Best Scoliosis Treatment in Hyderabad, India | Expert Spine Care

The evaluation of scoliosis is based on the history and physical examination, which help the healthcare professional to conclude the diagnosis. Scoliosis therapy is subject to the type and progression of the disease. The healthcare professional considers the following before selecting the appropriate tests to diagnose scoliosis:

• The presented signs and symptoms
• Age, family history and general health of the suspected patient
• Medical history and medication taken
• The results of previous medical tests

A spine surgeon will consider multiple factors before choosing the best treatment for scoliosis and suggest individualized treatment for each specific patient. These may include:

• Size of the curve
• Location of the curve in the spine
• Patient age 
• How much growth the patient has left in their spine
• If the child is still growing
• Type of abnormality
• Severity of the curve
• Likelihood of the curve worsening in the future
• Any other issues a patient has

The following are the current treatment options that the spine or orthopedic surgeons will use:

• Conservative treatment (non-surgical treatment)
• Observation
• The use of a brace (orthosis)
• Specific scoliosis exercises
• Alternative treatments
• Surgical treatment
• Spinal fusion (arthrodesis)
• Posterior approach
• Anterior approach
• Anterior and posterior approach
• Decompressive laminectomy
• Minimally invasive surgery (MIS)
• Thoracoscopic Approach

Scoliosis conservative management​ (non-surgical scoliosis treatment​)

Observation

• Observation and repeated examinations are known as the “Wait and Watch” approach. It involves periodically checking the spine by performing X-rays.
• In a growing child, curves (< 25 degrees) may be watched closely (observed) for progression. Larger curves in more mature teens may also be observed. 
• A healthcare professional may recommend X-rays and how often to see the patient to determine whether the spine is continuing to curve.
• Observation is appropriate for mild-size curves with a low risk of progression when the patient is still growing, or for moderate-size curves when growth is complete.

Bracing or casting

• Bracing (scoliosis brace) and casting methods are recommended for younger children with scoliosis and are less specific for adolescents.
• The goal is to keep the curve stable, preventing the spinal curve from getting worse until the child's skeleton matures and stops growing.
• Bracing will not straighten the spine and cannot always prevent curve progression. However, there is strong evidence that patients who wear a well-fitted brace for 13 or more hours per day will decrease the risk of progressing to surgery by 56%. It can only be effective if the child is willing to wear the brace and there is regular screening with a physician.
• A healthcare professional recommends a brace for growing children who have curves between 20-25˚ and 40-45˚ and for some smaller progressive curves to avoid getting larger.
• Young children with flexible spinal curves will receive a cast under general anesthesia, and it will need to be replaced every 3–4 months to accommodate their growth.
• Once the curve is under control, which typically takes 12–18 months, a molded brace is worn until skeletal maturity.
• The brace can be gradually discontinued in stable patients as the child nears maturity. If bracing is unsuccessful, surgery should be considered.

Scoliosis specific exercises

• Physical therapy, specific scoliosis exercises, and a bracing program have been suggested to help maintain core strength and improve flexibility.
• European-based Physiotherapy Scoliosis-Specific Exercises (PSSE) that focus on expanding the chest wall, elongating the spine, and correcting posture in daily life activities may be beneficial.
• Although these exercises are helpful, there is not enough evidence to show that they can replace bracing for treating progressive scoliosis.

Alternative treatments

Some alternative treatments include yoga, chiropractic, and other therapies. Although these methods may improve the patient's physical condition, there is no scientific evidence proving their effectiveness for progressive scoliosis.

Surgical treatment for scoliosis​

The following are some of the surgical treatments used to treat scoliosis:

Spinal fusion (arthrodesis):  This procedure removes the flexible elements of the spine to create a solid block of bone throughout the fused area of the curve.

In most cases, it is performed with the addition of an instrumentation system of hooks, rods, wires and screws to correct the curvature of the spine as much as possible and to maintain the stability of the spine in the postoperative period until the vertebrae are fused. 

This spine surgery may be performed mainly through an incision on the back (posterior approach) or on the side (anterior approach).

