TLSO has, the results and case studies are very promising. These designs are the culmination of a lifetime of work and effort by Dr. Cheneau from France and Dr. Rigo from Spain. Dr. Rigo currently still practices in Spain and continues to refine the design. |
Boston style scoliosis TLSO showing optimum in-brace one-dimensional correction
Wood Cheneau Rigo (WCR)® Scoliosis Orthosis
Charleston Bending Brace for Scoliosis (www.cbb.org)
Providence Nocturnal Scoliosis® Orthosis
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What are the chances the curve will progress?
Idiopathic scoliosis curves and there risk of progression in children and adolescents is directly related to the magnitude of the curve and the age of the patient. A 35 degree curve in a ten year old is almost certain to progress to a point surgery is needed without treatment while the same curve in a teenage patient 6 months from skeletal maturity may have a very small chance of progressing to the point surgery is needed in the absence of treatment. Therefore, being evaluated and followed by a skilled healthcare team is critical, specifically the physician monitoring the scoliosis. The knowledge of that professional will help guide your child’s care in an evidenced based manner, whether to observe, treat with a scoliosis TLSO, or consider surgery.
In general, curves under 20 degrees are monitored for progression. Curves from 20 to 40/45 degrees are managed with a Scoliosis TLSO with the expectation of avoiding surgery. Curves 50 degrees and larger typically are treated surgically (these curves may be treated with a TLSO to prevent them from getting worse before a surgery is attempted.) The specifics of scoliosis treatment are unique to each patient and directed by your doctor. Some healthcare providers have a very conservative view and will monitor curves into the 25 or 30 degree range without treatment. As a patient you will need to determine if you would like to be more proactive and consider treating the curves sooner with Schroth Therapy and/or a TLSO.
The research shows that, compared to no treatment, utilizing a scoliosis TLSO significantly reduces the risk of curves progressing to the point surgery is needed. However, the risk is present that, even with a perfectly fitted scoliosis TLSO, the curves may progress and require surgical correction.
Why do some TLSOs prevent surgery and others don’t?
There is no way to exactly know the answer to this question. A critical factor in scoliosis TLSO treatment is compliance. A patient significantly benefits from wearing the TLSO the prescribed amount of time. Boston and Rigo designs are essentially full-time wear devices and the Charleston and Providence designs are nighttime devices.
What about sports and activities?
The TLSO can be removed for sports and activities, bathing, swimming, and other events that are difficult to do with the TLSO. These activities need to be kept to 3 to 4 hours a day to maintain the “full time” wear schedule. If you are getting less than 16 hours in a full time TLSO you will be compromising the effectiveness of the treatment. Keeping wear at 18 to 20 hours a day is ideal. Nighttime devices need to be worn all night every night. It should be noted that it is difficult for nighttime designs to compare in effectiveness to the full-time devices, especially in larger curves, simply because the wear schedule means less time with the curves in a corrected position.
There are so many different views on Scoliosis! Who do I listen to?
In the end you will need to direct the care you receive and trust the treating physician you choose to work with. The treating physician is the most critical component of the picture. He/She will be the trained expert to look at your X rays and the clinical signs of scoliosis and determine what type of treatment and when you receive that treatment. You want to feel comfortable and trust this person.
Idiopathic scoliosis curves and there risk of progression in children and adolescents is directly related to the magnitude of the curve and the age of the patient. A 35 degree curve in a ten year old is almost certain to progress to a point surgery is needed without treatment while the same curve in a teenage patient 6 months from skeletal maturity may have a very small chance of progressing to the point surgery is needed in the absence of treatment. Therefore, being evaluated and followed by a skilled healthcare team is critical, specifically the physician monitoring the scoliosis. The knowledge of that professional will help guide your child’s care in an evidenced based manner, whether to observe, treat with a scoliosis TLSO, or consider surgery.
In general, curves under 20 degrees are monitored for progression. Curves from 20 to 40/45 degrees are managed with a Scoliosis TLSO with the expectation of avoiding surgery. Curves 50 degrees and larger typically are treated surgically (these curves may be treated with a TLSO to prevent them from getting worse before a surgery is attempted.) The specifics of scoliosis treatment are unique to each patient and directed by your doctor. Some healthcare providers have a very conservative view and will monitor curves into the 25 or 30 degree range without treatment. As a patient you will need to determine if you would like to be more proactive and consider treating the curves sooner with Schroth Therapy and/or a TLSO.
The research shows that, compared to no treatment, utilizing a scoliosis TLSO significantly reduces the risk of curves progressing to the point surgery is needed. However, the risk is present that, even with a perfectly fitted scoliosis TLSO, the curves may progress and require surgical correction.
Why do some TLSOs prevent surgery and others don’t?
There is no way to exactly know the answer to this question. A critical factor in scoliosis TLSO treatment is compliance. A patient significantly benefits from wearing the TLSO the prescribed amount of time. Boston and Rigo designs are essentially full-time wear devices and the Charleston and Providence designs are nighttime devices.
What about sports and activities?
The TLSO can be removed for sports and activities, bathing, swimming, and other events that are difficult to do with the TLSO. These activities need to be kept to 3 to 4 hours a day to maintain the “full time” wear schedule. If you are getting less than 16 hours in a full time TLSO you will be compromising the effectiveness of the treatment. Keeping wear at 18 to 20 hours a day is ideal. Nighttime devices need to be worn all night every night. It should be noted that it is difficult for nighttime designs to compare in effectiveness to the full-time devices, especially in larger curves, simply because the wear schedule means less time with the curves in a corrected position.
There are so many different views on Scoliosis! Who do I listen to?
In the end you will need to direct the care you receive and trust the treating physician you choose to work with. The treating physician is the most critical component of the picture. He/She will be the trained expert to look at your X rays and the clinical signs of scoliosis and determine what type of treatment and when you receive that treatment. You want to feel comfortable and trust this person.