• Posterior approach
• It is the most frequently performed scoliosis correction surgery. The procedure involves posterior spinal fusion with instrumentation and bone grafting, which is done through the back side while the patient lies on their stomach.
• The spinous processes, lamina and transverse processes of the spine will be exposed, and the surgeon will place the wires, hooks, or screws to provide fixation of the rod to the spine.
• Afterward, a bone graft is applied to the exposed bony surfaces of the spine, which allows this bone (vertebrae) to subsequently grow together or fuse with other bones, connecting each vertebra to one another.

• Anterior approach
• In some curve patterns, correction and fusion can be performed via an anterior approach, where the spine surgeon accesses the spinal column by making incisions on the abdomen or side of the chest, exposing the anterior or front part of the spine.
• It is in this area where the discs and vertebral bodies are located.
• Fusion in this area involves the removal of the soft disc material between the bone and replacing this tissue with a bone graft, which may allow bony union or fusion between the adjacent vertebral bodies.
• Instrumentation systems that are applied anteriorly generally include fixation with a screw and connection between the screws with a rod system.
• Depending on the curve patterns, this anterior approach can be performed in the thoracic, thoracolumbar, or lumbar regions.

• Anterior and posterior approach
• There are some situations where both the anterior (front) and posterior (back) approach to the spine are required, such as when the curve is extremely rigid or the patient is quite young (less than 10–12 years).
• Much of the spine's growth potential is located in the vertebral body next to the disc.
• This growth center is responsible for vertebral body growth and contributes to much of the curvature progression during spinal growth. 
• Therefore, anterior fusion is recommended to decrease or stop anterior vertebral body growth in young patients. 
• If the curve cannot be instrumented anteriorly, anterior fusion in combination with posterior fusion and instrumentation may be required. 
• When a curve is particularly rigid and large, correction may be inadequate if posterior instrumentation is performed without removing the anterior discs. Removing the anterior discs in such a case increases the spine's flexibility and improves the instrumentation system to better correct the deformity.

Decompressive laminectomy: It is often recommended for scoliosis patients to relieve pressure on nerves or the spinal cord caused by spinal stenosis or other conditions. The laminae (roof) of the vertebrae will be removed to create more space for the nerves and reduce the neurological symptoms associated with compression.

• Minimally invasive surgery (MIS): Sometimes, fusion may be performed through smaller incisions through using minimally invasive surgery  (MIS), using advanced fluoroscopy (X-ray imaging during surgery) and endoscopy (camera technology).

• Thoracoscopic approach
• The thoracoscopic approach is performed through the chest (anterior approach), where the surgeon uses small incisions and video technology to view the spine. 
• Specialized instruments are used to access the spine and perform disc removal, instrumentation, and fusion. 
• In some cases, a posterior fusion is also needed to perform the instrumentation portion of the procedure, although some curves can now be corrected using the endoscopic approach alone.

✅Considerations of spine or orthopedic surgeon or neurosurgeon before performing scoliosis surgery

Scoliosis correction surgery may be recommended by considering the following when:

• Bracing treatment has failed
• A curve continues to worsen, and there is substantial growth left in the spine
• A curve of the thoracic spine greater than 45 – 50 degrees
• A curve of the lumbar spine greater than 35-40 degrees

Curves larger than 50 degrees tend to continue to progress even after the skeleton has finished maturing, which may cause a loss of lung function and even respiratory problems. 

For example, in patients with curves between 60 and 100 degrees, total lung capacity can be reduced to 68% of normal values.

It is more challenging to surgically treat larger curves. This could result in the need for more surgical anchors, a longer procedure, more blood loss, and a higher rate of surgical complications. Congenital, neuromuscular, and syndromic scoliosis are more likely to need surgery than other types.

• Prevent the worsening of the curve
• Correct and balance the spine safely

✅Scoliosis recovery​ time

For children and teens, returning to school may take 4 – 6 weeks, and for most patients, returning to full activity may take up to three months. The complete healing process may take 6–12 months.

Patients who undergo combined anterior and posterior spine procedures may need a slightly longer stay in the hospital. However, modern scoliosis surgeries now offer much shorter recovery times.

✅Scoliosis surgery risk

Spinal surgery is a major operation which can take up to one year or more to recover fully. Sometimes, it also carries a risk of complications, including:

• Blood clots
• Wound infection
• Failure to reduce the pain 
• Rarely, it may cause damage to the nerves in the spine – which may result in permanent leg numbness or weakness or some degree of paralysis in rare cases
• Spinal cord abnormalities or injury.

Frequently Asked Questions (FAQs) On Scoliosis Treatment

What part of the spine curves in people with scoliosis?

Scoliosis may affect the spine in any of its three major sections, including:

• Cervical spine (neck) also called cervical scoliosis
• Thoracic spine (chest and upper back region)
• Lumbar spine (lower back)

What are the symptoms of scoliosis?

The following are some of the most common symptoms of scoliosis:

• Bulge or deformity in the back
• Pain
• Structural abnormalities
• Difference in shoulder blade height or position
• Difference in shoulder height
• Difference in hip height or positioning
• The head is off-centre from the rest of the body
• When standing upright, the arms hang differently from the sides of the body.
• When bending forward, the sides of the back are distinctly different in heights.

Will scoliosis get better without treatment?

Scoliosis cannot correct itself on its own. However, not all patients will require treatment. Only about 5% of children or adolescents with scoliosis require bracing or scoliosis surgery. Monitoring will be needed if the curvature progresses. It's crucial to have a suspected case of scoliosis assessed by a specialist as soon as possible. Early intervention, such as bracing, can prevent the need for surgery later in life.

How does scoliosis surgery work?

There are different surgical methods, but the most common standard type of scoliosis correction surgery is a posterior spinal fusion with artificial implants (instrumentation).

In this procedure, the spine surgeon or orthopedic surgeons or neurosurgeon makes an incision from the backside and essentially "welds" the vertebrae (bones) together using bone chips such as autografts (taken from elsewhere in the patient's body) or allografts (acquired from donors via a bone bank). The spine is aligned and then stabilized using hooks, screws, and rods to facilitate healing. Once the spinal fusion is complete, the implants are no longer necessary but are left in place to avoid the need for additional surgery.

Is scoliosis dangerous?

If scoliosis is mild, then it is generally not dangerous and does not require treatment. However, severe cases may lead to complications, including back pain, breathing difficulties, and fatigue. Early detection and appropriate treatment, such as observation, bracing, or surgery in severe cases, can effectively manage and treat scoliosis and avoid complications, ensuring better long-term outcomes for patients.

What is mild lumbar scoliosis?

It is nothing but a slight sideways curvature of the spine in the lumbar (lower back) region. Mild lumbar scoliosis is characterized by a curve measuring less than 20 degrees on an X-ray evaluation.



Mild scoliosis is not a major problem and often does not cause any significant symptoms; hence, treatment is not required. However, monitoring may be recommended to ensure that there is no progression.

Can a chiropractor help with scoliosis?

As per available research, chiropractic-specific treatments such as spinal manipulation and rehabilitation are not recommended over proven treatments, including bracing, surgery, and specific rehabilitation programs. Chiropractic care may relieve symptoms such as pain associated with scoliosis; however, it does not fix the abnormal curvature of the spine.

Can mild scoliosis get worse?

Generally, mild scoliosis is not serious, but it can sometimes worsen over time, particularly during growth spurts in adolescence. Monitoring is crucial in managing scoliosis. Mild cases often remain stable or improve with age; however, if not monitored, some may progress to moderate or severe curvature. Regular screening and appropriate management, including exercises or bracing, may help prevent worsening and maintain spinal health.

Can scoliosis cause sciatica?

Scoliosis may cause sciatica if the abnormal curve of the spine compresses or irritates the nearby sciatic nerve roots, leading to pain, weakness, or numbness in the legs. This may occur when spine curvature causes changes in the alignment of the bones, resulting in inflammation of the nerve. However, proper diagnosis and management of both scoliosis and sciatica symptoms are important to reduce pain and prevent complications.

What causes scoliosis pain?

Typically, scoliosis pain that a patient experience may result due to pressure on the spinal discs, muscle imbalances, strain on the spine's supporting structures, and pressure on facet joints. However, in severe cases, the abnormal curvature of the spine can stretch or irritate nerves, causing nerve inflammation, pain or discomfort. Pain intensity may vary widely among individuals and depends on the degree and location of the spinal curvature.